Differential Diagnosis for 79 Year Old Female with Left Sided Posterior Headache
- Single Most Likely Diagnosis
- Tension headache: This is the most common type of headache and can occur at any age, including in the elderly. The posterior location is consistent with tension headaches, which often present with bilateral or unilateral pain in the posterior or occipital region.
- Other Likely Diagnoses
- Cervicogenic headache: Given the posterior location of the headache, cervicogenic headache is a possibility. This type of headache is referred from the cervical spine and can be exacerbated by neck movement or pressure on the neck.
- Migraine: Although migraines are more common in younger populations, they can still occur in the elderly. The posterior location of the headache could be consistent with a migraine, especially if accompanied by other migraine symptoms such as nausea, vomiting, or sensitivity to light and sound.
- Occipital neuralgia: This condition involves inflammation of the occipital nerves and can cause sharp, stabbing pain in the posterior region of the head. It can be triggered by pressure on the nerves or by certain movements of the neck.
- Do Not Miss Diagnoses
- Subarachnoid hemorrhage: Although less likely, a subarachnoid hemorrhage is a medical emergency that requires immediate attention. The sudden onset of a severe headache, often described as "the worst headache of my life," can be a presenting symptom.
- Temporal arteritis: This condition, also known as giant cell arteritis, is an inflammation of the blood vessels in the head and can cause headaches, often in the temporal or posterior region. It is more common in the elderly and can lead to serious complications, such as blindness, if not treated promptly.
- Posterior circulation stroke: A stroke in the posterior circulation can present with headache, among other symptoms such as dizziness, vertigo, or visual disturbances. It is crucial to consider this diagnosis, especially in an elderly patient with risk factors for stroke.
- Rare Diagnoses
- Chiari malformation: This is a rare structural defect in the cerebellum that can cause headaches, often in the posterior region, due to compression of the brainstem or cerebellum.
- Posterior fossa tumor: Although rare, a tumor in the posterior fossa can cause headaches due to increased intracranial pressure or direct compression of brain structures.