What is the diagnosis for a patient with bilateral parietal headaches, fatigue, and photophobia (sensitivity to screens), currently being treated for anxiety with escitalopram (escitalopram) 20 milligrams (mg) once daily (OD)?

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Differential Diagnosis

  • Single most likely diagnosis
    • Tension headache: This is the most likely diagnosis given the patient's symptoms of bilateral parietal headaches, tiredness, and eye strain from screens. Tension headaches are often associated with anxiety, which the patient has been diagnosed with, and can be exacerbated by stress and screen time.
  • Other Likely diagnoses
    • Dry eye syndrome: The patient's complaint of eye hurt from screens could be indicative of dry eye syndrome, which is a common condition that can cause eye discomfort and fatigue.
    • Migraine: Although the patient's headaches are bilateral, some migraines can present without the typical unilateral pain, and the sensitivity to screens could be a trigger.
    • Eye strain: Prolonged screen time can cause eye strain, which may contribute to the patient's headaches and eye discomfort.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Subarachnoid hemorrhage: Although unlikely, a sudden and severe headache could be indicative of a subarachnoid hemorrhage, which is a medical emergency.
    • Temporal arteritis: This condition can cause headaches, eye pain, and vision changes, and is a medical emergency if not treated promptly.
    • Brain tumor: A brain tumor could cause headaches, fatigue, and vision changes, and would require prompt medical attention.
  • Rare diagnoses
    • Idiopathic intracranial hypertension: This condition can cause headaches, vision changes, and eye pain, and is often associated with obesity and other factors.
    • Optic neuritis: This condition can cause eye pain, vision changes, and headaches, and is often associated with multiple sclerosis or other autoimmune disorders.
    • Hypothyroidism: Some patients with hypothyroidism may experience headaches, fatigue, and eye symptoms, although this is less common.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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