Differential Diagnosis

The patient presents with headaches, nausea/vomiting, body aches, and photophobia (suggested by relief with darkness), which are common symptoms of various conditions. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Migraine: Given the patient's history of migraines and the presence of photophobia (relief with darkness), this is the most likely diagnosis. The symptoms of headaches, nausea/vomiting, and body aches are also consistent with migraine, especially considering the patient's past experience with the condition.

• Other Likely Diagnoses

  • Viral illness (e.g., influenza, viral gastroenteritis): The combination of headaches, body aches, nausea, and vomiting could suggest a viral illness. The lack of response to Tylenol does not rule out this diagnosis, as viral illnesses often require supportive care rather than specific antiviral treatments.
  • Tension headache: Although less likely given the photophobia, tension headaches can present with similar symptoms and are common in the general population.
  • Medication overuse headache: Despite the patient's denial of taking medications, it's possible that overuse of over-the-counter (OTC) pain medications like Tylenol could contribute to or exacerbate headache symptoms.

• Do Not Miss Diagnoses

  • Subarachnoid hemorrhage: Although less likely given the duration and nature of the symptoms, a subarachnoid hemorrhage is a medical emergency that can present with sudden, severe headache (often described as "the worst headache of my life"), nausea, and sometimes body aches. It's crucial to consider this diagnosis, especially if there's a sudden onset or significant change in symptoms.
  • Meningitis: Symptoms can include headache, fever, nausea/vomiting, and photophobia. Given the potential severity of meningitis, it's essential to consider this diagnosis, especially if the patient shows signs of fever, stiff neck, or altered mental status.
  • Temporal arteritis: This condition, more common in older adults, can cause headaches, but it's less likely given the patient's age is not specified and the presence of body aches and nausea/vomiting.

• Rare Diagnoses

  • Cluster headaches: These are extremely painful headaches that occur in clusters or cycles, often accompanied by autonomic symptoms like nasal congestion or eye watering. They are less common and typically do not present with body aches or nausea/vomiting as primary symptoms.
  • Trigeminal neuralgia: Characterized by intense pain along a branch of the trigeminal nerve, this condition is less likely given the description of the patient's symptoms, which does not specifically mention facial pain.
  • Idiopathic intracranial hypertension (IIH): This condition can cause headaches, nausea, and vision changes, including photophobia. However, it is less common and often associated with other symptoms like papilledema or specific findings on imaging studies.