REFERENCE · CO-OCCURRING CONDITION
Persistent Headache Alongside FND
This page covers: Persistent primary headache patterns, especially tension-type headache and new daily persistent headache; migraine has its own page.
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
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For the Person With FND
Understanding the pattern
“Persistent headache” describes a problem, not one diagnosis. Chronic tension-type headache commonly feels pressing or tightening. New daily persistent headache (NDPH) starts on a clearly remembered day and becomes continuous within 24 hours, lasting over three months; it may feel migraine-like or tension-type-like. Chronic migraine more often develops from an earlier pattern of attacks. These distinctions help guide care. [1]
Where altered pain processing contributes, the nervous system may respond more strongly to ordinary input. That resembles one principle relevant to some FND explanations: symptoms can arise from changes in processing and regulation, not only from visible structural injury. It does not establish that persistent headache is FND, or that every headache shares the same mechanism. [2][3]
Persistent pain can consume attention and disrupt sleep, leaving less room for FND rehabilitation. For people whose headache has migraine features, the migraine–FND overlap may be relevant. There is much less direct research on FND with NDPH or tension-type headache. A useful joint plan can still address pain, sleep and everyday participation without claiming a proven shared cause. [2][4][5]
Recovery and treatment options
- Match treatment to the headache pattern: a clinician can identify whether migraine-like, tension-type-like or another pattern is most useful for treatment. This is the foundation of a plan, not a recovery exercise by itself. NDPH treatment is often borrowed from migraine or tension-type care. [1][5] [Clinical guidance; limited NDPH-specific evidence]
- Consider prevention: discuss headache-specific preventive treatment where appropriate, with a clear review of benefit and side effects. Continuous pain does not mean treatment is futile, but NDPH responses are variable and no single approach reliably resolves it. [5][6] [Guideline-based practice; uncertain evidence for NDPH]
- Make acute relief sustainable: agree which rescue medicines are appropriate and how often they can be used. Review possible medication-overuse headache with support rather than escalating rescue treatment indefinitely. [6] [Guideline-based practice]
- Consider acupuncture for chronic tension-type headache: this is one guideline-supported option. It should have agreed goals and review points; evidence for that diagnosis cannot simply be transferred to NDPH. [6] [Guideline-based practice]
- Use a pain rehabilitation plan when pain remains: adapt tasks, support sleep, and consider pain-focused CBT or acceptance and commitment therapy where chronic primary pain care is appropriate. These approaches help people do more of what matters with less disruption from pain; they do not imply that thoughts caused the headache. [7] [Adjacent chronic primary pain guidance]
During a familiar flare: use the agreed relief plan and temporarily scale back demands. A newly continuous headache deserves assessment. Sudden severe onset, fever with neck stiffness, or a new persistent neurological deficit needs urgent care. Some other persistent patterns, such as strictly one-sided continuous headache or headache following injury, require their own treatment pathway. [1][6]
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
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For Family, Friends, and Other Supporters
Continuous pain can be hard to see. Believe the person’s report without requiring them to look unwell. Help protect meals, rest and appointments, and allow plans to change. Ask about what they managed or enjoyed as well as the pain score.
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
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For Clinicians and the Care Team
Establish onset, time course, phenotype, medication exposure and examination findings. Distinguish NDPH from gradually evolving chronic migraine and relevant secondary headaches. Do not repeatedly investigate an unchanged, assessed pattern without a clinical reason, or deny reassessment when it changes. Label phenotype-based NDPH treatment as extrapolated evidence. [1][5][6]
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
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Research and Sources
Evidence reviewed: September 23, 2026. This is a first-stage treatment map, not a catalogue of every headache syndrome. Evidence for NDPH treatment and its interaction with FND is substantially thinner than migraine evidence.
Technique labels describe the evidence for the named condition. A treatment working does not confirm an FND diagnosis or prove a shared mechanism.
| No. | Source and stable record | What it supports and limits | Figure |
|---|---|---|---|
| 1 | Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38:1–211. Classification. doi:10.1177/0333102417738202. FND-CIT-0200 | Diagnostic classification; supports distinctions between migraine and other persistent headache patterns, not treatment efficacy. | — |
| 2 | Stone J, Coebergh J, Khoja L, Butler M, Nicholson TR, Dodick DW. Migraine and functional neurological disorder (FND)—a review of comorbidity and potential overlap. Brain Communications. 2025;7(4):fcaf288. https://doi.org/10.1093/braincomms/fcaf288 FND-CIT-0049 | Migraine–FND review; proposed overlap and clinical interactions, with limited direct treatment evidence. | — |
| 3 | International Association for the Study of Pain. Terminology: nociplastic pain. Definitions. Accessed September 23, 2026. FND-CIT-0203 | Terminology and pain-mechanism distinctions; not a diagnostic test or intervention study. | — |
| 4 | Steinruecke M, Mason I, Keen M, McWhirter L, Carson AJ, Stone J, Hoeritzauer I. Pain and functional neurological disorder: a systematic review and meta-analysis. Journal of Neurology, Neurosurgery & Psychiatry. 2024;95(9):874–885. https://doi.org/10.1136/jnnp-2023-332810 FND-CIT-0015 | FND pain systematic review; co-occurrence and treatment burden, not proof of common causation. | — |
| 5 | Robbins M. New Daily Persistent Headache. Continuum (Minneap Minn). 2024;30:425–437. PubMed. FND-CIT-0211 | Clinical review: treatment commonly follows the migraine-like or tension-type-like phenotype; controlled NDPH-specific evidence is limited. | — |
| 6 | National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. CG150. Recommendations. Accessed September 23, 2026. FND-CIT-0199 | Guideline for headache treatment and medication-overuse management; not an FND treatment trial. | — |
| 7 | National Institute for Health and Care Excellence. Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. NG193. Recommendations. Accessed September 23, 2026. FND-CIT-0204 | Chronic primary pain guideline; recommendations must not be generalized to every pain cause or to FND efficacy. | — |
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
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