Differential Diagnosis for Pulsating Headache behind Unilateral Eye accompanied by Nausea
- Single most likely diagnosis
- Migraine: This is the most likely diagnosis due to the classic symptoms of a pulsating headache, unilateral location (behind one eye), and accompanying nausea. Migraines are common and often present with these characteristics.
- Other Likely diagnoses
- Cluster Headache: Characterized by severe, unilateral orbital or periorbital pain, often accompanied by nausea and other autonomic symptoms. While less common than migraines, the unilateral eye pain is a hallmark of cluster headaches.
- Tension-Type Headache: Although typically bilateral, some tension-type headaches can present unilaterally and may cause nausea, especially if severe. However, the pain is usually described as pressing or tightening rather than pulsating.
- Sinusitis: Inflammation of the sinuses can cause pain behind the eyes, especially if the ethmoid or frontal sinuses are involved. Nausea can occur due to the infection or associated headache.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid Hemorrhage: A sudden, severe headache (often described as "the worst headache of my life") can be a sign of a subarachnoid hemorrhage, which is a life-threatening condition. Although the headache is typically bilateral and not limited to behind one eye, the severity and potential for nausea warrant consideration.
- Temporal Arteritis: This condition, also known as giant cell arteritis, can cause unilateral headache, often accompanied by visual disturbances and nausea. It's a medical emergency due to the risk of vision loss if not promptly treated.
- Acute Angle-Closure Glaucoma: Severe eye pain, often accompanied by nausea and vomiting, can be a symptom of acute angle-closure glaucoma, a condition that requires immediate medical attention to prevent vision loss.
- Rare diagnoses
- Trigeminal Neuralgia: Characterized by sudden, severe, shock-like pain around the eyes, nose, or jaw, often triggered by specific actions. While it can cause unilateral pain, it's less commonly associated with nausea.
- Occipital Neuralgia: Involves pain in the distribution of the occipital nerves, which can include the area behind the eye. It's less common and typically not associated with nausea.
- Idiopathic Intracranial Hypertension: Can cause headaches that worsen with coughing or straining, and may be accompanied by nausea and visual disturbances, including transient vision loss. The headache is often bilateral but can be unilateral.