Differential Diagnosis

The patient's symptoms of head pain triggered by laughing, sneezing, lifting, and coughing, along with fluctuating blood pressure, hand numbness, and pain worsening at night, suggest a complex clinical picture. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Pseudotumor Cerebri (Idiopathic Intracranial Hypertension): This condition is characterized by increased intracranial pressure without a detectable cause, often presenting with headache worsened by activities that increase intrathoracic pressure, such as coughing or sneezing. The fluctuating blood pressure and the worsening of symptoms after stopping Buspar (which could have been masking some symptoms) support this diagnosis. However, the hand numbness and pain, especially worsening at night, might suggest other contributing factors or a different primary diagnosis.

• Other Likely Diagnoses

  • Cervical Spondylosis or Cervical Disc Disease: These conditions could explain the headaches and hand numbness/pain, especially if the symptoms worsen with activities that involve neck movement or strain. The nocturnal worsening of hand symptoms could be related to sleeping posture or increased pressure on cervical nerves during sleep.
  • Hypertension-related Headaches: Given the patient's fluctuating blood pressure, it's possible that the headaches are related to hypertension. However, the specific triggers (laughing, sneezing, lifting, coughing) and the pattern of pain (lasting seconds to minutes) are less typical for hypertension-related headaches alone.
  • Multiple Sclerosis: This condition could explain the varied neurological symptoms, including hand numbness and pain. However, the specific headache triggers and the absence of other typical MS symptoms (e.g., optic neuritis, more widespread neurological deficits) make this less likely without further diagnostic evidence.

• Do Not Miss Diagnoses

  • Subarachnoid Hemorrhage or Other Intracranial Bleeds: Although less likely given the recurrent, short-lasting nature of the headaches, it's crucial to rule out intracranial bleeding, especially with fluctuating blood pressure and severe headache episodes.
  • Temporal Arteritis: This condition, more common in older adults, can cause severe headaches and should be considered, especially if there are symptoms like jaw claudication or visual disturbances, although these are not mentioned.
  • Cervical Artery Dissection: This is a serious condition that could explain the headaches and, potentially, some of the neurological symptoms. It often follows neck trauma or strain, which might not be immediately apparent.

• Rare Diagnoses

  • Chiari Malformation: A structural defect in the cerebellum that controls balance could potentially cause headaches worsened by coughing or sneezing due to increased intracranial pressure. However, this would typically be associated with other symptoms like ataxia or lower cranial nerve deficits.
  • Ehlers-Danlos Syndrome: This genetic disorder can lead to vascular and neurological complications, including headaches and possibly some of the patient's other symptoms. However, it's a broad diagnosis with many possible presentations, and specific diagnostic criteria would need to be met.