Differential Diagnosis for Headache and Inability to Open Eyes while Driving

• Single most likely diagnosis:
  • Migraine with aura: This condition is characterized by severe headaches often accompanied by neurological symptoms such as visual disturbances, which could explain the inability to open eyes due to pain or photophobia.
• Other Likely diagnoses:
  • Tension headache: Although typically less severe than migraines, severe tension headaches can cause significant discomfort and sensitivity to light, potentially making it difficult to open eyes.
  • Cluster headache: Known for their extreme pain, cluster headaches can occur with autonomic symptoms like ptosis (drooping eyelid), which might be perceived as an inability to open the eyes.
  • Sinus headache: Inflammation and pressure in the sinuses can cause pain that radiates to the eyes, potentially leading to discomfort when opening them.
• Do Not Miss diagnoses:
  • Subarachnoid hemorrhage: A life-threatening condition where bleeding occurs in the space surrounding the brain, often presenting with a sudden, severe headache (thunderclap headache) and potentially affecting eye movement or causing photophobia.
  • Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, which can cause severe headache, photophobia, and in severe cases, neurological deficits.
  • Temporal arteritis: An inflammation of the blood vessels in the head, which can cause severe headache, visual disturbances, and even blindness if not promptly treated.
• Rare diagnoses:
  • Ophthalmoplegic migraine: A rare condition characterized by recurrent episodes of migraine headache accompanied by paresis of one or more ocular cranial nerves, which could result in difficulty opening the eyes.
  • Idiopathic intracranial hypertension (IIH): Also known as pseudotumor cerebri, this condition involves increased pressure within the skull without any apparent cause, leading to symptoms like headache and vision changes, including transient vision obscurations that might be mistaken for an inability to open the eyes.