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NDPH – Distinguishing Feature — SCE Neurology MCQ

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EasyHeadache & Facial PainNDPH – Distinguishing FeatureSCE Neurology

A 30-year-old woman presents with new daily persistent headache for 4 months. She reports the exact day the headache started — she was at work and it came on 'like a switch'. She has tried sumatriptan and paracetamol without relief. She has no prior headache history. What is the key diagnostic criterion that distinguishes NDPH from other chronic daily headaches?

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Correct answer: D — The patient's ability to precisely recall the day the headache began — the headache is daily and unremitting from its very onset in a patient without prior headache

The pathognomonic feature of NDPH is the patient's clear recall of the exact onset date. Unlike chronic migraine or chronic TTH (which evolve gradually from episodic forms), NDPH begins abruptly and is continuous from day one. The patient remembers precisely when and where the headache started. This 'switch-on' onset distinguishes it from all other primary chronic daily headaches. NDPH can have migraine-like or tension-type features. It is notoriously treatment-resistant. A: NDPH typically does not respond to triptans. C: Duration is a criterion but not the distinguishing feature. D: Location is variable. E: Quality is variable.

Reference: ICHD-3 (2018)