Differential Diagnosis for Headache

• Single Most Likely Diagnosis
  • Tension headache: This is the most common type of headache and is often described as a band or a squeezing sensation around the forehead, usually accompanied by muscle tension in the neck and scalp. It's typically bilateral, mild to moderate in severity, and can be related to stress, poor posture, or fatigue.
• Other Likely Diagnoses
  • Migraine: Characterized by severe, unilateral, throbbing headaches, often accompanied by nausea, vomiting, and sensitivity to light and sound. Migraines can be triggered by various factors, including hormonal changes, certain foods, and stress.
  • Sinus headache: Caused by inflammation or infection of the sinuses, leading to pain and pressure in the face, particularly in the cheeks and forehead. It's often accompanied by nasal congestion, fever, and cough.
  • Cluster headache: Extremely painful, unilateral headaches that occur in clusters or cycles, often waking the patient from sleep. They are accompanied by autonomic symptoms like nasal congestion, rhinorrhea, and ptosis on the same side as the headache.
• Do Not Miss Diagnoses
  • Subarachnoid hemorrhage: A life-threatening condition caused by bleeding into the space surrounding the brain, leading to a sudden, severe headache often described as "the worst headache of my life." It requires immediate medical attention.
  • Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, usually due to infection. Symptoms include severe headache, fever, stiff neck, and confusion.
  • Temporal arteritis: Inflammation of the blood vessels in the temples, which can lead to blindness if not treated promptly. It's characterized by a severe, unilateral headache, jaw claudication, and visual disturbances, typically affecting individuals over 50 years old.
  • Brain tumor: Although rare, headaches can be a symptom of brain tumors, especially if they are large enough to cause increased intracranial pressure or if they exert pressure on specific areas of the brain.
• Rare Diagnoses
  • Trigeminal neuralgia: A chronic pain condition that affects the trigeminal nerve, causing intense, shock-like or stabbing pain in parts of the face.
  • Hypnic headache: A rare type of headache that occurs only during sleep and wakes the patient, typically occurring in older adults.
  • Thunderclap headache: An extremely severe headache that reaches its maximum intensity within a minute, often indicative of a subarachnoid hemorrhage but can also be due to other causes like cerebral venous thrombosis or reversible cerebral vasoconstriction syndrome.