Differential Diagnosis for Morning Headaches with Vomiting
Single Most Likely Diagnosis
- Tension Headache: Morning headaches that worsen with vomiting could be indicative of a tension headache, especially if the patient experiences stress or has a history of similar episodes. The absence of nausea before vomiting is not uncommon in tension headaches.
Other Likely Diagnoses
- Migraine: Although typically associated with nausea, some migraine patients may experience vomiting without preceding nausea. The worsening of headaches in the morning could be related to migraine patterns.
- Idiopathic Intracranial Hypertension (IIH): Morning headaches that worsen throughout the day, accompanied by vomiting, could suggest IIH, especially in obese females. However, the absence of other symptoms like papilledema or visual disturbances makes this less likely.
- Sleep Apnea: Morning headaches can be a symptom of sleep apnea, and while less common, vomiting could occur due to increased intrathoracic pressure during apneic episodes.
Do Not Miss Diagnoses
- Subarachnoid Hemorrhage: Although the patient does not exhibit focal neurological signs, a sudden onset of severe headache (often described as "the worst headache of my life") with vomiting could indicate a subarachnoid hemorrhage. This condition requires immediate medical attention.
- Brain Tumor: A brain tumor could cause increased intracranial pressure, leading to morning headaches that worsen and vomiting. The absence of other neurological signs does not rule out this possibility.
- Meningitis: While typically associated with fever, neck stiffness, and altered mental status, atypical presentations of meningitis, especially in immunocompromised patients, could include headache and vomiting without other initial symptoms.
Rare Diagnoses
- Chiari Malformation: A structural defect in the cerebellum that controls balance could lead to headaches and vomiting, especially if there's an associated syrinx or hydrocephalus.
- Cyclic Vomiting Syndrome: A condition characterized by recurrent episodes of severe vomiting, which could be accompanied by headaches. However, this typically has a more cyclic pattern and is often associated with nausea.
- Pseudotumor Cerebri Syndrome (PTCS) with Spontaneous Intracranial Hypotension: A rare condition where low intracranial pressure leads to headaches and potentially vomiting, often worsened by standing or Valsalva maneuvers.