Differential Diagnosis for Headache behind Eyes
Single most likely diagnosis
- Chronic Tension Headache: This is a common condition characterized by frequent or constant headaches that can last for days, weeks, or even months. The headache is often described as a band or a squeezing sensation around the forehead, but can also be felt behind the eyes. The lack of response to triptans, which are typically used for migraines, supports this diagnosis.
Other Likely diagnoses
- Chronic Migraine: Although triptans were not helpful, some patients with chronic migraine may not respond to these medications. Chronic migraine is characterized by headaches that occur at least 15 days per month, with at least 8 days of headache meeting migraine criteria.
- Hemicrania Continua: This is a rare headache disorder, but given the duration and location of the headache, it should be considered. Hemicrania continua is characterized by a continuous, unilateral headache with exacerbations of severe pain.
- Cluster Headache: Cluster headaches are severe, unilateral headaches that occur in clusters or cycles. They are often accompanied by autonomic symptoms such as nasal congestion or eye watering. Although the duration of 20 days is longer than typical cluster periods, it's possible that the patient is experiencing a prolonged cluster cycle.
Do Not Miss diagnoses
- Giant Cell Arteritis: This is an inflammatory condition that affects the blood vessels and can cause headaches, often accompanied by visual disturbances or jaw claudication. It's essential to consider this diagnosis due to the potential for irreversible vision loss if left untreated.
- Temporal Arteritis: Similar to giant cell arteritis, temporal arteritis can cause headaches and visual symptoms. It's crucial to rule out this condition to prevent complications such as blindness.
- Brain Tumor: Although rare, a brain tumor can cause headaches that are persistent and unresponsive to typical treatments. It's essential to consider this diagnosis to ensure prompt evaluation and treatment if necessary.
- Idiopathic Intracranial Hypertension: This condition is characterized by increased intracranial pressure without a known cause, often accompanied by headaches and visual disturbances.
Rare diagnoses
- Short-Lasting Unilateral Neuralgiform Headache with Conjunctival Injection and Tearing (SUNCT): This is a rare headache disorder characterized by short-lasting, severe headaches with autonomic symptoms.
- Trigeminal Neuralgia: This condition is characterized by sudden, severe facial pain, often triggered by specific factors such as chewing or talking. Although it's typically not described as a headache behind the eyes, it's possible that the patient is experiencing a variant of this condition.
- Cervicogenic Headache: This type of headache is caused by referred pain from the cervical spine and can be felt behind the eyes. It's often accompanied by neck pain or stiffness.