Background:The frequent headache syndrome is among the most challenging disorder that conforms clinician on a routine basis. A major problem with the relatively new form chronic daily headache (CDH) has been its confusion with chronic tension type headache (CTTH) and other community used term for which there have never been operational diagnosable criteria or even informal clinical criteria. The medical literature is replete with example over the past three decades in which the terms mixed headache combined headache tension headache; vascular headache and rebound headache are used interchangeably by interference. CDH became synonymous in many clinical setting with CTTH or inconvenient vascular or migrainous features or medication overuse. Now CDH is well described in literature with defined classification. Hence, the researcher is used to interested what is the burden and proportion of the various type of CDH. Aims and Objectives: Primary aim of this exploratory prospective study was to study the incidence of primary headache and secondary headache which were CDH in patient attending neurology outpatient department, to study the incidence of type of primary headache, the cause of secondary headache, the age wise distribution and sex wise attribution of CDH and to study the impact of family history, occupation and precipitating factor on CDH. Materials and Methods: In our study, a total of 626 cases fulfilling the International Headache Society-4 th revised criteria comprising inclusion and exclusion criteria were included after informed consent, meticulous history taking pertaining to headache, in particular, thorough examinations and relevant laboratory investigations, and were certified by one neurologist. Results: Primary headache including migraine, tension-type headache, Short-lasting unilateral neuralgiform headache with conjunctival injection, new daily persistent headache, and medication overuse headache was the most common headache that caused CDH. Neurocysticercosis was leading cause of a secondary headache that leads to CDH. Light, fast, and stress were leading precipitants associated with CDH. Conclusion: CDH was mostly associated with primary headache over the secondary headache. Chronic migraine was leading cause of CDH in comparison to CTTH. Females were more affected both in chronic migraine and CTTH. Family history was more positive in case of chronic migraine. Vomiting nausea, photophobia, and phonophobia vertigo were leading symptoms associated with CDH whereas light, fast, and stress were leading precipitants associated with CDH.

Miliary tuberculosis (TB) is a severe form of disseminated TB. In developing countries childhood miliary TB is a significant health problem. Pulmonary TB is the most common type of TB in children. Of all TB cases miliary TB accounts for about 1%. We report a case of paediatric miliary TB with acute presentation in a eleven years old female who presented with fever and cough since 3 days and rapid breathing since one day. Clinical examination showed hepatosplenomegaly, on auscultation chest was clear and air entry bilateral equal, chest x-ray was suggestive of miliary shadows suggestive of TB and it was confirmed by HRCT chest. Laboratory studies revealed anaemia and elevated erythrocyte sedimentation rate (ESR). Tuberculin test was negative, gastric lavage for acid-fast bacilli Gene-Xpert was positive for mycobacterium tuberculosis. Fundus examination revealed bilateral small, white sub retinal opacities with the classical appearance of choroidal tubercles. The diagnosis of Miliary TB was confirmed and the patient was started on anti TB therapy.

Pheochromocytoma is a rare catecholamine-producing tumor arising from chromaffin tissue in the adrenal medulla, occurring in less than 0.2 percent of patients with hypertension. The mean age at diagnosis is about 40 years. Pheochromocytomas are commonly inherited as features of multiple endocrine neoplasia type 2 or several other pheochromocytoma-associated syndromes and have variable clinical presentation. Among the presenting symptoms, episodes of palpitations, headaches, and profuse sweating are typical and constitute a classic triad. We report a case of a 17-year-old male patient with rare bilateral pheochromocytoma presenting with persistent hiccups for 4 months and blurring of vision for 1 week, later followed by hypertensive crisis. There was neither family history of pheochromocytoma nor any classic symptoms. Patient was diagnosed with bilateral pheochromocytoma without any syndromic association. But still this patient needs to be followed for future development of medullary carcinoma of thyroid because it could be an initial presentation of MEN 2A/2B/VHL syndromes. Our paper highlights the importance of maintaining a high level of suspicion for persistent hiccups and careful clinical screening for hypertension even in absence of associated syndromes of pheochromocytoma and classical symptoms to achieve prompt diagnosis and to avoid improper management.

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