Differential Diagnosis for 18-year-old Female with Headaches
- Single most likely diagnosis
- Migraine: Although Imitrex (sumatriptan) is not helping, migraine is still a possible diagnosis, especially given the location and radiation of the headaches. The lack of response to Imitrex does not rule out migraine, as some patients may not respond to triptans.
- Other Likely diagnoses
- Tension headache: The location of the headaches behind the eyes and radiating to the side of the head and neck is consistent with tension headaches. The absence of a specific cause and the presence of triggers also support this diagnosis.
- Cluster headache: Although less common in females, cluster headaches can occur in women and are characterized by severe, unilateral headaches that can radiate to the neck and are often accompanied by autonomic symptoms.
- Sinus headache: The location of the headaches behind the eyes could suggest a sinus headache, especially if the patient has a history of sinusitis or allergies.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage: A sudden, severe headache (often described as "the worst headache of my life") can be a sign of a subarachnoid hemorrhage, which is a medical emergency.
- Temporal arteritis: Although rare in an 18-year-old, temporal arteritis can cause headaches and is a medical emergency due to the risk of vision loss.
- Brain tumor: A brain tumor can cause headaches, especially if it is located in the posterior fossa or is causing increased intracranial pressure.
- Rare diagnoses
- Occipital neuralgia: This condition is characterized by sharp, stabbing pains in the neck and head, often accompanied by tenderness to the touch.
- Trigeminal neuralgia: Although rare in young adults, trigeminal neuralgia can cause severe, unilateral facial pain that can radiate to the head and neck.
- Hypnic headache: This is a rare condition characterized by recurrent headaches that occur only during sleep and can wake the patient from sleep.