Differential Diagnosis for Intractable Occipital Headache
Single Most Likely Diagnosis
- Tension Headache: This is often the most common cause of headaches, including those localized to the occipital region. Tension headaches are typically characterized by a band-like pressure around the head, but can also present with pain primarily in the occipital area. The intractable nature could be due to untreated or undertreated tension headaches.
Other Likely Diagnoses
- Cervicogenic Headache: These headaches are referred from the cervical spine and are a common cause of occipital headaches. They can be intractable if the underlying cervical issue is not addressed.
- Occipital Neuralgia: Involves the occipital nerves and can cause severe, sharp, or stabbing pain in the occipital region. It can be intractable if not properly diagnosed and treated.
- Migraine: Although migraines often present with unilateral pain, they can sometimes be bilateral and localized to the occipital area. They can be intractable if not managed correctly.
Do Not Miss Diagnoses
- Subarachnoid Hemorrhage: Although typically presenting with a sudden, severe headache (often described as "the worst headache of my life"), it's crucial not to miss this diagnosis. Occipital headache could be a presentation in some cases, especially if the bleed affects the posterior circulation.
- Giant Cell Arteritis: This condition can cause headaches, including those localized to the occipital region, especially in older adults. It's a "do not miss" diagnosis due to the risk of vision loss if not promptly treated.
- Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, which can cause severe headache, including occipital headache, along with other symptoms like fever and neck stiffness.
Rare Diagnoses
- Chiari Malformation: A structural defect in the cerebellum that controls balance can cause occipital headaches, especially with coughing or straining.
- Eagle Syndrome: Elongation of the styloid process or calcification of the stylohyoid ligament can cause sharp, stabbing pain in the side of the face and the occipital region.
- Atlantoaxial Subluxation: Instability at the joint between the first and second cervical vertebrae can cause severe occipital headaches due to compression or irritation of the nerves and blood vessels.