Headache Differential Diagnosis

When approaching a patient with a headache, it's crucial to consider a wide range of potential causes to ensure accurate diagnosis and appropriate treatment. The differential diagnosis can be organized into several categories based on likelihood and potential impact.

• Single Most Likely Diagnosis
  • Tension Headache: This is often the most common cause of headache and is characterized by a band-like pressure around the forehead, back of the neck, or both. It's typically bilateral, mild to moderate in intensity, and not accompanied by other symptoms like nausea, vomiting, or neurological deficits.
• Other Likely Diagnoses
  • Migraine: A common cause of headache that can be unilateral or bilateral, often described as pulsating, and can be accompanied by nausea, vomiting, photophobia, or phonophobia. Some migraines are preceded by an aura.
  • Sinusitis: Inflammation of the sinuses can cause headache, typically localized to the forehead or facial area, and may be accompanied by nasal congestion, fever, or facial pain.
  • Cervicogenic Headache: Originates from the cervical spine and is often related to neck movement or posture. It's typically unilateral and can be accompanied by neck pain or stiffness.
• Do Not Miss Diagnoses
  • Subarachnoid Hemorrhage (SAH): A life-threatening condition caused by bleeding into the space surrounding the brain. It presents with a sudden, severe headache (often described as "the worst headache of my life"), which may be accompanied by nausea, vomiting, altered consciousness, or focal neurological deficits.
  • Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, which can be caused by infection. Symptoms include headache, fever, stiff neck, and potentially altered consciousness or seizures.
  • Temporal Arteritis: Inflammation of the blood vessels, particularly those in the temples. It's more common in older adults and can cause headache, jaw claudication, and visual disturbances. If untreated, it can lead to blindness.
  • Idiopathic Intracranial Hypertension (IIH): Characterized by increased pressure within the skull without an apparent cause. Symptoms include headache, vision changes (such as double vision or transient visual obscurations), and tinnitus.
• Rare Diagnoses
  • Trigeminal Neuralgia: A chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. It's characterized by intense, shock-like or stabbing pain in parts of your face.
  • Hemicrania Continua: A rare form of headache that is continuous and strictly unilateral, often accompanied by autonomic symptoms like nasal congestion or eye watering on the same side as the headache.
  • Cluster Headache: Extremely painful headaches that occur in cycles or clusters, often waking the patient from sleep. They are typically unilateral, centered around the eye, and accompanied by autonomic symptoms like nasal congestion or eye watering.

Each of these diagnoses has distinct characteristics and potential consequences, emphasizing the importance of a thorough evaluation to determine the underlying cause of a headache.