Since NDPH is a diagnosis of exclusion, it is important to rule out any other potential causes of persistent headache. This can usually be accomplished by running a fairly standard set of tests and looking at the patient history and exam. If all of these are unremarkable, NDPH is the likely diagnosis.

Diagnosis Criteria

According to the International Classification of Headache Disorders, NDPH “must not be accounted for by another ICHD-3 diagnosis,” including chronic migraine, chronic tension headache, or hemicrania continua. The criteria for an NDPH diagnosis are:

Persistent headache, daily from its onset, which is clearly remembered. The pain lacks characteristic features, and may be migraine-like or tension-type-like, or have elements of both.​

  1. Persistent headache fulfilling criteria B and C
  2. Distinct and clearly-remembered onset, with pain becoming continuous and unremitting within 24 hours
  3. Present for >3 months
  4. Not better accounted for by another ICHD-3 diagnosis

Doctors to visit to rule out other causes

  • Primary care doctor/internist
  • Ear, nose, & throat specialist (ENT)
  • Dentist/TMJ specialist
  • Sleep specialist
  • Ophthalmologist
  • Neurologist
  • Psychologist

Tests to discuss with your Doctor

  • MRI (Magnetic Resonance Imaging) of head and cervical spine (with and without contrast)
  • MRA (Magnetic Resonance Angiogram) of head and neck
  • MRV (Magnetic Resonance Venography) of head
  • CT (Computed Tomography) of head
  • Lumbar puncture/spinal tap
  • Blood tests (CBC, metabolic panel, thyroid)
  • Allergy testing
  • EEG (Electroencephalogram)
  • Doppler of carotid arteries
  • Sleep study
  • Sinus x-rays and CT

NDPH Mimics

The list of conditions that can potentially mimic NDPH is obviously too long to list here, but here is a non-exhaustive​ list of other conditions that can seem like NDPH but aren’t. These should be thoroughly investigated and ruled out before making a final NDPH diagnosis:

  • Chronic migraine
  • Chronic tension-type headache
  • Hemicrania continua (responds to indomethacin, with dosing up to 200 mg/day)
  • Cervicogenic headache/ post-traumatic headache
  • Medication overuse headache
  • Occipital neuralgia
  • Trigeminal neuralgia
  • Nummular headache
  • Intranasal contact point headache (see here)
  • Reversible cerebral vasoconstriction syndrome (RCVS)
  • Sphenoid sinusitis
  • Giant cell arteritis
  • Carotid artery dissection
  • Brain tumor (especially pituitary, which can refer pain to the top of the head)
  • Cerebral spinal fluid (CSF) leak
  • Idiopathic intracranial hypertension/hypotension (CSF pressure issues)
  • Normal pressure hydrocephalus
  • Cerebral venous thrombosis
  • Arteriovenous malformation (AVM)
  • Unremitting head and neck pain (UHNP) (see here)
  • Chronic meningitis
  • Parasite infection

Other Research Articles on Causes

Conditions to Rule Out

By: Jaclyn R. Duvall, MD, Carrie E. Robertson, MD, Mark A. Whealy, MD, and Ivan Garza, MD

Nutcracker Syndrome

By: Anker Stubberud, Sanjay Cheema, Erling Tronvik, and Manjit Matharu

New Daily Persistent Headache

By: Todd D. Rozen, MD, FAAN

Unremitting Head & Neck Pain

By: Pamela Blake and Rami Burstein