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New Daily Persistent Headache — SCE Neurology MCQ

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ModerateHeadache & Facial PainNew Daily Persistent HeadacheSCE Neurology

A 45-year-old woman presents with a headache that started suddenly 3 weeks ago and has been present continuously since. She describes it as a moderate, bilateral, pressing headache present every day without remission. She has no prior headache history. MRI brain, MRA, MRV, and LP are all normal. What is the diagnosis?

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Correct answer: E — New daily persistent headache (NDPH)

NDPH is defined by ICHD-3 as a headache that is daily and unremitting from onset (or within 3 days of onset), in a patient who can clearly recall the exact date of onset. The headache phenotype may resemble tension-type or migraine. The key feature is the acute onset of a chronic daily headache in someone without prior headache history, with the patient remembering the specific day it began. Secondary causes must be excluded. NDPH is notoriously treatment-resistant. A: Chronic migraine requires pre-existing migraine and develops gradually. C: Chronic TTH develops gradually from episodic TTH. D: MOH requires analgesic overuse. E: No trauma history.

Reference: ICHD-3 (2018); ABN Headache Guidelines