Differential Diagnosis for a 65-year-old Man with Headaches, Neck Stiffness, and Watery Eyes
- Single most likely diagnosis:
- Tension headache: This is the most common type of headache and can be exacerbated by stress, poor posture, or other factors. The fact that Tylenol helps and the headaches are consistent in the morning suggests a tension headache. Morning headaches can also be related to sleep quality or position.
- Other Likely diagnoses:
- Sinusitis: The presence of watery eyes and morning headaches could suggest sinusitis, especially if the patient has other symptoms like facial pain or nasal congestion.
- Migraine: Although less common in men, migraines can present with neck stiffness and watery eyes. However, migraines typically have other characteristics like photophobia, phonophobia, or aura, which are not mentioned.
- Cluster headache: These are severe headaches that occur in clusters or cycles, but they are less likely given the description of the headaches being consistent for 2 weeks and responsive to Tylenol.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Subarachnoid hemorrhage: Although the patient's symptoms have been consistent for 2 weeks and are relieved by Tylenol, it's crucial to consider subarachnoid hemorrhage due to the potential for sudden, severe headache (often described as "the worst headache of my life") and neck stiffness. The fact that the headaches are in the morning could be related to increased intracranial pressure during sleep.
- Temporal arteritis: This condition, also known as giant cell arteritis, can cause headaches, neck stiffness, and visual symptoms. It's a medical emergency due to the risk of blindness if not promptly treated.
- Meningitis: Although less likely given the chronic nature of the symptoms and the absence of fever or other systemic signs, meningitis must be considered, especially if there's any suspicion of infection.
- Rare diagnoses:
- Trigeminal neuralgia: This condition causes sudden, severe facial pain but can sometimes be accompanied by headache. It's less likely given the description of the headaches.
- Occipital neuralgia: Involves pain in the distribution of the occipital nerves and could be considered if the headaches are localized to the back of the head.
- Hypnic headache: A rare condition characterized by recurrent headaches that occur only during sleep and wake the patient, typically in the early morning hours.