Differential Diagnosis for Pain Along Forehead in a 44-year-old Male with Stress and History of HSV Oral Sores

• Single Most Likely Diagnosis
  • Tension Headache: This is the most likely diagnosis given the patient's stress and the location of the pain along the forehead. Tension headaches are often described as a band or a squeezing sensation around the forehead, usually associated with stress.
• Other Likely Diagnoses
  • Migraine: Although migraines can present with unilateral pain, they can also be bilateral and may involve the forehead. The stress could be a trigger, and the history of HSV oral sores might not be directly related but could indicate a predisposition to recurrent pain conditions.
  • Sinusitis: Given the location of the pain along the forehead, sinusitis, especially frontal sinusitis, could be a consideration. However, other symptoms such as nasal congestion, facial pressure, and fever would typically accompany sinusitis.
  • Herpes Zoster (if the pain is unilateral and in a dermatomal distribution): Although less likely given the description, if the pain is confined to one side of the forehead and follows a dermatomal pattern, herpes zoster (shingles) could be considered, especially if the patient has a history of varicella-zoster virus infection.
• Do Not Miss Diagnoses
  • Temporal Arteritis: This condition, although rare, is critical not to miss due to the risk of vision loss. It typically presents with unilateral headache, often in the temporal region, but can radiate to the forehead. Jaw claudication and visual symptoms are red flags.
  • Subarachnoid Hemorrhage or Other Intracranial Hemorrhages: A sudden, severe headache (often described as "the worst headache of my life") could indicate a subarachnoid hemorrhage or another type of intracranial hemorrhage. Although the history provided does not strongly suggest this, any new, severe headache warrants consideration of these life-threatening conditions.
• Rare Diagnoses
  • 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. It's less likely given the description of pain along the forehead but could be considered if the pain is severe and shock-like.
  • Occipital Neuralgia: Involves pain in the upper neck, back of the head, and behind the eyes, which could potentially radiate to the forehead. It's characterized by sharp, stabbing, or electric shock-like pain.