Differential Diagnosis

The patient presents with a complex set of symptoms including lightheadedness, blurred vision, persistent headache, and a recent history of significant stress. Considering these symptoms, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis
  • Stress-Related Tension Headache: Given the patient's recent history of increased stress due to family tragedy and new responsibilities, a tension headache is a plausible explanation for his symptoms. The headache's description as frontal and pressure-like, worsening in the morning, aligns with tension headache characteristics.
• Other Likely Diagnoses
  • Anxiety or Panic Disorder: The patient's symptoms of lightheadedness and blurred vision, especially in the context of significant stress, could be indicative of anxiety or panic attacks. The ongoing stress from his family situation could trigger or exacerbate these conditions.
  • Hypertension: The patient's symptoms, including headache and lightheadedness, could be related to undiagnosed or uncontrolled hypertension, especially considering the potential for stress to elevate blood pressure.
  • Sleep Disturbances: The patient mentions his headache is worse in the morning, which could suggest sleep disturbances, possibly related to his stress and new family situation, contributing to his symptoms.
• Do Not Miss Diagnoses
  • Subarachnoid Hemorrhage or Other Intracranial Bleeds: Although the patient denies head injury, the sudden onset of severe headache (possibly described as "persistent" over two weeks but could have acute exacerbations), lightheadedness, and visual disturbances necessitates consideration of intracranial hemorrhage, which is a medical emergency.
  • Transient Ischemic Attack (TIA) or Stroke: The transient nature of the patient's visual loss and lightheadedness could indicate a TIA, which is a precursor to a potential stroke. Given the patient's age and stress levels, vascular events should be considered.
  • Postural Orthostatic Tachycardia Syndrome (POTS): This condition, characterized by a rapid increase in heart rate upon standing, could explain the lightheadedness and is often seen in individuals under significant stress.
• Rare Diagnoses
  • Temporal Arteritis: Although less common, given the patient's age, temporal arteritis (giant cell arteritis) could be a consideration, especially if the headache is accompanied by other symptoms like jaw claudication or visual disturbances.
  • Pheochromocytoma: A rare tumor of the adrenal gland that could cause episodic hypertension, leading to headaches, lightheadedness, and visual disturbances, especially in the context of significant stress triggering episodes.

Each of these diagnoses should be considered in the context of the patient's full medical history, physical examination, and appropriate diagnostic testing to determine the underlying cause of his symptoms.