Differential Diagnosis for Bilateral Head Pain

• Single most likely diagnosis
  • Tension headache: This is the most common type of headache and often presents with bilateral head pain, typically described as a band or a squeezing sensation around the forehead, back of the neck, or both.
• Other Likely diagnoses
  • Migraine: Although migraines are often unilateral, they can be bilateral, especially in children or as part of a migraine aura. They are usually accompanied by other symptoms such as nausea, vomiting, and sensitivity to light or sound.
  • Sinusitis: Inflammation of the sinuses can cause pain in the face and head, which can be bilateral, especially if multiple sinuses are involved. This pain is often accompanied by nasal congestion, fever, and facial pressure.
  • Medication overuse headache: Frequent or excessive use of headache medications can lead to rebound headaches, which are typically bilateral and can occur daily.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Subarachnoid hemorrhage: Although rare, this condition is life-threatening and can present with a sudden, severe headache, often described as "the worst headache of my life." It may be bilateral and is accompanied by other symptoms such as nausea, vomiting, and loss of consciousness.
  • Meningitis: Inflammation of the protective membranes covering the brain and spinal cord can cause severe, bilateral headache, along with fever, stiff neck, and confusion.
  • Temporal arteritis: This condition involves inflammation of the blood vessels in the head and can cause severe, bilateral headaches, especially in older adults. It's accompanied by symptoms such as jaw claudication, visual disturbances, and fever.
• Rare diagnoses
  • Idiopathic intracranial hypertension: This condition involves increased pressure within the skull without any apparent cause and can lead to bilateral headaches, often accompanied by vision changes and tinnitus.
  • Hypnic headache: A rare type of headache that occurs only during sleep and can wake the person, typically presenting as a bilateral, dull headache.