Differential Diagnosis for 61-year-old Male with Headache
- Single most likely diagnosis
- Tension headache: This is the most common type of headache and is often described as a pressure or band-like sensation around the forehead, which can be exacerbated in the morning. The fact that it is mildly alleviated with Tylenol and lacks nausea or vomiting supports this diagnosis.
- Other Likely diagnoses
- Migraine: Although migraines are typically associated with nausea and vomiting, some individuals may experience migraine variants without these symptoms. The pressure behind one eye could be indicative of a migraine.
- Cluster headache: These are severe headaches that occur in clusters or cycles, often waking the patient from sleep, and can cause pressure or pain behind one eye. However, they are typically more severe and accompanied by other symptoms like nasal congestion or eye watering.
- Sinus headache: Given the location of the pain (behind the right eye), a sinus headache could be considered, especially if the patient has a history of sinusitis or allergies.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage: Although the headache is not described as "thunderclap" (sudden and severe), any new or worsening headache in an adult warrants consideration of this potentially life-threatening condition.
- Temporal arteritis: This condition, also known as giant cell arteritis, can cause headaches, often accompanied by jaw claudication or visual disturbances. It's a medical emergency due to the risk of blindness if not promptly treated.
- Brain tumor: A new or changing headache pattern, especially in an older adult, should prompt consideration of a brain tumor, which could cause increased intracranial pressure and lead to morning headaches.
- Rare diagnoses
- Trigeminal neuralgia: This condition causes sudden, severe, shock-like pain around the eyes, lips, or nose mainly because of abnormal blood vessels pressing on the trigeminal nerve in the head. It's less likely given the description of a pressure headache.
- Idiopathic intracranial hypertension (IIH): Also known as pseudotumor cerebri, this condition can cause morning headaches due to increased intracranial pressure without any obvious cause. It's more common in younger, obese females but can occur in anyone.
- Hypertension-related headache: Severe hypertension can cause headaches, although these are typically more generalized and not limited to one eye. However, given the age of the patient, hypertension should be considered as a potential contributing factor.