Differential Diagnosis
- Single most likely diagnosis
- C. Tension headache: This is the most likely diagnosis due to the description of the headache as a bilateral, constricting sensation that feels like it's compressing the skull, and tenderness to palpation around the temples and occipital region. The lack of nausea, vomiting, auras, and other neurological symptoms also supports this diagnosis.
- Other Likely diagnoses
- A. Migraine headache: Although the patient denies nausea and vomiting, some migraines can be without these symptoms. The frequency and duration of the headaches could also be consistent with migraines. However, the absence of auras, eye pain, and other typical migraine features makes it less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- D. Subarachnoid hemorrhage: Although the patient's presentation does not strongly suggest a subarachnoid hemorrhage (e.g., no sudden, severe headache, no trauma, no neurological deficits), it is a potentially life-threatening condition that must be considered, especially given the patient's hypertension.
- Other possibilities in this category could include: temporal arteritis, meningitis, or brain tumor, although these are not directly suggested by the patient's symptoms.
- Rare diagnoses
- B. Cluster headache: This diagnosis is less likely due to the lack of characteristic symptoms such as severe, unilateral orbital or periorbital pain, accompanied by eye pain, excess tearing, or a runny nose on the same side as the headache.
- Other rare possibilities: could include headaches secondary to fibroids (if they were to cause a mass effect), or other less common headache disorders, but these would be speculative without further evidence.