Differential Diagnosis for Unilateral Pulsating Headache
Single Most Likely Diagnosis
- Migraine: This is the most likely diagnosis given the unilateral pulsating nature of the headache, accompanied by photosensitivity, nausea, and worsening with exertion. The mild numbness sensation to the temple area could be indicative of a migraine aura.
Other Likely Diagnoses
- Cluster Headache: Although less common, cluster headaches can present with unilateral pain and are often accompanied by autonomic symptoms. However, they typically do not have the same level of photosensitivity or nausea as migraines.
- Tension-Type Headache: While tension-type headaches are usually bilateral and non-pulsating, some variants can present unilaterally and with some degree of pulsation, though they less commonly include nausea or photosensitivity.
- Hemicrania Continua: A continuous, unilateral headache that can have periods of exacerbation, sometimes with autonomic features, though it's less likely given the description of pulsating headache and specific exacerbation with exertion.
Do Not Miss Diagnoses
- Subarachnoid Hemorrhage: Although the presentation doesn't strongly suggest a hemorrhagic stroke (e.g., sudden onset, "thunderclap" headache), any new or severe headache, especially with exertion, warrants consideration of this potentially life-threatening condition.
- Temporal Arteritis (Giant Cell Arteritis): This condition can cause unilateral headache and is a medical emergency due to the risk of vision loss. However, it typically affects older adults and is accompanied by other symptoms like jaw claudication and visual disturbances.
- Stroke or Transient Ischemic Attack (TIA): While less likely given the description, any neurological symptom, including headache with numbness, should prompt consideration of stroke or TIA, especially if there are other risk factors.
Rare Diagnoses
- Trigeminal Neuralgia: Characterized by sudden, severe, shock-like or stabbing pain around the eyes, lips, or nose mainly because of abnormal blood vessels pressing on the trigeminal nerve in the head. It doesn't typically present with the combination of symptoms described.
- Occipital Neuralgia: Involves inflammation or irritation of the occipital nerves, which can cause severe, sharp, or stabbing pain in the back and side of the head. It's less likely given the specific characteristics of the headache described.
- Idiopathic Stabbing Headache: Brief, sharp pains that can occur anywhere in the head, often without other symptoms. This diagnosis doesn't fit well with the combination of symptoms provided, especially the duration and associated features like photosensitivity and nausea.