Differential Diagnosis for Headache with Dizziness when Bending Forward

Single Most Likely Diagnosis

• Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, intense episodes of vertigo triggered by specific head movements, such as bending forward. The symptoms can also include headache due to the discomfort and tension associated with the vertigo.

Other Likely Diagnoses

• Cervicogenic Headache: This type of headache is caused by referred pain from the cervical spine. Bending forward can exacerbate the pain and cause dizziness due to the mechanical stress on the neck.
• Tension Headache: Tension headaches can be triggered or worsened by bending forward, especially if the individual has poor posture or muscle tension in the neck and scalp. Dizziness may accompany the headache due to muscle strain or tension.
• Sinusitis: Sinus infections can cause headaches and dizziness, especially when bending forward, as this position can increase pressure in the sinuses.

Do Not Miss Diagnoses

• Subarachnoid Hemorrhage: Although less common, a sudden, severe headache (often described as "the worst headache of my life") accompanied by dizziness when bending forward could be indicative of a subarachnoid hemorrhage, which is a life-threatening condition requiring immediate medical attention.
• Brain Tumor: A brain tumor could cause increased intracranial pressure, leading to headaches that worsen with certain positions, including bending forward. Dizziness could also be present due to the tumor's effect on balance centers in the brain.
• Chiari Malformation: This condition involves the cerebellum extending into the spinal canal, which can cause headaches and dizziness, especially with certain head movements or positions like bending forward.

Rare Diagnoses

• Vestibular Migraine: A less common condition that involves vertigo and headache, which can be triggered by specific movements or positions, including bending forward.
• Orthostatic Hypotension: Although more commonly associated with standing up, in some cases, bending forward could precipitate a drop in blood pressure, leading to dizziness and potentially headache.
• Temporal Arteritis: This inflammatory condition of the blood vessels can cause headaches and, less commonly, dizziness, especially in older adults. Bending forward might exacerbate the symptoms due to increased blood vessel tension.