Differential Diagnosis for Headache and Stiff Neck after a Fall

The patient's symptoms of headache and stiff neck after a fall warrant a thorough differential diagnosis to ensure all possible causes are considered. The differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Concussion or Mild Traumatic Brain Injury (mTBI): This is the most likely diagnosis given the mechanism of injury (fall and hit to the head) and the symptoms presented (headache and stiff neck). A concussion or mTBI can result from a blow to the head or a violent shaking of the head and body, which could have occurred during the fall.

• Other Likely Diagnoses

  • Cervical Strain or Whiplash: The fall could have caused strain to the neck muscles or a whiplash injury, leading to neck stiffness and headache.
  • Post-Traumatic Migraine: Head trauma can trigger migraines, which could explain the headache. However, migraines typically have other associated symptoms such as nausea, vomiting, or sensitivity to light and sound.
  • Subacute or Chronic Subdural Hematoma: Although less common, especially if the patient is not elderly or on anticoagulants, a subdural hematoma could present with headache and neck stiffness after a fall.

• Do Not Miss Diagnoses

  • Epidural Hematoma: A potentially life-threatening condition that requires immediate intervention. It can present with headache, neck stiffness, and altered mental status after a head injury.
  • Subarachnoid Hemorrhage: Bleeding into the space surrounding the brain can cause severe headache (often described as "the worst headache of my life") and neck stiffness.
  • Meningitis: Although less directly related to trauma, if the fall somehow compromised the protective barriers of the brain (e.g., through a basilar skull fracture), meningitis could be a consideration, especially if fever or other signs of infection are present.
  • Cervical Spine Fracture or Dislocation: A serious injury that could lead to spinal cord damage if not promptly diagnosed and treated. Neck stiffness and headache could be presenting symptoms.

• Rare Diagnoses

  • Arteriovenous Fistula or Malformation: Trauma could potentially cause or exacerbate an arteriovenous fistula or malformation, leading to headache and possibly neck stiffness due to the abnormal blood flow.
  • CSF Leak: A head injury could result in a cerebrospinal fluid leak, which might present with headache and neck stiffness, among other symptoms like clear nasal discharge.
  • Vertebrobasilar Insufficiency or Stroke: Although rare, a fall could potentially cause or contribute to a vertebral artery injury leading to vertebrobasilar insufficiency or stroke, presenting with a variety of neurological symptoms including headache and neck stiffness.

Each of these diagnoses requires careful consideration based on the patient's specific presentation, history, and physical examination findings, along with appropriate diagnostic testing to confirm the diagnosis and guide treatment.