Differential Diagnosis for Dizziness, Headache, Photophobia with Elevated BP

Single Most Likely Diagnosis

• Hypertensive Crisis: The combination of dizziness, headache, photophobia, and significantly elevated diastolic blood pressure (100 mmHg) points towards a hypertensive crisis. This condition is characterized by severely high blood pressure that can lead to organ damage, and the symptoms presented are consistent with this diagnosis.

Other Likely Diagnoses

• Migraine: Migraines can cause dizziness, headache, and photophobia. Although they are not directly related to elevated blood pressure, the symptoms overlap, and some individuals with migraines may also experience blood pressure fluctuations.
• Anxiety or Panic Attack: Anxiety and panic attacks can manifest with dizziness, headache, and photophobia, and can also be associated with transient elevations in blood pressure.
• Vestibular Migraine: This condition involves vertigo (dizziness) and can be accompanied by headache and photophobia, similar to a traditional migraine but with a focus on vestibular symptoms.

Do Not Miss Diagnoses

• Subarachnoid Hemorrhage: Although less likely, this is a critical diagnosis not to miss due to its high mortality and morbidity. The sudden onset of a severe headache (often described as "the worst headache of my life"), accompanied by photophobia and possibly elevated blood pressure, could indicate a subarachnoid hemorrhage.
• Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension, headaches, and other symptoms due to the excessive release of catecholamines.
• Posterior Reversible Encephalopathy Syndrome (PRES): Characterized by headache, confusion, seizures, and visual disturbances, PRES is associated with high blood pressure and can be a medical emergency.

Rare Diagnoses

• Autonomic Dysfunction: Certain conditions affecting the autonomic nervous system can lead to blood pressure dysregulation, dizziness, and other symptoms.
• Intracranial Hypertension: Conditions that increase pressure within the skull, such as idiopathic intracranial hypertension, can cause headache, photophobia, and sometimes transient visual disturbances.
• Cervicogenic Dizziness: Dizziness originating from the cervical spine, which can be accompanied by headache and possibly exacerbated by certain neck movements.