Differential Diagnosis for Sudden Acute Headache while Exercising
Single Most Likely Diagnosis
- Exertional headache: This is the most likely diagnosis due to the direct correlation between physical exertion and the onset of headache. Exertional headaches are typically benign and related to the physical strain of exercise.
Other Likely Diagnoses
- Migraine: Migraines can be triggered by physical activity and are characterized by severe, throbbing headaches, often accompanied by other symptoms like nausea, vomiting, and sensitivity to light and sound.
- Tension headache: Although less likely to be sudden and severe, tension headaches can occur during or after exercise due to muscle strain or tension.
- Dehydration headache: Exercising without adequate hydration can lead to dehydration, which may cause headaches.
Do Not Miss Diagnoses
- Subarachnoid hemorrhage: A sudden, severe headache (often described as "the worst headache of my life") could be indicative of a subarachnoid hemorrhage, which is a life-threatening condition requiring immediate medical attention.
- Stroke: While less common, a sudden headache during exercise could be a symptom of a stroke, especially if accompanied by other signs like weakness, confusion, or difficulty speaking.
- Temporal arteritis: Although more common in older adults, temporal arteritis can cause sudden, severe headaches and is a medical emergency due to the risk of vision loss.
Rare Diagnoses
- Pituitary apoplexy: A rare condition where a pituitary tumor suddenly hemorrhages or infarcts, leading to a severe headache, often with visual disturbances and acute hormonal deficiencies.
- Colloid cyst: A rare brain cyst that can cause obstructive hydrocephalus, leading to sudden, severe headaches, especially with changes in posture or exertion.
- Arteriovenous malformation (AVM): A rare condition where there's an abnormal connection between arteries and veins in the brain, which can cause sudden, severe headaches, especially if it ruptures.