Differential Diagnosis

The patient presents with a unique combination of symptoms, including headaches coinciding with ejaculation, left temple throbbing pain, and left eye ptosis. Here's a differential diagnosis based on the provided information:

• Single most likely diagnosis
  • Cluster headaches: The patient's symptoms of severe, unilateral headaches with a temporal relationship to ejaculation, and accompanying ptosis and jaw pain, are suggestive of cluster headaches. The fact that the headaches have resolved on their own also fits with the episodic nature of cluster headaches.
• Other Likely diagnoses
  • Tension headaches: The patient's description of a throbbing pain and jaw pain could also be consistent with tension headaches, although the temporal relationship to ejaculation is less typical.
  • Migraines: Although the patient denies aura and photophobia, migraines can sometimes present without these features. The unilateral nature of the pain and accompanying ptosis could be consistent with a migraine variant.
• Do Not Miss
  • Subarachnoid hemorrhage: Although the patient's symptoms have resolved, it's essential to consider the possibility of a subarachnoid hemorrhage, especially given the severity of the headaches. The lack of antecedent head trauma and the absence of other symptoms such as fever or weight loss make this less likely, but it's crucial to rule out this potentially life-threatening condition.
  • Giant cell arteritis: The patient's age and symptoms of jaw pain and ptosis could be consistent with giant cell arteritis, although the lack of other symptoms such as visual changes or systemic symptoms makes this less likely.
• Rare diagnoses
  • Autonomic cephalalgias: The patient's symptoms of headaches coinciding with ejaculation and accompanying ptosis and jaw pain could be consistent with autonomic cephalalgias, such as short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) or short-lasting unilateral neuralgiform headache attacks with autonomic symptoms (SUNA).
  • Raeder syndrome: The patient's symptoms of ptosis, jaw pain, and headaches could be consistent with Raeder syndrome, a rare condition characterized by a combination of these symptoms. However, the lack of other symptoms such as facial weakness or sensory changes makes this less likely.