The headache that started with a virus and never left.

Infection is the most common known trigger of NDPH

New daily persistent headache is a daily, unremitting headache that starts on a day you can remember.¹ When people with NDPH can point to a trigger, the most common one is an infection or flu-like illness: about a third of patients in one series,⁵ and 22% in another, where about half could not identify any trigger at all.⁴ The Epstein-Barr virus, which causes glandular fever, has been studied most: in a 1987 study, 84% of 32 patients with NDPH showed signs of active infection, against 25% of controls.⁶

What we know about headache after COVID-19

Headache is one of the most common symptoms of COVID-19, and for some people it outlasts the infection. In a prospective study of patients seen in an emergency department, 75% had headache; six weeks later, 38% of those followed up still did — and half of them had no previous headache history.³⁶ Reviews describe post-COVID headache as often migraine-like or NDPH-like, frequently moderate to severe, and often hard to treat.³⁷

The research is still thin. A systematic review looking specifically for post-COVID NDPH found only four published case reports.³⁸ So if your headache began with COVID, you are not unusual — but science cannot yet say much about how post-COVID NDPH behaves differently from NDPH after other infections.

Is it NDPH, or something else?

Formally, NDPH needs the headache to have been continuous for more than three months, and nothing else to explain it better.¹ Before that, or if anything about the headache is unusual, a doctor will want to rule out other causes first. Get urgent care for:

• a sudden, severe “worst ever” headache;
• headache with fever, a stiff neck, confusion or a rash;
• new weakness, numbness, trouble speaking or loss of vision;
• a headache that is clearly worse when you stand up and eases when you lie down, or the reverse;
• a seizure.

What can help

There is no treatment proven specifically for post-viral NDPH. Doctors usually choose treatment according to what the headache looks like — migraine-like or tension-type-like — as they would for NDPH from any cause.⁴⁰ Three things are worth doing early:

• Keep a record from now. The headache calendar shows your doctor the pattern; the history sheet captures how it started while you still remember.
• Watch your painkiller days. Taking acute medicine too often can add a second, medication-driven headache on top. The overuse checker shows the limits.
• Ask about a headache specialist, especially if the first treatments don’t help. The rest of the NDPH guide covers the self-care that supports treatment.