Differential Diagnosis for Bilateral Temporal Headache

• Single most likely diagnosis
  • Migraine: The patient's symptoms of bilateral temporal headache, dizziness, nausea, and improvement with Reglan (metoclopramide), Benadryl (diphenhydramine), and Toradol (ketorolac) are consistent with a migraine headache. The patient's history of similar episodes in the past also supports this diagnosis.
• Other Likely diagnoses
  • Tension headache: Although the patient's symptoms improved with medications typically used for migraines, the bilateral temporal location of the headache could also be consistent with a tension headache.
  • Hypertensive headache: The patient's history of hypertension and missed medication dose could contribute to a hypertensive headache, although the lack of severely elevated blood pressure readings makes this less likely.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Subarachnoid hemorrhage: Although the head CT showed stable findings, it is essential to consider subarachnoid hemorrhage in any patient presenting with a sudden-onset headache, even if the CT is negative, as some cases may not be visible on initial imaging.
  • Posterior reversible encephalopathy syndrome (PRES): Given the patient's history of hypertension, it is crucial to consider PRES, especially if the patient's blood pressure was severely elevated at any point.
  • Temporal arteritis: Although less likely in a younger patient, temporal arteritis can cause headaches and should be considered, especially if the patient has other symptoms such as jaw claudication or visual disturbances.
• Rare diagnoses
  • Idiopathic intracranial hypertension: This condition can cause headaches and should be considered, especially in obese patients, although it is less likely given the lack of other symptoms such as papilledema or visual disturbances.
  • Cervicogenic headache: Although less common, cervicogenic headaches can cause bilateral temporal pain and should be considered, especially if the patient has a history of neck trauma or strain.