Differential Diagnosis
- Single most likely diagnosis
- B. Cluster headache: The patient's symptoms of sharp pain behind one eye, accompanied by nausea, vomiting, eye pain, excess tearing, and runny nose, are characteristic of cluster headaches. The episodic nature of the headaches, occurring in clusters or cycles, also supports this diagnosis.
- Other Likely diagnoses
- A. Migraine headache: Although the patient denies sensitivity to noise or light and auras, migraines can present with a variety of symptoms, including sharp pain, nausea, and vomiting. The location of the pain behind one eye could also be consistent with a migraine.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- D. Subarachnoid hemorrhage: Although the patient's symptoms and physical exam do not strongly suggest a subarachnoid hemorrhage, this diagnosis is a medical emergency that requires prompt attention. The sudden onset of a severe headache, often described as "the worst headache of my life," is a classic presentation of subarachnoid hemorrhage.
- Rare diagnoses
- C. Tension headache: While tension headaches are common, the patient's symptoms of sharp pain behind one eye, accompanied by nausea, vomiting, and other autonomic features, are not typical of tension headaches, which are usually characterized by a dull, aching pain.
- Other rare diagnoses, such as temporal arteritis or trigeminal neuralgia, could be considered, but the patient's symptoms and physical exam do not strongly suggest these conditions. Temporal arteritis typically presents with jaw claudication, visual disturbances, and a tender temporal artery, while trigeminal neuralgia is characterized by sudden, severe, shock-like pain in the face.