Differential Diagnosis for 27-year-old Patient with Headaches, N/V, and Body Aches

• Single Most Likely Diagnosis
  • Migraine: Given the patient's history of migraines and the description of symptoms (headaches, N/V, body aches) that are partially alleviated by darkness, which is a common feature of migraines. The fact that she denies taking any medications for it, stating they don't help, might indicate either a lack of effective treatment or a misunderstanding of her condition.
• Other Likely Diagnoses
  • Viral Gastroenteritis: The combination of nausea/vomiting (N/V), body aches, and headaches could suggest a viral infection affecting the gastrointestinal system.
  • Tension Headache: Although less likely given the severity of symptoms and the specific relief from darkness, tension headaches can present with similar symptoms and are very common.
  • Medication Overuse Headache: Despite the patient's denial of taking medications, the ineffectiveness of OTC Tylenol and the chronic nature of her symptoms could suggest overuse of pain medications, leading to rebound headaches.
• Do Not Miss Diagnoses
  • Subarachnoid Hemorrhage: A severe headache with sudden onset, often described as "the worst headache" of the patient's life, accompanied by nausea and vomiting, requires immediate consideration and ruling out with imaging studies.
  • Meningitis: Symptoms can include headache, fever, neck stiffness, and nausea/vomiting. The severity and potential for rapid progression make this a critical diagnosis not to miss.
  • Encephalitis: Inflammation of the brain tissue, which can present with headache, fever, confusion, and sometimes nausea and vomiting, is a serious condition requiring prompt diagnosis and treatment.
• Rare Diagnoses
  • Temporal Arteritis: Although more common in older adults, this condition can cause severe headaches and should be considered, especially if there are visual disturbances or jaw claudication.
  • Idiopathic Intracranial Hypertension: Characterized by increased intracranial pressure without a detectable cause, leading to headaches that can be worse in the morning and with certain maneuvers, and often accompanied by visual disturbances.
  • Brain Tumor: A rare cause of headaches, but one that must be considered, especially with persistent, worsening, or unusual headache patterns, and other neurological symptoms.