Differential Diagnosis for Headache

Based on the description of the pain being between a burning and a sharp pain, with pressure on one side of the head, the following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Migraine: This is often characterized by unilateral, throbbing, or pulsating pain, which can sometimes be described as sharp or burning. The pressure on one side of the head aligns with migraine symptoms, which can also include sensitivity to light, sound, or nausea.
• Other Likely Diagnoses
  • Tension Headache: While typically bilateral, tension headaches can sometimes present unilaterally and are characterized by a pressing or tightening sensation, which might fit the description of pressure on one side of the head.
  • Cluster Headache: Known for severe, unilateral pain often described as burning or piercing, usually around the eye. The pain can be so severe it's often described in extreme terms, which might align with the burning/sharp pain description.
  • Sinusitis: Given the mention of sinuses, sinusitis is a consideration, especially if the pain is in the facial area, including the cheeks and forehead, and is accompanied by other symptoms like nasal congestion or fever.
• Do Not Miss Diagnoses
  • Subarachnoid Hemorrhage: A severe, sudden headache (often described as "the worst headache of my life") could be indicative of a subarachnoid hemorrhage, a life-threatening condition requiring immediate medical attention.
  • Temporal Arteritis: This condition, more common in older adults, involves inflammation of the blood vessels and can cause severe, unilateral headaches, along with other symptoms like jaw claudication or visual disturbances.
  • Brain Tumor: Although rare, a brain tumor could cause headaches that are worse in the morning, worsen over time, or are accompanied by other neurological symptoms like seizures, confusion, or weakness.
• Rare Diagnoses
  • Trigeminal Neuralgia: Characterized by sudden, severe, shock-like or stabbing pain around the eyes, lips, or nose mainly because of abnormal blood vessels pressing on the trigeminal nerve in the head.
  • Occipital Neuralgia: Involves inflammation or irritation of the occipital nerves, which can cause severe, sharp, or stabbing pain in the back and side of the head, often accompanied by sensitivity to light.

Each of these diagnoses should be considered in the context of the patient's full medical history, physical examination, and potentially, further diagnostic testing to determine the underlying cause of the headache.