Differential Diagnosis for Headaches
The following is a comprehensive differential diagnosis for headaches, categorized for clarity and emphasis on critical conditions.
Single Most Likely Diagnosis
- Tension headache: This is the most common type of headache and is often related to stress, muscle tension, or poor posture. It is characterized by a band-like pressure around the forehead, back of the neck, or both.
- Migraine: A frequent cause of headache, especially in younger individuals, characterized by unilateral, throbbing pain, often accompanied by nausea, vomiting, and sensitivity to light and sound.
Other Likely Diagnoses
- Cluster headache: Known for severe, unilateral orbital or periorbital pain, often accompanied by autonomic symptoms like lacrimation and nasal congestion.
- Sinus headache: Caused by inflammation or infection of the sinuses, leading to pain and pressure in the face, particularly in areas surrounding the sinuses.
- Medication overuse headache: Occurs in individuals who frequently use headache medications, leading to a vicious cycle of headache and medication overuse.
- Cervicogenic headache: Originates from the cervical spine and is often related to neck movement or posture.
Do Not Miss Diagnoses
- Subarachnoid hemorrhage: A life-threatening condition caused by bleeding into the space surrounding the brain, often presenting with a sudden, severe headache (thunderclap headache).
- Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, which can be caused by infection and presents with headache, fever, and stiff neck.
- Temporal arteritis: Inflammation of the blood vessels, particularly those in the temples, which can lead to blindness if not promptly treated.
- Brain tumor: Although rare, can cause headaches due to increased intracranial pressure, often worse in the morning and associated with nausea and vomiting.
- Acute angle-closure glaucoma: A medical emergency that causes severe eye pain, headache, and vision changes due to increased pressure in the eye.
Rare Diagnoses
- Trigeminal neuralgia: Characterized by intense pain along a branch of the trigeminal nerve, often triggered by light touch.
- Hypnic headache: A rare headache disorder that occurs only during sleep and wakes the patient.
- Hemicrania continua: A persistent, one-sided headache with autonomic features, which is completely responsive to indomethacin.
- Chiari malformation: A structural defect in the cerebellum that can cause headaches, often worsened by coughing or straining.
- Idiopathic intracranial hypertension (IIH): Characterized by increased pressure within the skull without a detectable cause, often presenting with headache and vision changes.