Differential Diagnosis for 72y Male with Headache and Eye Tearing

• Single most likely diagnosis:

  • Cluster headache: This condition is characterized by severe, unilateral headaches that are often accompanied by autonomic symptoms such as tearing of the eye, redness, and nasal congestion on the same side as the headache. The headache typically lasts 15-180 minutes and can occur in clusters or cycles.

• Other Likely diagnoses:

  • Migraine with autonomic features: Migraines can cause severe, unilateral headaches and may be accompanied by autonomic symptoms like tearing and redness of the eye. However, migraines usually last longer than 20 minutes and are often associated with other symptoms like nausea, vomiting, and sensitivity to light and sound.
  • Trigeminal neuralgia: This condition involves sudden, severe, shock-like pain around the eyes, lips, or nose mainly because of abnormal blood vessels pressing on the trigeminal nerve in the head. While it can cause pain in the face and jaw, it typically doesn't cause tearing of the eye.
  • Temporomandibular joint (TMJ) disorder: TMJ disorders can cause pain in the jaw, face, and head, which might radiate to the top of the head. However, tearing of the eye is not a common symptom.

• Do Not Miss diagnoses:

  • Temporal arteritis (Giant Cell Arteritis): This is an inflammation of the blood vessels in the head, which can cause severe headaches, jaw pain, and visual disturbances. If left untreated, it can lead to blindness. Although it's less common, the potential for serious complications makes it a critical diagnosis not to miss.
  • Acute angle-closure glaucoma: This is a medical emergency that causes severe eye pain, blurred vision, headache, and sometimes tearing. It requires immediate treatment to prevent permanent vision loss.
  • Carotid artery dissection: This involves a tear in the carotid artery, which can cause a headache and neck pain, sometimes with neurological symptoms. It's a rare but potentially life-threatening condition.

• Rare diagnoses:

  • SUNCT (Short-lasting Unilateral Neuralgiform headache with Conjunctival injection and Tearing) or SUNA (Short-lasting Unilateral Neuralgiform headache with Autonomic symptoms): These are rare headache disorders characterized by short-lasting, severe, unilateral headaches with autonomic features like tearing and redness of the eye.
  • Paroxysmal hemicrania: This is a rare condition that causes frequent, short-lasting headaches on one side of the head, often accompanied by autonomic symptoms. It's similar to cluster headaches but occurs more frequently throughout the day.