Differential Diagnosis for 27 y/o Female with Headaches, N/V, Body Aches

• Single Most Likely Diagnosis
  • Migraine: Given the patient's history of migraines, the symptoms of headaches, nausea/vomiting, and body aches, along with the fact that darkness helps, strongly suggest a migraine episode. The ineffectiveness of Tylenol could be due to the severity of the migraine or the patient's resistance to over-the-counter pain medications.
• Other Likely Diagnoses
  • Viral Gastroenteritis: The combination of nausea/vomiting, body aches, and headaches could also indicate a viral gastroenteritis, especially if the patient has been exposed to someone with similar symptoms.
  • Tension Headache: Although less likely given the patient's history of migraines, tension headaches can present with similar symptoms and could be exacerbated by stress or other factors.
  • Medication Overuse Headache: Despite the patient's denial of taking any medications, it's possible that she might be experiencing medication overuse headaches, especially if she has been taking Tylenol frequently without relief.
• Do Not Miss Diagnoses
  • Subarachnoid Hemorrhage: Although unlikely, a sudden, severe headache (often described as "the worst headache of my life") with nausea and vomiting could indicate a subarachnoid hemorrhage, which is a medical emergency.
  • Meningitis: Symptoms such as headache, nausea, vomiting, and body aches, especially if accompanied by fever, stiff neck, or photophobia, could indicate meningitis, a potentially life-threatening condition.
  • Encephalitis: Inflammation of the brain, which could present with similar symptoms, including severe headache, nausea, vomiting, and sensitivity to light.
• Rare Diagnoses
  • Temporal Arteritis: Although more common in older adults, temporal arteritis can cause severe headaches, nausea, and visual disturbances, and is a diagnosis that should not be missed due to its potential for causing blindness.
  • Cluster Headaches: These are extremely painful headaches that occur in clusters or cycles, but are less common and typically present with other distinctive features such as unilateral pain and autonomic symptoms like nasal congestion or eye watering.