4.10 New daily persistent headache (NDPH)

Identification: Female patient, 32 years old, teacher, with no known previous comorbidities.

History of Present Illness: The patient reports a sudden onset of headache 3 months ago, describing it as bilateral, with a pressing or tightening quality, of moderate to severe intensity (7-8/10 on the visual analog scale), without aura or prodromal symptoms. The pain is continuous, present from the moment she wakes up until bedtime, with no periods of relief. She reports worsening with physical exertion, stress, and bright light. Denies any previous history of headache or head trauma.

Associated Symptoms:

Mild photophobia.

Occasional nausea, without vomiting.

Fatigue and difficulty concentrating.

Insomnia secondary to pain.

Treatments Undertaken:

Use of common analgesics (paracetamol and ibuprofen) without significant relief.

Attempted treatment with amitriptyline (25 mg/day) for 4 weeks, without improvement.

Physical and Neurological Examination:

No significant alterations.

Normal fundoscopic examination.

No signs of intracranial hypertension or focal neurological deficits.

Complementary Examinations:

Cranial magnetic resonance imaging: normal.

Laboratory analyses (complete blood count, thyroid function, electrolytes): within normal parameters.