Differential Diagnosis for Central Vision Loss, Dizziness, Nausea, Upper Neck Pain, and Back of Head Hurts

• Single Most Likely Diagnosis
  • Migraine: This condition is characterized by episodes of severe headaches, often accompanied by sensitivity to light, sound, or smells, and can include symptoms like dizziness, nausea, and visual disturbances including central vision loss. The upper neck pain and pain at the back of the head could be part of the migraine syndrome.
• Other Likely Diagnoses
  • Cervicogenic Headache: This type of headache is caused by referred pain from the cervical spine and can include symptoms like dizziness, nausea, and pain in the upper neck and back of the head. Central vision loss could be related to tension or strain on the neck muscles.
  • Benign Paroxysmal Positional Vertigo (BPPV): Although BPPV primarily causes vertigo, it can also lead to nausea and dizziness. The upper neck pain and pain at the back of the head might not be directly related but could be coincidental or part of a broader musculoskeletal issue.
  • Tension Headache: While typically not causing central vision loss, severe tension headaches can lead to a wide range of symptoms including dizziness, nausea, and significant pain in the neck and back of the head.
• Do Not Miss Diagnoses
  • Subarachnoid Hemorrhage: A life-threatening condition that requires immediate medical attention. Although it typically presents with a sudden, severe headache, it can also cause nausea, vomiting, and sometimes visual disturbances due to increased intracranial pressure.
  • Stroke or Transient Ischemic Attack (TIA): Central vision loss, especially if sudden, could be a symptom of a stroke affecting the visual pathways. Dizziness and nausea can also occur. Immediate medical evaluation is crucial.
  • Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, which can cause severe headache, fever, nausea, and sometimes visual disturbances. The neck pain could be due to meningismus (stiff neck).
• Rare Diagnoses
  • Multiple Sclerosis: An autoimmune disease that can affect various parts of the brain and spinal cord, leading to a wide range of symptoms including vision problems, dizziness, and pain. Central vision loss could be due to optic neuritis, a common presentation of MS.
  • Chiari Malformation: A structural defect in the cerebellum that controls balance, which can cause dizziness, nausea, and headaches. Vision problems, including central vision loss, can occur due to increased intracranial pressure or direct compression of the brainstem.
  • Occipital Neuralgia: Involves the nerves that run from the upper neck to the scalp and can cause pain at the back of the head, which might be accompanied by visual disturbances, dizziness, and nausea in some cases.