Differential Diagnosis for New Headache, Neck into Posterior Head on Xarelto
- Single most likely diagnosis:
- Tension headache: This is a common type of headache that can be exacerbated by the stress of starting a new medication like Xarelto. The location of the pain, from the neck into the posterior head, is consistent with tension headache.
- Other Likely diagnoses:
- Cervicogenic headache: Given the referral of pain from the neck to the posterior head, a cervicogenic headache is possible. This type of headache is caused by referred pain from the cervical spine.
- Migraine: Although migraines are typically unilateral and can be accompanied by other symptoms like nausea and photophobia, they can sometimes present with posterior head pain and could be exacerbated by the initiation of Xarelto.
- Medication overuse headache: If the patient has been taking other pain medications in addition to Xarelto, there's a possibility of developing a medication overuse headache.
- Do Not Miss diagnoses:
- Subarachnoid hemorrhage (SAH): Although less likely, given the patient is on Xarelto (an anticoagulant), the risk of bleeding, including intracranial hemorrhage like SAH, increases. This is a medical emergency.
- Cervical artery dissection: This condition can cause neck pain and headache and is a risk due to the anticoagulant therapy, which could worsen any bleeding.
- Intracranial venous thrombosis: This is another condition that could be exacerbated by anticoagulation therapy and presents with headache.
- Rare diagnoses:
- Giant cell arteritis: This condition can cause headache but typically presents in older adults with other symptoms like jaw claudication and visual disturbances.
- Temporal arteritis: Similar to giant cell arteritis, this would be unusual without other systemic symptoms.
- Occipital neuralgia: This involves the nerves that run from the spine to the scalp and could cause pain in the posterior head and neck area, but it's less common.