Differential Diagnosis for a 66 year-old patient with left sided temple, throbbing and dizziness
- Single most likely diagnosis
- Migraine: This is a common condition characterized by throbbing headaches, often unilateral, and can be accompanied by dizziness. The absence of sensitivity issues, pain with chewing, fever, and vomiting reduces the likelihood of other conditions but fits with migraine, especially given the description of the headache as throbbing.
- Other Likely diagnoses
- Tension headache: Although typically bilateral, tension headaches can occasionally present unilaterally and might be accompanied by dizziness, especially if the patient is experiencing significant stress or anxiety.
- Temporomandibular joint (TMJ) disorder: Despite the absence of pain with chewing, some patients with TMJ disorders may experience referred pain to the temple area and could potentially have dizziness due to the close anatomical relationship between the TMJ and the inner ear structures.
- Benign paroxysmal positional vertigo (BPPV): This condition primarily causes dizziness but can be accompanied by headaches. The dizziness in BPPV is typically positional, which might not be explicitly mentioned but could be considered if the patient's dizziness is triggered or worsened by specific head movements.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Giant Cell Arteritis (GCA): Although less common, GCA is a critical diagnosis to consider in older adults presenting with new-onset headaches, especially if they are unilateral and throbbing. The absence of jaw claudication or visual symptoms does not rule out GCA, and it can be deadly if missed due to the risk of blindness and aortic aneurysm.
- Stroke or Transient Ischemic Attack (TIA): While the presentation might not be typical, stroke or TIA can sometimes manifest with headache and dizziness. Given the potential for severe consequences, these diagnoses must always be considered, especially in older patients.
- Temporal lobe seizure: Seizures can manifest with a variety of symptoms, including headaches and dizziness, and are crucial to diagnose due to their implications for driving, work, and overall management.
- Rare diagnoses
- Trigeminal neuralgia: Typically presents with sharp, stabbing pains in the face, but could potentially cause referred pain to the temple area and might be accompanied by dizziness in rare cases.
- Occipital neuralgia: Involves the nerves at the base of the skull and can cause pain that feels like it's coming from the back and top of the head, potentially radiating to the temple area, and could be associated with dizziness.
- Cervicogenic headache: Originates from the cervical spine and can refer pain to the temple area, potentially accompanied by dizziness if there's an associated cervical spine issue affecting balance.