Differential Diagnosis for 62 yo with New Onset Headache

Single Most Likely Diagnosis

• Tension Headache: This is the most common type of headache and can occur at any age. The timing of the headache (between 4:30 and 6 pm daily) could suggest a pattern related to daily stress or activities, which is consistent with tension headaches.

Other Likely Diagnoses

• Migraine: Although migraines can occur at any time, some people experience them at consistent times of the day, possibly related to hormonal or circadian rhythms. The new onset in a 62-year-old could be related to hormonal changes or other factors.
• Cluster Headache: These are less common but can occur in cycles, sometimes at the same time each day. However, they are typically more severe and accompanied by other symptoms like nasal congestion or eye watering.
• Medication Overuse Headache: If the patient is taking frequent pain medication, this could lead to a pattern of daily headaches, especially if they are taking it around the same time each day.

Do Not Miss Diagnoses

• Giant Cell Arteritis (Temporal Arteritis): This condition is a medical emergency and can cause new onset headaches in older adults. It's crucial to consider this diagnosis due to the risk of vision loss if not promptly treated.
• Subarachnoid Hemorrhage or Other Intracranial Bleeds: Although less likely to present with a daily pattern, any new onset headache, especially in an older adult, warrants consideration of a possible bleed, given the potentially catastrophic consequences.
• Brain Tumor: A new onset headache, particularly if it's worsening over time or accompanied by other neurological symptoms, could indicate a brain tumor. The daily pattern might be related to posture or other factors.

Rare Diagnoses

• Hypnic Headache: A rare condition characterized by headaches that occur at the same time each day, typically waking the patient from sleep. Although the timing in the question doesn't perfectly match the typical presentation, it's an interesting consideration given the daily pattern.
• Cervicogenic Headache: These headaches are referred from the cervical spine and can have a consistent pattern if related to specific activities or postures that occur daily at the same time.
• Trigeminal Neuralgia: While not typically presenting as a headache, this condition involves sudden, severe facial pain and could potentially be confused with or contribute to headache patterns, especially if the pain is referred.