Differential Diagnosis
Given the uncertainty and lack of a definitive answer, considering various possibilities is essential. Here's a structured approach to the differential diagnosis:
Single Most Likely Diagnosis
- Migraine: This is considered due to the mention of it in the question and the fact that migraines can be challenging to diagnose definitively, often relying on clinical presentation and exclusion of other causes. The symptoms of migraines can vary widely and may not always include the classic aura and headache phases, making diagnosis tricky.
Other Likely Diagnoses
- Tension Headache: Common and can present with varying degrees of severity and frequency, sometimes mimicking migraine symptoms.
- Cluster Headache: Although less common, cluster headaches can be very severe and may not fit the typical migraine pattern, leading to diagnostic uncertainty.
- Sinus Headache: Often presents with facial pain and pressure, which could be confused with migraine or other headache types without proper diagnostic workup.
Do Not Miss Diagnoses
- Subarachnoid Hemorrhage: A life-threatening condition that requires immediate medical attention. Although unlikely, the sudden onset of a severe headache (often described as "the worst headache" ever) warrants consideration of this diagnosis.
- Temporal Arteritis: Particularly in older adults, this condition can cause severe headaches and visual disturbances. Missing this diagnosis can lead to serious complications, including blindness.
- Brain Tumor: Although rare, a brain tumor can cause headaches that may mimic migraines. The presence of other neurological symptoms or signs would increase suspicion.
Rare Diagnoses
- Trigeminal Neuralgia: Characterized by intense pain along a branch of the trigeminal nerve, which could be mistaken for migraine or cluster headaches due to its severe and episodic nature.
- Hypnic Headache: A rare headache disorder that occurs exclusively during sleep, which might be considered if the patient experiences headaches waking them up.
- New Daily Persistent Headache (NDPH): A rare condition where a headache starts suddenly and persists daily for more than three months, which could be a consideration in the differential diagnosis due to its chronic nature.