Differential Diagnosis for Frontal Headaches

The patient's symptoms of occasional frontal headaches for the last 2 decades, exacerbated by beer consumption and heat, suggest several potential diagnoses. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Migraines: Given the long history of headaches, their frontal location, and triggers such as alcohol (beer) and heat, migraines are a strong consideration. Migraines can be episodic, lasting from hours to days, and are often unilateral but can be bilateral, including frontal headaches.

• Other Likely Diagnoses

  • Tension-Type Headaches: These are common and can be triggered by various factors, including stress, alcohol, and environmental changes. They often present as bilateral, frontal, or occipital headaches.
  • Cluster Headaches: Although less common, cluster headaches can occur in cycles and are typically unilateral and centered around the eye. However, some patients may experience bilateral or frontal pain. Triggers can include alcohol and heat.
  • Sinusitis: Frontal headaches can be a symptom of sinusitis, especially if the patient experiences other symptoms like facial pain, nasal congestion, or fever.

• Do Not Miss Diagnoses

  • Subarachnoid Hemorrhage: Although rare, a sudden, severe headache (often described as "the worst headache of my life") could indicate a subarachnoid hemorrhage, especially if accompanied by other symptoms like vomiting, seizures, or loss of consciousness.
  • Temporal Arteritis: This condition, more common in older adults, can cause headaches, often unilateral and temporal, but can be frontal. It's crucial to consider due to the risk of vision loss if not promptly treated.
  • Brain Tumor: A new onset of headaches or a change in headache pattern could be indicative of a brain tumor, especially if accompanied by other neurological symptoms like seizures, confusion, or focal neurological deficits.

• Rare Diagnoses

  • Trigeminal Neuralgia: Characterized by sudden, severe, shock-like pain around the eyes, lips, or nose, typically on one side of the face. It's less likely given the description of frontal headaches but could be considered if the pain has a specific, shock-like quality.
  • Hypnic Headache: A rare condition causing headaches that only occur during sleep and wake the patient, often described as dull and bilateral, including frontal.
  • Hemicrania Continua: A rare headache disorder characterized by a continuous, often unilateral headache with periods of exacerbation, sometimes accompanied by autonomic symptoms like nasal congestion or eye watering.