Differential Diagnosis for 11 Days of Severe Headache in a 59-Year-Old Female
Single Most Likely Diagnosis
- Tension-Type Headache or Migraine: Given the waxing and waning nature of the headache and the fact that it's not responsive to conservative treatment, a primary headache disorder such as tension-type headache or migraine is a strong consideration. The age and gender of the patient also align with these diagnoses.
Other Likely Diagnoses
- Temporal Arteritis (Giant Cell Arteritis): This condition is more common in older adults and can cause severe, persistent headaches. The waxing and waning nature could be due to the variability in inflammation.
- Sinusitis: Chronic or recurrent sinusitis could cause severe headaches that worsen over time, especially if not adequately treated.
- Cervicogenic Headache: Referral of pain from the cervical spine to the head could cause severe, persistent headaches, especially if there's an underlying cervical spine condition.
Do Not Miss Diagnoses
- Subarachnoid Hemorrhage: Although less likely given the duration, a subarachnoid hemorrhage can present with a severe headache that may wax and wane if there are intermittent bleeds or rebleeds.
- Meningitis: Infection of the meninges can cause severe headache, and while the presentation is typically more acute, some forms (like chronic meningitis) can have a more prolonged course.
- Brain Tumor: A tumor in the brain could cause increased intracranial pressure, leading to severe, persistent headaches that may worsen over time.
- Stroke or Transient Ischemic Attack (TIA): Certain types of stroke, like a hemorrhagic stroke, or repeated TIAs could cause severe, intermittent headaches.
Rare Diagnoses
- Trigeminal Neuralgia: While typically characterized by sharp, stabbing pains in the face, in rare cases, it could present with headache-like symptoms.
- Hypnic Headache: A rare primary headache disorder that occurs exclusively during sleep and wakes the patient, though it's less likely given the description of waxing and waning throughout the day.
- New Daily Persistent Headache (NDPH): A rare headache disorder characterized by a headache that is continuous from its onset, though the waxing and waning nature described might not perfectly fit this diagnosis.