Calvarial Metastasis of Breast Carcinoma Manifesting as a New Daily Persistent Headache: A Case Report.

New-onset daily persistent headache (NDPH) is a primary headache syndrome characterized by a sudden onset of daily headaches persisting for more than three months in patients with no prior headache history. We report the case of a 49-year-old Indian lady who presented to the neurology outpatient clinic with new daily persistent headache. The headache had an insidious onset, described as continuous, holocranial, and dull aching. Visual analog scale (VAS) of pain severity was estimated to be 8/10. Her medical history was significant for carcinoma of the left breast cT3N1(Stage IIIA), for which she had received treatment two and a half years prior and was subsequently declared disease-free. Although symptomatic treatment for her headache was initiated, she remained refractory to standard therapy. A gadolinium-enhanced magnetic resonance imaging of the brain revealed large, heterogeneous, enhancing areas within the diploic space of the frontal bone. The patient subsequently received palliative external beam radiotherapy. At the 3-month follow-up post radiotherapy, her pain had significantly subsided, with a recorded VAS score of 2/10. In conclusion, patients presenting with acute headaches, particularly in the context of cancer, warrant neuro-radiological imaging. Timely diagnosis of calvarial metastasis is critical in preventing further disease progression and enhancing the patient's quality of life.