Differential Diagnosis for Pulsating Headache behind Unilateral Eye
- Single most likely diagnosis
- Migraine: This is the most common cause of unilateral headaches, often accompanied by pulsating pain, and can be localized behind one eye. Migraines can also be triggered by various factors and may be accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound.
- Other Likely diagnoses
- Cluster headache: Characterized by severe, unilateral pain typically centered around one eye, cluster headaches are less common than migraines but are known for their intense, pulsating nature.
- Tension headache: Although typically bilateral, tension headaches can occasionally present unilaterally and may cause pain that feels like it's behind the eye, though it's usually more of a dull ache than a pulsating pain.
- Sinusitis: Inflammation of the sinuses can cause pain that is perceived behind the eyes, especially if the ethmoid or frontal sinuses are involved. This pain can be pulsating, especially if it's associated with an infection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage: A life-threatening condition caused by bleeding into the space surrounding the brain, which can present with a sudden, severe headache, often described as "the worst headache of my life." Although the pain can be bilateral, it may initially be perceived as unilateral.
- Temporal arteritis: An inflammatory condition affecting the blood vessels, particularly those in the temples, which can cause severe, unilateral headaches, often accompanied by jaw claudication and visual disturbances. If left untreated, it can lead to blindness.
- Pituitary apoplexy: A rare but potentially life-threatening condition caused by hemorrhage or infarction of the pituitary gland, which can present with sudden, severe headache, often accompanied by visual disturbances and alterations in consciousness.
- Rare diagnoses
- Trigeminal neuralgia: A chronic pain condition that affects the trigeminal nerve, which can cause intense, shock-like or stabbing pain in parts of the face, including areas around the eyes. However, this pain is typically more fleeting and shock-like rather than pulsating.
- Occipital neuralgia: Involves the occipital nerves and can cause pain that starts in the neck and travels up to the back of the head, sometimes perceived behind the eye. The pain is usually sharp and stabbing rather than pulsating.
- Idiopathic stabbing headache: A rare condition characterized by brief, stabbing pains, often in the head or around the eyes, which can be unilateral but are typically very short-lived, lasting only seconds.