Differential Diagnosis for Intermittent Headaches
- Single most likely diagnosis
- C) Migraine headache: This is the most likely diagnosis due to the characteristics of the headaches, including severe pain behind the eye, nausea, and occurrence of two to three times monthly. Migraines often begin in the morning and can last throughout the day, which aligns with the patient's symptoms.
- Other Likely diagnoses
- A) Cluster headache: Although less likely, cluster headaches could be considered due to the severe pain behind the eye. However, cluster headaches typically occur in clusters or cycles, are usually shorter in duration (15 minutes to 3 hours), and are often accompanied by other symptoms like nasal congestion or eye watering.
- B) Medication overuse headache: This could be a possibility if the patient is taking frequent pain medication for her headaches, leading to a cycle of overuse and rebound headaches. However, there's no direct information provided about medication use.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage or other intracranial hemorrhages: Although extremely unlikely given the intermittent and long-standing nature of the headaches, it's crucial to consider these life-threatening conditions, especially if there's a sudden change in headache pattern or severity.
- Temporal arteritis: This condition, characterized by inflammation of the blood vessels, can cause severe headaches and is a medical emergency if not promptly treated. It's more common in older adults but should be considered in the differential diagnosis due to its potential severity.
- Rare diagnoses
- D) Occipital neuralgia: This condition involves inflammation of the occipital nerves and can cause severe pain in the back and side of the head. It's less likely given the description of pain behind the eye and the absence of specific triggers or relief with certain positions.
- E) Tension headache: While tension headaches are common, they typically present with a band-like pressure around the head, which doesn't match the patient's description of severe pain behind the eye. They are also usually less severe and not accompanied by nausea.