Differential Diagnosis for Headaches in a 14-year-old

Single Most Likely Diagnosis

• Tension Headache: This is the most common type of headache in adolescents, often related to stress, poor posture, or muscle tension. The age and duration of the headaches (2 weeks) make this a plausible diagnosis.

Other Likely Diagnoses

• Migraine: Common in adolescents, especially with a family history. Migraines can be triggered by various factors, including stress, certain foods, or hormonal changes.
• Sinusitis: Infections or inflammation of the sinuses can cause headaches, especially if accompanied by other symptoms like facial pain, nasal congestion, or fever.
• Stress or Anxiety-related Headache: Given the age of the patient, stress from school or social pressures could be a significant contributing factor.

Do Not Miss Diagnoses

• Brain Tumor: Although rare, brain tumors can present with headaches, especially if they are worsening over time, or accompanied by other neurological symptoms like seizures, vision changes, or weakness.
• Meningitis: An infection of the meninges, which can present with severe headache, fever, neck stiffness, and vomiting. Early diagnosis is crucial for effective treatment.
• Subarachnoid Hemorrhage: Though uncommon in adolescents, it's a medical emergency that can cause sudden, severe headache, often described as "the worst headache" ever experienced.
• Idiopathic Intracranial Hypertension (IIH): Can cause headaches that worsen over time, often accompanied by vision changes or papilledema.

Rare Diagnoses

• Temporal Arteritis: More common in older adults but can occur in younger individuals, presenting with headache, jaw claudication, and visual disturbances.
• Chiari Malformation: A structural defect in the cerebellum that can cause headaches, especially after coughing, sneezing, or straining, due to the displacement of the cerebellar tonsils into the spinal canal.
• Pseudotumor Cerebri: Similar to IIH, it involves increased intracranial pressure without a detectable cause, leading to headaches and potential vision problems.

Each of these diagnoses should be considered based on the patient's full clinical presentation, including any additional symptoms, physical examination findings, and potentially, diagnostic tests such as imaging or blood work.