History of Present Illness (HPI)
The patient is a [insert age]-year-old female with a 7-year history of bilateral temporal headaches characterized as sharp and throbbing. The headaches are triggered by movement and exacerbated by physical activity, with associated nausea. The pain scale ranges from 0/10 at rest to 10/10 at its worst, typically worsening in the afternoon and improving with rest. She denies radiation of pain, double vision, or sensitivity to light and sound. Additionally, she reports an ongoing discharge for months, for which she was prescribed Flagyl 2 months ago but never picked up.
Differential Diagnosis
- Single Most Likely Diagnosis
- Migraine headaches: The patient's symptoms of sharp and throbbing headaches, triggered by movement and exacerbated by physical activity, with associated nausea, are consistent with migraine headaches. The improvement with rest also supports this diagnosis.
- Other Likely Diagnoses
- Tension headaches: The patient's headaches are bilateral and worsen with physical activity, which could also be consistent with tension headaches.
- Sinus headaches: The patient's report of an ongoing discharge could suggest a sinus infection or sinusitis, which could be contributing to her headaches.
- Temporomandibular joint (TMJ) disorder: The patient's bilateral temporal headaches could be related to TMJ disorder, especially if she has a history of jaw pain or clicking.
- Do Not Miss Diagnoses
- Subarachnoid hemorrhage: Although the patient's symptoms do not suggest a sudden, severe headache, it is essential to consider this diagnosis, especially if she has a history of hypertension or other risk factors.
- Temporal arteritis: This diagnosis is crucial to consider in older adults, especially if they have a history of polymyalgia rheumatica or other autoimmune disorders.
- Brain tumor: Although rare, a brain tumor could cause headaches that worsen with physical activity, and it is essential to consider this diagnosis, especially if the patient has a history of cancer or other risk factors.
- Rare Diagnoses
- Trigeminal neuralgia: This diagnosis is characterized by sudden, severe, and sharp pain in the face, which could be consistent with the patient's sharp and throbbing headaches.
- Occipital neuralgia: This diagnosis is characterized by sharp and stabbing pain in the back of the head, which could be consistent with the patient's headaches.
- Idiopathic intracranial hypertension: This diagnosis is characterized by increased intracranial pressure without a known cause, which could cause headaches that worsen with physical activity.