Differential Diagnosis
The patient's symptoms of daily episodes, triggered by cold temperatures, poor sleep, and exercise, accompanied by cold hands and feet, suggest a complex condition. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Migraine: The patient's symptoms, such as daily episodes peaking at specific times, cold sensitivity, and triggers like poor sleep and exercise, are consistent with migraine. The accompanying cold hands and feet could be related to vasospasm, a common feature in migraine.
- Other Likely diagnoses
- Cluster headache: Although less common, cluster headaches can be triggered by cold temperatures and occur at specific times of the day. However, they typically don't have the same level of cold sensitivity as described.
- Trigeminal autonomic cephalalgia (TAC): TACs, including cluster headaches and paroxysmal hemicrania, can have similar triggers and accompanying symptoms like cold hands and feet.
- Hypnic headache: These headaches occur at the same time daily, often in the early morning or evening, and can be triggered by sleep patterns.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Temporal arteritis: Although less likely given the patient's age and symptom duration, temporal arteritis can cause headaches, jaw claudication, and visual disturbances. It's essential to rule out this condition due to its potential for serious complications, such as blindness.
- Secondary headache due to underlying conditions (e.g., hypertension, sleep apnea, or anemia): These conditions can cause headaches and should be considered, especially if the patient has a history of underlying medical conditions.
- Rare diagnoses
- Cold stimulus headache (cold stimulus headache or "ice cream headache"): This rare condition is characterized by headaches triggered by cold temperatures or substances.
- Primary cold headache: A rare condition where headaches are triggered by cold temperatures, but without other migraine features.
- Erythromelalgia: A disorder characterized by burning pain, heat, and redness in the hands and feet, which could be related to the patient's cold hands and feet symptoms.