Differential Diagnosis for New Persistent Headache with Mastoid Disease and Possible Acute Infarct on CT Head

• Single Most Likely Diagnosis
  • Migraine or tension headache: Given the duration of two weeks, these primary headache disorders are common and can be exacerbated or triggered by various factors, including stress, sleep disturbances, or even the mastoid disease itself, leading to persistent symptoms.
• Other Likely Diagnoses
  • Mastoiditis: The presence of mastoid disease on the CT scan suggests that the headache could be directly related to this condition, especially if there's an infectious or inflammatory process involved.
  • Sinusitis: Often associated with headaches, sinusitis could be a contributing factor, especially if the mastoid disease is part of a broader sinus or respiratory infection.
  • Temporomandibular joint (TMJ) disorder: Given the proximity of the TMJ to the mastoid process, disorders of the TMJ could radiate pain to the area, contributing to the headache.
• Do Not Miss Diagnoses
  • Acute infarct (stroke): As mentioned, the CT scan cannot exclude an acute infarct, making this a critical diagnosis not to miss due to its severe implications and the need for immediate intervention.
  • Meningitis or encephalitis: Infections that could spread from the mastoid area to the meninges or brain tissue, these conditions are medical emergencies.
  • Subarachnoid hemorrhage: Although less likely given the CT findings, this is a potentially life-threatening condition that requires prompt diagnosis and treatment.
  • Brain abscess: Especially in the context of mastoiditis, a brain abscess is a serious complication that could present with headache and requires urgent attention.
• Rare Diagnoses
  • Temporal arteritis (giant cell arteritis): This condition can cause headaches and is more common in older adults, but it's less likely given the presence of mastoid disease.
  • Venous sinus thrombosis: A rare condition that could present with headache and is associated with mastoiditis or other conditions affecting the sinuses.
  • Intracranial tumors: Although rare, tumors could cause persistent headaches and would be identified on a CT scan, but the presence of mastoid disease might suggest other diagnoses initially.