Differential Diagnosis for Headaches

• Single Most Likely Diagnosis
  • Tension headache: This is the most common type of headache and is often described as a band or a squeezing sensation around the forehead, usually accompanied by muscle tension in the neck and scalp. The high prevalence of tension headaches in the general population makes it the single most likely diagnosis for headaches.
• Other Likely Diagnoses
  • Migraine: Characterized by severe, unilateral, throbbing headaches often accompanied by nausea, vomiting, and sensitivity to light and sound. Migraines are common and can be triggered by various factors, including stress, certain foods, and hormonal changes.
  • Sinus headache: Caused by inflammation or infection of the sinuses, leading to pain and pressure in the face and head. This diagnosis is likely if the headache is accompanied by other symptoms such as nasal congestion, facial pain, and fever.
  • Cluster headache: Known for severe, unilateral orbital or periorbital pain, often accompanied by autonomic symptoms like lacrimation and nasal congestion. Although less common than migraines or tension headaches, cluster headaches are distinctive and can be very debilitating.
• Do Not Miss Diagnoses
  • Subarachnoid hemorrhage: A life-threatening condition caused by bleeding into the space surrounding the brain, leading to a sudden, severe headache often described as "the worst headache of my life." Early diagnosis is crucial for survival and recovery.
  • Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, which can be caused by infection. Symptoms include severe headache, fever, and stiff neck. Prompt treatment is necessary to prevent serious complications.
  • Temporal arteritis: Inflammation of the blood vessels in the head, which can lead to blindness if not treated promptly. It typically affects older adults and is characterized by headache, jaw claudication, and visual disturbances.
  • Brain tumor: Although rare, a brain tumor can cause headaches due to increased intracranial pressure. Other symptoms may include seizures, focal neurological deficits, and changes in personality or cognitive function.
• Rare Diagnoses
  • Trigeminal neuralgia: A chronic pain condition that affects the trigeminal nerve, causing intense shock-like or stabbing pain in parts of the face. It's relatively rare and can be mistaken for other conditions like dental problems or sinusitis.
  • Hypnic headache: A rare type of headache that occurs only during sleep and wakes the patient up, typically in older adults. The cause is unknown, and it's diagnosed based on the unique timing of the headache.
  • Thunderclap headache: An extremely severe headache that reaches its maximum intensity within a minute, often described as "the worst headache of my life." It can be a symptom of subarachnoid hemorrhage but also has other, less common causes.