Differential Diagnosis for Seizure and Headache in a 13-year-old
Single Most Likely Diagnosis
- Migraine with aura: This condition is common in adolescents and can present with headache and seizure-like symptoms, such as visual or sensory auras. The seizure-like activity in migraine is usually not a true seizure but can be concerning.
Other Likely Diagnoses
- Epilepsy: A condition characterized by recurrent seizures, which can be accompanied by headaches. The type of epilepsy and the seizure focus can influence the likelihood of headache as a symptom.
- Post-traumatic headache and seizure: If the patient has a history of head trauma, this could be a likely diagnosis, especially if the headache and seizure are new onset after the injury.
- Infection (e.g., meningitis, encephalitis): Although less common, infections of the central nervous system can cause both headache and seizure, especially if the infection is severe or involves areas of the brain that control seizure activity.
Do Not Miss Diagnoses
- Subarachnoid hemorrhage: A life-threatening condition that can cause sudden, severe headache (often described as "the worst headache of my life") and can be accompanied by seizure. It is crucial to identify and treat promptly.
- Brain tumor: Although rare, brain tumors can cause both headache and seizure, especially if they are located in areas that affect seizure control or increase intracranial pressure.
- Arteriovenous malformation (AVM): An AVM can cause seizures and headaches due to the abnormal blood vessels in the brain, which can rupture and lead to severe consequences if not identified and treated.
Rare Diagnoses
- Mitochondrial disorders: Conditions like MELAS syndrome (Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes) can present with seizures, headaches, and other neurological symptoms, but are relatively rare.
- Autoimmune encephalitis: A rare condition where the immune system attacks the brain, leading to symptoms that can include seizures and headaches, among others.
- Cerebral vasculitis: Inflammation of the blood vessels in the brain, which can cause a variety of symptoms including headache and seizure, but is uncommon in adolescents without a underlying condition.