Differential Diagnosis for a Female with a History of Lupus Presenting with a Headache
- Single most likely diagnosis:
- Lupus headache or lupus cerebritis: This is a common neurological manifestation of systemic lupus erythematosus (SLE) and can present as a headache. The patient's history of lupus makes this a likely consideration.
- Other Likely diagnoses:
- Migraine: Given the high prevalence of migraines in the general population and their potential to be exacerbated by the stress of chronic illness, migraines are a plausible cause of headache in a patient with lupus.
- Tension headache: Similar to migraines, tension headaches are common and could be triggered or worsened by the psychological and physical stresses associated with living with lupus.
- Medication-overuse headache: Patients with chronic conditions like lupus may be on multiple medications, including those for pain management, which can lead to medication-overuse headaches.
- Do Not Miss diagnoses:
- Central nervous system (CNS) vasculitis: Although less common, CNS vasculitis is a serious complication of lupus that can present with headache and requires prompt diagnosis and treatment to prevent severe outcomes.
- CNS infection: Patients with lupus, especially those on immunosuppressive therapy, are at increased risk of infections, including those affecting the CNS, which can present with headache among other symptoms.
- Hypertension-related headache: Uncontrolled hypertension, which can be associated with lupus nephritis or as a side effect of certain medications, can cause headaches and is crucial to identify and manage.
- Rare diagnoses:
- Chorea-associated headache: Although rare, chorea is a known manifestation of lupus, and associated headaches could be part of the clinical presentation.
- Libman-Sacks endocarditis with embolic phenomena: This rare condition involves non-bacterial endocarditis associated with lupus, and if it leads to embolic events, it could potentially cause headaches among a myriad of other neurological symptoms.
- Posterior reversible encephalopathy syndrome (PRES): This is a rare but serious condition that can occur in patients with lupus, especially those with hypertension or on certain immunosuppressive drugs, presenting with headache, seizures, and visual disturbances.