Differential Diagnosis for Constant Dull Headaches in a 71-Year-Old Female

Single Most Likely Diagnosis

• Tension Headache: This is the most common type of headache and is often described as a constant, dull ache. It's more prevalent in women and can be exacerbated by stress, poor posture, and other factors common in the elderly population.

Other Likely Diagnoses

• Migraine: Although migraines are often associated with younger populations, they can occur at any age. In the elderly, migraines might present differently, with less prominent aura symptoms and more frequent or persistent headaches.
• Cervicogenic Headache: Given the age of the patient, cervical spine degeneration could be contributing to headaches. These headaches are typically dull and constant, referred from the cervical spine to the head.
• Medication Overuse Headache: Elderly patients often take multiple medications, increasing the risk of medication overuse headaches. These occur when frequent or excessive use of headache medications leads to worsening headache frequency or intensity.

Do Not Miss Diagnoses

• Giant Cell Arteritis (Temporal Arteritis): Although less common, this condition is critical to diagnose due to the risk of vision loss. It typically presents with headache, scalp tenderness, and jaw claudication in patients over 50.
• Subdural Hematoma: Especially in the elderly, even minor trauma can lead to a subdural hematoma, which may present with a gradual onset of headache.
• Brain Tumor: Although rare, a new onset of headache in an elderly patient could be a symptom of a brain tumor. The headache is often worse in the morning and can be accompanied by neurological deficits.
• Chronic Subarachnoid Hemorrhage: A less common but critical diagnosis, chronic subarachnoid hemorrhage can present with a constant headache and might not have an obvious acute onset.

Rare Diagnoses

• Trigeminal Neuralgia: This condition involves sudden, severe, shock-like pain around the eyes, lips, or nose mainly on one side of the face. While it's more common in the elderly, it's less likely to present as a constant dull headache.
• Hypnic Headache: A rare condition characterized by recurrent headaches that occur only during sleep and wake the patient, typically in the elderly.
• Idiopathic Intracranial Hypertension (IIH): More common in younger, obese females but can occur in any demographic. It presents with headache, often worse in the morning, and can be accompanied by visual disturbances.