New onset daily persistent headache

New daily persistent headache starts on a distinct day and then continues. A clinician will ask about onset, location, severity, triggers, vision, nausea, fever, neck stiffness, medicines and previous headaches. Examination may include blood pressure and a neurological assessment. Imaging or other tests may be advised when the pattern, examination or medical history raises concern.

A persistent headache can have several explanations, including migraine, medication-related headache, infection or a problem affecting blood vessels or pressure around the brain. A brain tumour, glioblastoma or brain metastases can also present with headache, but a headache alone does not establish any of these diagnoses.

Arrange a medical review and record when the headache began, whether it was sudden, how it changes during the day and what medicines you have taken. Include pregnancy, recent injury, cancer history, immune problems and blood-thinning medicines in the history. Avoid repeatedly increasing pain medicines without guidance, since frequent use can maintain headaches.

Seek emergency care for a sudden severe headache, new weakness, facial drooping, trouble speaking, seizure, fainting, confusion, stiff neck with fever or repeated vomiting. Urgent assessment is also needed for a new headache after head injury, during pregnancy, with vision loss or when it steadily worsens. A person receiving cancer treatment should report a new persistent headache to the oncology team promptly.

What features of my history or examination matter most? Do I need brain imaging or blood tests? Could any medicine be contributing? What warning signs should send me to emergency care? When should I return if the headache continues?