Differential Diagnosis for 15-year-old Female with Nontraumatic Headache and Dizziness
Single Most Likely Diagnosis
- Tension Headache: This is the most common type of headache in adolescents, often presenting with a non-traumatic onset and accompanied by symptoms like dizziness due to muscle tension and possible stress.
Other Likely Diagnoses
- Migraine: A common cause of headaches in teenagers, which can be accompanied by dizziness, nausea, and sensitivity to light and sound.
- Viral Meningitis: Although less common, it can present with headache and dizziness, especially if there's an associated fever or stiff neck.
- Sinusitis: Inflammation of the sinuses can cause headaches and dizziness, particularly if there's an infection involved.
Do Not Miss Diagnoses
- Subarachnoid Hemorrhage: A life-threatening condition that requires immediate attention, presenting with a sudden, severe headache (often described as "the worst headache of my life") and possible dizziness.
- Brain Tumor: Although rare, it's crucial not to miss this diagnosis, as it can present with gradually worsening headaches and dizziness due to increased intracranial pressure.
- Idiopathic Intracranial Hypertension (IIH): Characterized by increased pressure within the skull without an apparent cause, leading to headaches and vision changes, which could be mistaken for dizziness.
- Stroke: Though uncommon in teenagers, it's a critical diagnosis to consider, especially if there are focal neurological deficits accompanying the headache and dizziness.
Rare Diagnoses
- Pseudotumor Cerebri: A condition similar to IIH but with a different pathophysiology, presenting with symptoms of increased intracranial pressure.
- Arteriovenous Malformation (AVM): A rare congenital condition that can cause headaches and neurological symptoms due to abnormal blood vessel connections in the brain.
- Chiari Malformation: A structural defect in the cerebellum that can cause headaches and dizziness, especially with certain movements or positions.
Workup and Management
The workup should include a thorough medical history, physical examination, and neurological assessment. Initial tests may involve:
- Complete Blood Count (CBC) to rule out infection or inflammation
- Blood cultures if infection is suspected
- Imaging studies such as MRI or CT scans of the head to evaluate for structural abnormalities, hemorrhage, or tumors
- Lumbar puncture (LP) if meningitis is suspected, after ensuring there's no increased intracranial pressure
Management will depend on the diagnosis:
- Tension Headache and Migraine: Over-the-counter pain relievers, rest, hydration, and possibly prescription medications for migraines.
- Viral Meningitis: Supportive care, hydration, and antiviral medications if appropriate.
- Sinusitis: Antibiotics if bacterial, decongestants, and pain management.
- Subarachnoid Hemorrhage, Brain Tumor, Stroke, IIH, and other critical conditions: Immediate medical or surgical intervention as necessary.
Each patient's management plan should be tailored to their specific diagnosis and clinical presentation, with close monitoring for any changes in condition.