Differential Diagnosis for Pressure Migraines
Given the symptoms of light, pressure migraines on the back of the head just above the right ear and above the right occipital nerve, with normal MRI and CT scans, the following differential diagnoses are considered:
- Single Most Likely Diagnosis
- Tension Headache: This is the most common type of headache and can present with pressure or band-like sensations around the head, including the back. The location above the right ear and near the occipital nerve could be consistent with referred pain from tense neck muscles.
- Other Likely Diagnoses
- Occipital Neuralgia: Involves irritation or injury to the occipital nerves, which can cause pain in the back and top of the head. The pain can be sharp and stabbing or a dull ache, and it's often on one side of the head.
- Cervicogenic Headache: Originates from the cervical spine and is often associated with neck pain and stiffness. The pain can refer to the back of the head, consistent with the described location.
- Migraine: Although migraines are typically more severe and often accompanied by other symptoms like nausea, vomiting, and sensitivity to light and sound, some individuals may experience milder forms that could fit the description.
- Do Not Miss Diagnoses
- Giant Cell Arteritis: An inflammatory condition affecting the blood vessels, particularly those in the head. It can cause headaches, often on one side, and is a medical emergency if it involves the arteries supplying the eyes, as it can lead to blindness.
- Temporal Arteritis: Similar to giant cell arteritis but typically affects the temporal arteries. It can cause severe headaches, usually on one side of the head, and jaw claudication.
- Subarachnoid Hemorrhage or Other Intracranial Bleeds: Although the MRI and CT scans were reported as normal, the possibility of a small bleed or other vascular issue cannot be entirely ruled out without considering the clinical context and potentially repeating or expanding imaging studies.
- Rare Diagnoses
- Trigeminal Neuralgia: Typically involves the face but can rarely cause pain that might be perceived in the back of the head due to the complex innervation of the head and neck.
- Chiari Malformation: A structural defect in the cerebellum that controls balance, can cause headaches that are often worse with coughing, sneezing, or straining, and might be perceived in the back of the head.
- Eagle Syndrome: Involves an elongated styloid process or calcified stylohyoid ligament, which can cause sharp, stabbing pain in the side of the face and head, including the area behind the ear.
Each of these diagnoses should be considered in the context of the patient's full clinical presentation, including any additional symptoms, medical history, and the results of a thorough physical examination. Further diagnostic testing or referral to a specialist may be necessary to determine the underlying cause of the symptoms.