Differential Diagnosis
- Single most likely diagnosis
- Migraine with aura: The patient's symptoms of unilateral headache, bilateral blurry vision, and numbness/tingling of the arm are consistent with a migraine with aura. The exacerbation of headache with sounds also supports this diagnosis, as migraines are often sensitive to sensory stimuli. The patient's history of migraines further increases the likelihood of this diagnosis.
- Other Likely diagnoses
- TIA (Transient Ischemic Attack): Although the patient's symptoms could be consistent with a TIA, the presence of a headache and sensitivity to sounds makes migraine a more likely diagnosis. However, TIAs can present with a variety of symptoms, including numbness and tingling, and should be considered in the differential.
- Occipital neuralgia: This condition can cause unilateral headaches and blurry vision, but it is less likely to cause numbness and tingling in the arm.
- Do Not Miss diagnoses
- Subarachnoid hemorrhage: Although this diagnosis is less likely given the patient's symptoms and history, it is a potentially life-threatening condition that must be considered. A sudden, severe headache (often described as "the worst headache of my life") is a classic symptom of subarachnoid hemorrhage.
- Stroke: Similar to TIA, a stroke can present with a variety of symptoms, including numbness and tingling. Although the patient's symptoms are more consistent with migraine, stroke must be considered and ruled out.
- Temporal arteritis: This condition can cause headaches, blurry vision, and numbness, but it is more common in older adults.
- Rare diagnoses
- Multiple sclerosis: This condition can cause a variety of neurological symptoms, including numbness and tingling, but it is less likely given the patient's age and presentation.
- Cluster headache: This condition can cause severe, unilateral headaches, but it is less likely to cause numbness and tingling in the arm.
- Idiopathic intracranial hypertension: This condition can cause headaches and blurry vision, but it is less likely to cause numbness and tingling in the arm.