Differential Diagnosis of Worst Headache of Life
The differential diagnosis for the worst headache of life, also known as a "thunderclap headache," is broad and includes various conditions that require immediate medical attention. The following categories help organize the potential diagnoses:
Single Most Likely Diagnosis
- Subarachnoid hemorrhage (SAH): This is often considered the most likely diagnosis for a thunderclap headache due to its severity and the sudden onset of symptoms. SAH is a life-threatening condition that requires immediate medical intervention.
Other Likely Diagnoses
- Migraine: Although migraines can cause severe headaches, they typically have a more gradual onset and are accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound.
- Cluster headache: Cluster headaches are extremely painful and occur in cyclical patterns, but they usually have a shorter duration than SAH and are accompanied by other symptoms like nasal congestion and eye watering.
- Tension headache: Tension headaches can be severe but are typically less intense than SAH and have a more gradual onset.
- Cervicogenic headache: These headaches originate from the cervical spine and can be severe, but they usually have a more gradual onset and are accompanied by neck pain and stiffness.
Do Not Miss Diagnoses
- Intracranial hemorrhage (ICH): ICH is a life-threatening condition that requires immediate medical attention. It can cause sudden and severe headaches, and missing this diagnosis can be fatal.
- Meningitis: Meningitis is an infection of the meninges that can cause severe headaches, fever, and stiff neck. It requires prompt medical attention to prevent serious complications and death.
- Encephalitis: Encephalitis is an inflammation of the brain that can cause severe headaches, fever, and altered mental status. It requires immediate medical attention to prevent serious complications and death.
- Temporal arteritis: Temporal arteritis is an inflammation of the blood vessels in the head that can cause severe headaches, jaw claudication, and visual disturbances. It requires prompt medical attention to prevent blindness and other complications.
- Pituitary apoplexy: Pituitary apoplexy is a rare but life-threatening condition that occurs when a pituitary tumor suddenly hemorrhages or infarcts. It can cause sudden and severe headaches, visual disturbances, and altered mental status.
Rare Diagnoses
- Venous sinus thrombosis: This is a rare condition that occurs when a blood clot forms in the venous sinuses of the brain. It can cause severe headaches, seizures, and other neurological symptoms.
- Arteriovenous malformation (AVM): AVM is a rare condition that occurs when there is an abnormal connection between arteries and veins in the brain. It can cause severe headaches, seizures, and other neurological symptoms.
- Colloid cyst: A colloid cyst is a rare type of brain tumor that can cause severe headaches, hydrocephalus, and other neurological symptoms.
- Spontaneous intracranial hypotension: This is a rare condition that occurs when there is a spontaneous leak of cerebrospinal fluid, causing severe headaches, nausea, and vomiting.