Beginning of Chronic Headache

It’s very hard, or impossible, to diagnose a chronic illness during the first week of symptoms.  As long as there are suggestions of serious disease, your neuro exam is normal, and no other diagnosis except “tension headache” comes to mind, treat as such and follow.  Even if it turns out to be a mass, you’ll be excused.  Just always be sure to tell all your patients to return if they’re getting worse.