Differential Diagnosis for Headache, Pulsating

• Single Most Likely Diagnosis
  • Migraine: This is the most common cause of pulsating headaches, often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound.
• Other Likely Diagnoses
  • Tension Headache: While typically described as a band or a squeezing sensation, some tension headaches can have a pulsating quality, especially if they are severe.
  • Cluster Headache: These are extremely painful headaches that occur in clusters or cycles, often described as pulsating and usually affecting one side of the head.
  • Sinusitis: Inflammation of the sinuses can cause headaches that may have a pulsating component, often accompanied by facial pain and pressure.
• Do Not Miss Diagnoses
  • Subarachnoid Hemorrhage: A life-threatening condition caused by bleeding into the space surrounding the brain, which can present with a sudden, severe, pulsating headache (often described as "the worst headache" of their life).
  • Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, which can cause a severe, pulsating headache along with fever, neck stiffness, and vomiting.
  • Temporal Arteritis: Inflammation of the blood vessels in the head, which can cause pulsating headaches, especially in older adults, and is associated with jaw claudication and visual disturbances.
• Rare Diagnoses
  • Trigeminal Neuralgia: A chronic pain condition that affects the trigeminal nerve, which can cause intense, shock-like or stabbing pain in parts of the face, sometimes perceived as pulsating.
  • Hypnic Headache: A rare headache disorder that occurs only during sleep and wakes the patient up, often described as a dull, pulsating headache.
  • Primary Thunderclap Headache: A very severe headache that reaches its maximum intensity within a minute, often described as pulsating, and can be a sign of a subarachnoid hemorrhage or other serious conditions.