Differential Diagnosis for Headache with Sensation of Fluids in the Skull

• Single most likely diagnosis:
  • Migraine: This condition is characterized by recurrent episodes of severe headaches, often accompanied by sensitivity to light, sound, or smells, and can include a sensation of fluid movement or pressure in the head due to the dilation and constriction of blood vessels.
• Other Likely diagnoses:
  • Tension Headache: Although typically less severe than migraines, tension headaches can cause a band-like pressure around the head and might be perceived as a fluid sensation, especially if the individual is highly sensitive to their bodily sensations.
  • Sinusitis: Inflammation of the sinuses can cause headaches and a sensation of fullness or fluid in the head, particularly in the forehead, cheeks, and nose area.
  • Benign Paroxysmal Positional Vertigo (BPPV): While primarily associated with vertigo, BPPV can cause a sensation of movement or fluid shift in the head when changing positions, which might be misinterpreted as fluid in the skull.
• Do Not Miss diagnoses:
  • Subarachnoid Hemorrhage: A life-threatening condition where there is bleeding into the space surrounding the brain, which can cause a sudden, severe headache and might be accompanied by a sensation of fluid or pressure in the head.
  • Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, which can cause severe headache, fever, and a stiff neck, and might be perceived as having fluid in the skull due to increased intracranial pressure.
  • Brain Tumor: Although rare, a tumor in the brain can cause increased intracranial pressure, leading to headaches and potentially a sensation of fluid or pressure, especially if the tumor obstructs the normal flow of cerebrospinal fluid.
• Rare diagnoses:
  • Chiari Malformation: A structural defect in the cerebellum that controls balance, which can cause headaches and a sensation of fluid movement, especially with changes in posture.
  • Pseudotumor Cerebri (Idiopathic Intracranial Hypertension): A condition characterized by increased pressure within the skull without any apparent cause, leading to headaches that can be severe and might include sensations of fluid or pressure in the head.
  • Arachnoid Cyst: A rare condition where a fluid-filled sac forms between the brain or spinal cord and the arachnoid membrane, which can cause headaches and a sensation of fluid in the skull, depending on its location and size.