What is the diagnosis for a patient experiencing intermittent band-like headaches, worsening in the morning and exacerbated by movement and light, with an associated pain scale of 2-7/10, and a history of normal menstrual flow and a recent eye examination?

Differential Diagnosis

• Single most likely diagnosis
  • Tension headache: The patient's description of a band-like character and intermittent nature, along with exacerbation by movement and lights, is consistent with tension headaches. The pain scale of 2/10 at worst and 7/10 at best also aligns with this diagnosis.
• Other Likely diagnoses
  • Migraine: Although the patient denies radiation, the exacerbation by lights and movement could suggest a migraine. However, the lack of severe pain and associated symptoms like nausea or aura makes this less likely.
  • Sinus headache: The patient's symptoms could be related to sinus pressure, especially with the worsening of pain in the morning. However, the absence of other sinus-related symptoms like congestion or facial pressure makes this less likely.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Subarachnoid hemorrhage: Although the patient's symptoms do not strongly suggest this diagnosis, it is essential to consider it due to the potential severity. The sudden onset of a severe headache, especially if it worsens over time, could indicate a subarachnoid hemorrhage.
  • Temporal arteritis: This condition can cause headaches, especially in older adults, and can lead to vision loss if not treated promptly. The patient's report of a normal eye exam a year ago does not rule out this diagnosis.
  • Pituitary apoplexy: This rare condition can cause sudden and severe headaches, often accompanied by visual disturbances. Although the patient denies radiation and has a normal eye exam, it is crucial to consider this diagnosis due to its potential severity.
• Rare diagnoses
  • Cluster headache: These headaches are characterized by severe, unilateral pain and are often accompanied by autonomic symptoms like nasal congestion or eye watering. The patient's symptoms do not strongly suggest this diagnosis, but it is essential to consider it due to its severity.
  • Idiopathic intracranial hypertension: This condition can cause headaches, especially in women of childbearing age, and can lead to vision loss if not treated promptly. The patient's report of a normal eye exam a year ago does not rule out this diagnosis, and her heavy menstrual bleeding could be a contributing factor.