Differential Diagnosis for 40-year-old with Migraine for 4 Days

• Single most likely diagnosis:
  • Migraine with prolonged aura or status migrainosus: This is the most likely diagnosis given the patient's history of migraine and the duration of symptoms. Status migrainosus is a condition where a migraine attack lasts more than 72 hours.
• Other Likely diagnoses:
  • Tension headache: Could be considered if the headache characteristics have changed or if there are signs of muscle tension.
  • Cluster headache: Although less common, cluster headaches can occur in cycles and may be confused with migraines.
  • Medication overuse headache: If the patient is taking frequent pain medication, this could be a contributing factor to the prolonged headache.
• Do Not Miss diagnoses:
  • Subarachnoid hemorrhage: A sudden, severe headache (often described as "the worst headache of my life") could indicate a subarachnoid hemorrhage, which is a medical emergency.
  • Meningitis: Infection of the meninges, which could present with headache, fever, and stiff neck.
  • Temporal arteritis: Especially in patients over 50, but can occur in younger patients, presenting with headache, jaw claudication, and visual disturbances.
  • Brain tumor: Although rare, a brain tumor could cause persistent or worsening headaches.
• Rare diagnoses:
  • Idiopathic intracranial hypertension (IIH): Characterized by increased intracranial pressure without a detectable cause, often presenting with headache and visual disturbances.
  • Cervicogenic headache: Headache referred from the cervical spine, which could be due to various cervical spine disorders.
  • Trigeminal neuralgia: Sudden, severe, shock-like pain around the eyes, lips, or nose, which could be mistaken for a migraine in some cases.