Differential Diagnosis for 12yo M with Intermittent Headache and Watery Eye
- Single most likely diagnosis
- Cluster headache: This is a strong consideration given the location of the headache (behind one eye), the intermittent nature, and the associated watery eye. The use of Goody's (containing acetaminophen, aspirin, and caffeine) for some relief also aligns with treatments sometimes used for cluster headaches, although they are not the first line of treatment.
- Other Likely diagnoses
- Migraine: Migraines can present with unilateral headaches and associated autonomic symptoms like a watery eye. The intermittent nature and the fact that the patient finds some relief with over-the-counter medications could fit a migraine diagnosis.
- Sinusitis: Given the location of the headache (behind the eye) and the watery eye, sinusitis could be a consideration, especially if there are other symptoms like facial pressure or nasal congestion, although these are not mentioned.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Acute angle-closure glaucoma: This is a medical emergency that can present with severe eye pain, blurred vision, and a red, watery eye. Although the patient's symptoms are not entirely typical, the presence of a watery eye and headache warrants consideration of this diagnosis to avoid missing a potentially blinding condition.
- Orbital cellulitis: An infection of the tissues surrounding the eye, which can cause pain, swelling, and watery discharge. It's a serious condition that requires prompt antibiotic treatment.
- Intracranial hemorrhage or other space-occupying lesions: Although less likely given the intermittent nature of the symptoms, any new onset of headache, especially with focal neurological signs or symptoms, should prompt consideration of intracranial pathology.
- Rare diagnoses
- Trigeminal neuralgia: This condition involves sudden, severe, shock-like pain around the eyes, lips, or nose mainly because of abnormal blood vessels pressing on the trigeminal nerve in the head. It's less common in children and might not fully explain the watery eye.
- Raeder's syndrome: A rare condition characterized by a group of symptoms including headache, ptosis (drooping eyelid), and lack of sweating on one side of the face, which could potentially explain some of the patient's symptoms if they are more extensive than described.