New Daily Persistent Headache Related to Sleep Apnea?

Stephen B. Silberstein, MD


January 04, 2010


Is there any correlation between new daily persistent headache and sleep apnea?

Response from Stephen B. Silberstein, MD
Professor of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania; Director, Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

New daily persistent headache (NDPH), a subtype of chronic daily headache that is extremely refractory to treatment, was first described in 1986. Most experts use the Silberstein-Lipton criteria[1] to diagnose NDPH. The International Classification of Headache Disorders-2 defines it as new-onset tension-type headache.[2] The criteria for NDPH are:

  • Average headache frequency > 15 days/month for > 1 month;

  • Average headache duration > 4 hours/day (untreated);

  • No history of tension-type headache or migraine that increases in frequency and decreases in severity in association with the onset of NDPH (over 3 months);

  • Acute onset (developing over < 3 days) of constant unremitting headache;

  • Headache is constant in location; and

  • Not attributable to another disorder, including hemicrania continua.

Sleep disorders, including hypersomnia and obstructive sleep apnea syndrome, are associated with primary headache syndromes. There are no studies of NDPH and sleep apnea. However, in population-based case-control studies, chronic daily headache sufferers were more likely to be habitual or daily snorers than controls.[3]

The mechanisms of the relationship between obstructive sleep apnea and chronic daily headache are not fully understood, but may involve intracranial and arterial pressure fluctuations during snoring in an individual susceptible to pain progression, hypoxia, hypercapnia, sleep fragmentation and disruptions, and increased muscle activation during awakenings.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: