Differential Diagnosis for Headache that Wakes from Sleep and is Better with Movement
- Single Most Likely Diagnosis
- Migraine: Often, migraines can wake patients from sleep and may improve with movement, although this is not a universal characteristic. The improvement with movement might be due to the patient getting out of a position that exacerbates the headache or due to the natural fluctuation in migraine symptoms.
- Other Likely Diagnoses
- Tension-Type Headache: While less common to wake from sleep, tension-type headaches can improve with movement as the patient stretches and relaxes tense muscles.
- Cluster Headache: These are severe headaches that can wake patients from sleep and might improve slightly with movement, although they are typically characterized by being on one side of the head and accompanied by other symptoms like nasal congestion or eye watering.
- Hypnic Headache: A rare condition but considered here because it wakes patients from sleep, hypnic headaches are typically bilateral and can last from 15 minutes to several hours. Movement might offer slight relief, but this is not a well-defined characteristic.
- Do Not Miss Diagnoses
- Subarachnoid Hemorrhage: Although less likely, a "thunderclap" headache that wakes a patient from sleep must be considered due to its potentially life-threatening nature. Improvement with movement is not a characteristic typically associated with this condition, but the severity and sudden onset are key distinguishing features.
- Temporal Arteritis: This condition can cause headaches that might wake patients from sleep and could potentially improve with movement, but it's more commonly associated with jaw claudication and visual disturbances. It's a "do not miss" due to the risk of blindness if not treated promptly.
- Brain Tumor: Headaches from brain tumors can occur at any time, including waking from sleep, and might improve with changes in position or movement, although this is highly variable. The concern for brain tumors makes this a critical diagnosis not to miss.
- Rare Diagnoses
- Chronic Daily Headache: This is a broad category that includes various headache disorders occurring more than 15 days per month. While not typically characterized by waking from sleep and improving with movement, the variability in presentation makes it a consideration in complex or refractory cases.
- Hemicrania Continua: A rare headache disorder characterized by a continuous, usually mild, headache with episodes of severe pain on the same side of the head. It can wake patients from sleep and might show some improvement with movement, but it's distinguished by its continuous nature and responsiveness to indomethacin.
- Cervicogenic Headache: Originating from the cervical spine, these headaches can wake patients from sleep and might improve with specific movements that alleviate cervical spine tension or irritation.