Differential Diagnosis for John's Headaches
Single Most Likely Diagnosis
- Cervicogenic Headache: This diagnosis is likely due to the patient's history of a car accident, which may have caused underlying cervical spine issues. The patient's complaints of a stiff neck, crunching in the neck, and headaches in the top back of the head are consistent with cervicogenic headache. The delay in onset of headaches after the accident is also consistent with this diagnosis.
Other Likely Diagnoses
- Tension Headache: The patient's description of the headache as "annoying" and constant suggests a tension-type headache. The absence of red flags and normal imaging studies support this diagnosis.
- Post-Traumatic Headache: Given the patient's history of a car accident, post-traumatic headache is a possible diagnosis. The headaches started about a year after the accident, which is within the expected timeframe for post-traumatic headaches.
- Cervical Spondylosis: The patient's age and complaints of neck stiffness and crunching suggest cervical spondylosis, which can cause headaches.
Do Not Miss Diagnoses
- Subarachnoid Hemorrhage: Although the patient has had normal imaging studies, subarachnoid hemorrhage is a potentially life-threatening condition that must be considered, especially given the patient's complaint of a sudden onset of headache.
- Giant Cell Arteritis: This condition is a medical emergency that can cause headaches, especially in older adults. Although the patient's symptoms are not typical, giant cell arteritis must be considered due to the patient's age.
- Brain Tumor: A brain tumor is a possible cause of headaches, especially if the tumor is located in the posterior fossa. Although the patient has had normal imaging studies, a brain tumor must be considered due to the patient's persistent and worsening symptoms.
Rare Diagnoses
- Chiari Malformation: This rare condition can cause headaches, especially in the back of the head. Although the patient's symptoms are not typical, Chiari malformation must be considered, especially if an MRI is performed.
- Eagle Syndrome: This rare condition is caused by an elongated styloid process and can cause headaches, especially in the back of the head. Although the patient's symptoms are not typical, Eagle syndrome must be considered, especially if an ENT evaluation is performed.