Differential Diagnosis for 24M with Tension Type Headache
- Single most likely diagnosis
- Tension-type headache: This is the most likely diagnosis given the description of the headache as being in the evening, accompanied by neck or shoulder pain, and responding to motrin (ibuprofen). Tension-type headaches are common, often described as a band or squeezing sensation around the forehead, and can be exacerbated by stress, poor posture, or muscle tension.
- Other Likely diagnoses
- Cervicogenic headache: Given the involvement of neck or shoulder pain, a cervicogenic headache is a plausible diagnosis. This type of headache is referred from the cervical spine and can be triggered by movements or postures that put strain on the neck.
- Migraine: Although the description does not fully align with classic migraine symptoms (e.g., unilateral pain, nausea, aura), some migraines can present with more generalized or bilateral pain and may be accompanied by neck pain. The response to motrin could also suggest migraine, as some patients find relief with over-the-counter pain medications.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage: Although extremely unlikely given the chronic nature of the symptoms and the response to motrin, it's crucial to consider subarachnoid hemorrhage in any patient presenting with a new or severe headache. The "thunderclap" headache characteristic of subarachnoid hemorrhage is typically sudden and extremely severe, but atypical presentations can occur.
- Temporal arteritis: This condition, also known as giant cell arteritis, can cause headaches, but it's more common in older adults. However, it's a "do not miss" diagnosis due to the risk of vision loss if not promptly treated.
- Meningitis: Infection or inflammation of the meninges can cause headache, often accompanied by fever, neck stiffness, and photophobia. Although the patient's symptoms do not strongly suggest meningitis, it's a critical diagnosis to consider due to its potential severity.
- Rare diagnoses
- Occipital neuralgia: This condition involves irritation of the occipital nerves and can cause pain in the back and top of the head, sometimes accompanied by neck pain. It's less common but could be considered if other diagnoses are ruled out.
- Myofascial pain syndrome: This condition involves pain and inflammation of the muscles and their surrounding fascia. While it could contribute to the patient's symptoms, it's less likely to be the primary diagnosis for the headache pattern described.