Differential Diagnosis for the Patient's Symptoms

The patient presents with dizziness, blurred vision, sensitivity to light, migraines, rib pain, and shortness of breath (SOB). Given these symptoms, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Migraine with aura: The patient's history of migraines, especially those triggered by sensitivity to light and accompanied by blurred vision and dizziness, suggests that the current symptoms could be an exacerbation or a variation of their migraine condition. The rib pain and SOB could be unrelated or possibly stress-induced.

• Other Likely Diagnoses

  • Tension headache: Given the patient's history of migraines and the current symptoms of pressure in the frontal area of the head, tension headaches could be a contributing factor, especially if the patient is experiencing stress or has recently undergone changes that could lead to increased muscle tension.
  • Viral or respiratory infection: The onset of rib pain and SOB could indicate a viral or respiratory infection, which might also exacerbate or trigger migraine symptoms.
  • Anxiety or panic disorder: The combination of dizziness, blurred vision, sensitivity to light, and SOB could also suggest an anxiety or panic disorder, especially if these symptoms are triggered by specific situations or if the patient has a history of anxiety.

• Do Not Miss Diagnoses

  • Pulmonary embolism (PE): Although less likely given the patient's age and presentation, PE must be considered due to the symptom of SOB. A PE would be a medical emergency.
  • Cardiac issues (e.g., myocardial infarction, pericarditis): The chest pain (rib pain) and SOB could be indicative of cardiac issues, which are critical to diagnose promptly.
  • Temporal arteritis: This condition, although more common in older adults, could present with headache, visual disturbances, and sensitivity to light. It's a diagnosis that should not be missed due to the risk of vision loss.
  • Intracranial hemorrhage or stroke: Given the patient's history of migraines and the current symptoms, it's crucial to rule out more severe intracranial pathologies, especially if there's a sudden change in the pattern of headaches or if the headaches are accompanied by other neurological deficits.

• Rare Diagnoses

  • Multiple sclerosis: This condition could present with a wide range of neurological symptoms, including vision problems, dizziness, and pain. However, it would be less likely without other specific neurological signs.
  • Mitochondrial myopathies: Given the patient's history of LASIK surgery and the current symptoms, although very rare, mitochondrial myopathies could be considered, especially if there's a family history or other systemic symptoms.
  • Porphyria: Acute intermittent porphyria can cause abdominal pain, neurological symptoms, and psychiatric disturbances. It's a rare condition but could be considered with a broad range of symptoms like the ones presented.