Differential Diagnosis for 9-Year-Old with Daily Headaches
Single Most Likely Diagnosis
- Tension Headache: This is the most common type of headache in children, often characterized by a dull, aching pain on both sides of the head, and can be related to stress, poor posture, or muscle tension. The daily occurrence in a 9-year-old could be linked to school-related stress or other environmental factors.
Other Likely Diagnoses
- Migraine: Although less common than tension headaches, migraines can occur in children and are characterized by severe, throbbing pain, often on one side of the head, and can be accompanied by nausea, vomiting, and sensitivity to light and sound.
- Chronic Daily Headache: This includes a variety of headache disorders that occur 15 days or more per month, which could encompass both migraines and tension headaches, among others.
- Sinus Headache: Headaches can be a symptom of sinus infections or allergies, especially if the child has other symptoms like facial pain, nasal congestion, or cough.
Do Not Miss Diagnoses
- Brain Tumor: Although rare, brain tumors can cause daily headaches due to increased intracranial pressure, often accompanied by other symptoms like vomiting, vision changes, or seizures.
- Idiopathic Intracranial Hypertension (IIH): Characterized by increased pressure within the skull without a detectable cause, leading to headaches, vision changes, and sometimes papilledema.
- Meningitis or Encephalitis: Infections of the meninges or brain can cause severe headaches, along with fever, neck stiffness, and altered mental status.
- Subarachnoid Hemorrhage: Bleeding into the space surrounding the brain can cause a sudden, severe headache, often described as "the worst headache" ever experienced.
Rare Diagnoses
- Chiari Malformation: A structural defect in the cerebellum that controls balance, can cause headaches, especially after coughing, sneezing, or straining.
- Pseudotumor Cerebri: Similar to IIH, but can be secondary to other conditions like vitamin A toxicity or certain medications.
- Temporal Arteritis: Inflammation of the blood vessels in the temple, more common in older adults but can occur in children, causing headaches, jaw claudication, and visual disturbances.
- Trigeminal Neuralgia: A chronic pain condition that affects the trigeminal nerve, causing intense shock-like or stabbing pain in parts of the face, which can be mistaken for headache.