Differential Diagnosis for Elevated Blood Pressure and Headache
Single Most Likely Diagnosis
- Hypertensive Crisis: This is the most likely diagnosis given the elevated blood pressure in the 180s, which is indicative of a hypertensive emergency or urgency. The headache could be a symptom of the elevated blood pressure affecting the blood vessels in the brain.
Other Likely Diagnoses
- Migraine: Although the blood pressure is elevated, migraines can cause significant headaches and sometimes are associated with transient elevations in blood pressure.
- Tension Headache: Similar to migraines, tension headaches can be severe and might be accompanied by elevated blood pressure due to stress or anxiety.
- Chronic Hypertension: If the patient has a history of uncontrolled high blood pressure, the current elevated reading could simply be a manifestation of poorly managed chronic hypertension, with the headache being a symptom of the hypertension.
Do Not Miss Diagnoses
- Hypertensive Encephalopathy: A condition where severely elevated blood pressure leads to brain edema and potentially life-threatening complications. The headache could be a symptom of this condition.
- Subarachnoid Hemorrhage: Although less likely, a sudden severe headache (often described as "the worst headache of my life") accompanied by elevated blood pressure could indicate a subarachnoid hemorrhage, which is a medical emergency.
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension and headaches due to the excessive release of catecholamines.
- Stroke or Transient Ischemic Attack (TIA): Elevated blood pressure is a risk factor for stroke or TIA, and a headache could be an accompanying symptom, especially if the stroke affects areas involved in pain regulation.
Rare Diagnoses
- Reversible Cerebral Vasoconstriction Syndrome (RCVS): A rare condition characterized by temporary narrowing of the blood vessels in the brain, which can cause severe headaches and sometimes elevated blood pressure.
- Autonomic Dysfunction: Certain conditions affecting the autonomic nervous system can lead to blood pressure fluctuations and headaches.
- Medication-Induced Hypertension: Certain medications can cause elevated blood pressure as a side effect, and if the patient is taking such medications, this could be a rare but possible cause of the symptoms.