Differential Diagnosis for Intermittent Sharp Temple Pain with Pain Behind the Eye and Shock Sensation

• Single Most Likely Diagnosis
  • Cluster headache: This condition is characterized by severe, unilateral orbital or periorbital pain, often accompanied by autonomic symptoms such as lacrimation, nasal congestion, or ptosis. The pain can be described as sharp and is typically intermittent, with periods of remission. The shock sensation could be related to the intense, stabbing quality of the pain.
• Other Likely Diagnoses
  • Migraine with aura: Migraines can cause sharp, unilateral pain, including pain behind the eye, and may be accompanied by sensory auras that could be interpreted as a shock sensation. The intermittent nature of migraines fits the described pattern.
  • Trigeminal neuralgia: This condition involves sudden, severe, shock-like pain around the eyes, lips, or nose mainly because of abnormal blood vessels pressing on the trigeminal nerve. The pain is typically unilateral and can be triggered by minor stimuli.
  • Temporal arteritis (Giant Cell Arteritis): While more common in older adults, this condition can cause severe, sharp headaches, often localized to the temples, and can be accompanied by visual disturbances, including pain behind the eye. The shock sensation might be less typical but could be related to the sudden onset of pain.
• Do Not Miss Diagnoses
  • Acute angle-closure glaucoma: This is an ophthalmologic emergency that presents with severe, unilateral eye pain, often described as sharp, and can be accompanied by nausea, vomiting, and visual disturbances, including seeing halos around lights. The pain can radiate to the temple and could be perceived as a shock sensation due to its intensity and sudden onset.
  • Cavernous sinus thrombosis: A rare but potentially life-threatening condition that can cause severe headache, often with pain behind the eye, and can be accompanied by neurological deficits. The shock sensation could be related to the sudden onset and severity of symptoms.
• Rare Diagnoses
  • Occipital neuralgia: Involves inflammation of the occipital nerves and can cause sharp, stabbing pain in the back and top of the head, which might radiate to the temple. It's less likely to cause pain behind the eye but could be considered in the differential.
  • Paratrigeminal syndrome (Raeder syndrome): A rare condition characterized by a combination of trigeminal neuralgia symptoms (sharp, stabbing pain) and sympathetic nervous system dysfunction (e.g., ptosis, miosis), which could potentially cause a shock-like sensation.
  • SUNCT (Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing) or SUNA (Short-lasting Unilateral Neuralgiform headache attacks with cranial autonomic symptoms): These are rare headache disorders that cause very short-lasting but extremely painful headaches, often with autonomic features. They could potentially cause a shock sensation due to their intensity.