Differential Diagnosis for Dull Constant Headache on Forehead and Nape
Single Most Likely Diagnosis
- Tension Headache: This is the most common type of headache and is often described as a dull, constant band or squeezing sensation around the forehead and back of the neck (nape), typically bilateral and of mild to moderate intensity. The justification for this diagnosis is the classic presentation of tension headache matching the symptoms described.
Other Likely Diagnoses
- Cervicogenic Headache: Originates from the cervical spine and is often referred to the forehead and nape due to the convergence of cervical and trigeminal nerve distributions. This diagnosis is considered because the headache's location and potential referral patterns from the neck align with the symptoms.
- Migraine: Although migraines are typically unilateral and throbbing, some individuals may experience a more diffuse, dull headache, especially in the prodromal or residual phases. The justification for including migraine is its high prevalence and the variability in presentation.
- Sinusitis: Inflammation of the sinuses can cause pain and pressure in the forehead and, less commonly, the nape of the neck. This diagnosis is considered due to the potential for referred pain from the sinuses to these areas.
Do Not Miss Diagnoses
- Subarachnoid Hemorrhage: Although typically presenting with a sudden, severe headache (often described as "the worst headache of my life"), it's crucial not to miss this diagnosis due to its high morbidity and mortality. A dull, constant headache could potentially be a warning leak or a less typical presentation.
- Meningitis: Inflammation of the protective membranes covering the brain and spinal cord can cause headache, fever, and neck stiffness. The justification for including meningitis is the potential for severe consequences if not promptly treated.
- Temporal Arteritis: This condition, more common in older adults, involves inflammation of the blood vessels and can cause headache, typically unilateral but sometimes bilateral, along with other symptoms like jaw claudication and visual disturbances.
Rare Diagnoses
- Occipital Neuralgia: Involves the nerves that run from the base of the skull to the scalp and can cause pain in the forehead and nape of the neck. This diagnosis is less common but should be considered in cases where other diagnoses are ruled out.
- Chiari Malformation: A structural defect in the cerebellum that controls balance can cause headaches, often worsened by coughing or straining, and may be referred to the forehead and nape. The justification for including this diagnosis is the potential for significant neurological consequences if not addressed.