Differential Diagnosis for Headache

The patient presents with a throbbing headache that radiates to the neck, accompanied by dizziness, and worsens when laying down. The following differential diagnoses are considered:

• Single most likely diagnosis
  • Migraine: This is the most likely diagnosis given the throbbing nature of the headache, radiation to the neck, and associated dizziness. Migraines can be exacerbated by positional changes, which aligns with the patient's report of worsening symptoms when laying down.
• Other Likely diagnoses
  • Tension headache: Although less likely than migraine, tension headaches can present with a throbbing quality and radiate to the neck. However, they are typically less severe and not usually associated with dizziness.
  • Cervicogenic headache: This type of headache originates from the cervical spine and can radiate to the head and neck, consistent with the patient's symptoms. The worsening of symptoms when laying down could be related to cervical spine positioning.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Subarachnoid hemorrhage: Although unlikely given the gradual onset over five days, a subarachnoid hemorrhage is a medical emergency that requires immediate attention. The severe pain and dizziness could be indicative of this condition.
  • Meningitis: Infection of the meninges can cause severe headache, dizziness, and worsening symptoms when laying down due to increased intracranial pressure. This diagnosis is critical to consider due to its potential for severe morbidity and mortality.
  • Temporal arteritis: This condition, although more common in older adults, can cause severe headache and should be considered, especially if there are accompanying symptoms like jaw claudication or visual disturbances.
• Rare diagnoses
  • Occipital neuralgia: This condition involves inflammation of the occipital nerves and can cause severe, throbbing headaches that radiate to the neck. However, it is less common and typically presents with more localized symptoms.
  • Chiari malformation: A structural defect in the cerebellum that can cause increased intracranial pressure, leading to severe headaches, dizziness, and worsening symptoms when laying down. This diagnosis is rare and would require imaging studies for confirmation.