Differential Diagnosis for Patient's Headaches

The patient presents with daily headaches, at least 5 days a week, for about a month, accompanied by light and noise sensitivity but no visual changes. The patient has tried various over-the-counter medications with little improvement and has recently quit smoking cigarettes and marijuana.

• Single Most Likely Diagnosis
  • Tension-Type Headaches: This is the most likely diagnosis given the frequency and duration of the headaches, the presence of light and noise sensitivity, and the lack of visual changes. The recent cessation of smoking and marijuana could contribute to the worsening of headache symptoms due to withdrawal effects or increased stress.
• Other Likely Diagnoses
  • Medication Overuse Headaches: Given the patient's use of Tylenol and Excedrin with little improvement, there's a possibility that the patient is experiencing medication overuse headaches, which can occur when pain relievers are taken too frequently.
  • Migraines: Although the patient mentions no visual changes, some migraines can occur without aura. The presence of light and noise sensitivity is consistent with migraines.
  • Stress-Related Headaches: The recent lifestyle change of quitting smoking and marijuana could be a source of stress, potentially contributing to the development of stress-related headaches.
• Do Not Miss Diagnoses
  • Subarachnoid Hemorrhage: Although unlikely given the chronic nature of the headaches, it's crucial to consider this diagnosis due to its severe consequences. However, the lack of sudden onset, severe headache, or other neurological deficits makes this less likely.
  • Temporal Arteritis: This condition is more common in older adults but can present with headaches and sensitivity to light. It's essential to rule out this condition due to the risk of vision loss if left untreated.
  • Brain Tumor: A brain tumor could cause increased intracranial pressure leading to headaches, but the absence of other neurological symptoms, visual changes, or a worsening pattern over time makes this less likely.
• Rare Diagnoses
  • Chiari Malformation: A structural defect in the cerebellum that can cause headaches, especially with coughing or straining. However, this would typically be associated with other neurological symptoms.
  • Idiopathic Intracranial Hypertension: Characterized by increased intracranial pressure without a detectable cause, often presenting with headaches and visual disturbances. The patient's lack of visual changes and the absence of other typical symptoms (such as papilledema) make this diagnosis less likely.