Differential Diagnosis for 50-year-old Male with Headaches
Single Most Likely Diagnosis
- Tension headache: Given the location of the headaches (back of the head) and the absence of other alarming symptoms, tension headache is a common and likely diagnosis. The patient's history of hyperlipidemia (HLD) and controlled blood pressure without a history of hypertension suggest that the headaches are not likely related to uncontrolled hypertension or other cardiovascular issues.
Other Likely Diagnoses
- Cervicogenic headache: The location of the headaches in the back of the head could also suggest a cervicogenic headache, which is referred pain from the cervical spine.
- Migraine: Although the patient does not have a history of hypertension, migraines can occur without any underlying conditions and may present with headaches in various locations, including the back of the head.
- Occipital neuralgia: This condition involves inflammation of the occipital nerves and can cause headaches in the back of the head, although it is less common.
Do Not Miss Diagnoses
- Subarachnoid hemorrhage: Although unlikely, a subarachnoid hemorrhage is a life-threatening condition that requires immediate attention. The sudden onset of a severe headache (often described as "the worst headache of my life") is a classic symptom, but it can sometimes present with more subtle symptoms.
- Giant cell arteritis: This condition can cause headaches, especially in older adults, and is associated with other symptoms such as jaw claudication and visual disturbances. Missing this diagnosis can lead to serious complications, including blindness.
- Brain tumor: A brain tumor can cause headaches due to increased intracranial pressure, although this is a less common cause of headaches.
Rare Diagnoses
- Temporomandibular joint (TMJ) disorder: Although TMJ disorders can cause headaches, they are less likely to cause headaches exclusively in the back of the head.
- Chiari malformation: This rare condition involves a structural defect in the cerebellum that can cause headaches, among other symptoms.
- Paget's disease: This rare bone disorder can cause headaches due to bone deformation and increased intracranial pressure.