Differential Diagnosis for Headaches in a 22-year-old Female
- Single most likely diagnosis
- Migraine headaches: The patient's symptoms of headaches occurring above and behind the left eye, accompanied by nausea and vomiting, and the fact that they are not related to stress, are classic for migraines. The patient's positive response to NSAIDs (Advil) and the family history of similar headaches also support this diagnosis.
- Other Likely diagnoses
- Tension headaches: Although the patient's symptoms are more suggestive of migraines, tension headaches can also cause nausea and are common in young adults. However, the location of the pain (above and behind the eye) and the severity of the symptoms make migraines more likely.
- Cluster headaches: These headaches are characterized by severe, unilateral pain, often accompanied by nausea and vomiting. However, they are less common in females and typically occur in clusters or cycles, which is not mentioned in the patient's history.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage: Although the patient's symptoms are chronic and not suggestive of a sudden, severe headache, it is essential to consider this diagnosis due to its potentially life-threatening consequences.
- Temporal arteritis: This condition can cause headaches, nausea, and vomiting, especially in older adults. However, it is less likely in a 22-year-old female, and the absence of other symptoms such as jaw claudication or visual disturbances makes it less probable.
- Brain tumor: A brain tumor can cause headaches, nausea, and vomiting, especially if it is located in the posterior fossa or is causing increased intracranial pressure. Although this diagnosis is unlikely, it is essential to consider it due to its potential severity.
- Rare diagnoses
- Trigeminal neuralgia: This condition causes severe, unilateral facial pain, which can be accompanied by nausea and vomiting. However, the pain is typically more localized to the face and is less likely to be confused with migraines.
- Idiopathic intracranial hypertension: This condition can cause headaches, nausea, and vomiting, especially in young, obese females. However, the patient's weight and body mass index are not mentioned, and other symptoms such as papilledema or visual disturbances are not present.