Differential Diagnosis for Occipital and Band-like Headache

• Single most likely diagnosis
  • Tension headache: This is the most common type of headache and often presents with a band-like or occipital distribution. It is typically characterized by a dull, aching pain that is mild to moderate in intensity.
• Other Likely diagnoses
  • Migraine: Although migraines are often unilateral, some patients may experience bilateral or occipital pain. The band-like quality could be due to the migraine's characteristic of spreading or being referred from other areas.
  • Cervicogenic headache: These headaches are referred from the cervical spine and often present with occipital pain due to the referral patterns of the cervical nerves.
  • Occipital neuralgia: Inflammation or irritation of the occipital nerves can cause severe, sharp, or stabbing pain in the occipital region, which might be perceived as band-like.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Subarachnoid hemorrhage: Although typically presenting with a sudden, severe headache (often described as "the worst headache of my life"), some cases might have a more gradual onset or atypical presentation, including an occipital or band-like distribution.
  • Meningitis: Inflammation of the meninges can cause headache, which might be diffuse or have an occipital component, especially if there is significant irritation of the meninges at the base of the brain.
  • Temporal arteritis (Giant Cell Arteritis): This condition can cause headache, often unilateral but sometimes bilateral, and might have an occipital component. It's crucial to consider this diagnosis due to the risk of vision loss if not promptly treated.
• Rare diagnoses
  • Chiari malformation: A structural defect in the cerebellum that controls balance can cause headaches, often occipital, due to the compression of cerebellar tonsils into the spinal canal.
  • Idiopathic intracranial hypertension (IIH): Also known as pseudotumor cerebri, this condition can cause headache, often worse in the morning and exacerbated by maneuvers that increase intrathoracic pressure, which might be perceived as having an occipital or band-like quality.