Differential Diagnosis for 80 yo with Occipital Headaches
Single Most Likely Diagnosis
- Cervicogenic Headache: This condition is characterized by headaches that are referred from the cervical spine, often exacerbated by specific neck movements or positions, such as leaning back or laying down. The patient's age and the nature of the headache suggest a mechanical origin, making cervicogenic headache a plausible diagnosis.
Other Likely Diagnoses
- Tension-Type Headache: Although more common in younger populations, tension-type headaches can occur at any age and may be exacerbated by certain positions, including leaning back or laying down, due to increased muscle tension in the neck and scalp.
- Occipital Neuralgia: This condition involves inflammation or irritation of the occipital nerves, leading to pain in the occipital region. It can be exacerbated by certain head or neck positions and may be more common in older adults due to degenerative changes.
Do Not Miss Diagnoses
- Subarachnoid Hemorrhage: Although less likely given the description, a sudden onset of headache, especially if severe and described as "the worst headache" of their life, warrants immediate consideration of subarachnoid hemorrhage, regardless of the patient's position.
- Giant Cell Arteritis: This condition can cause headaches, often unilateral, and is more common in older adults. While the position-dependent nature of the headache is not typical, giant cell arteritis can lead to serious complications like vision loss if not promptly treated.
- Cervical Spinal Stenosis: This condition can cause neurological symptoms, including pain, numbness, and weakness, which may be exacerbated by certain positions due to compression of the spinal cord or nerve roots.
Rare Diagnoses
- Chiari Malformation: A structural defect in the cerebellum that controls balance, can cause headaches that worsen with certain positions, such as leaning back or laying down, due to increased pressure on the cerebellum and brainstem.
- Paget's Disease: A condition of bone that initially results in the overproduction of bone material, leading to soft and weak bones. It can cause various symptoms, including headaches, if the bones of the skull are affected, though this would be less common and not typically position-dependent.