Differential Diagnosis for Headache
- Single most likely diagnosis
- Tension headache: This is the most common type of headache and is often described as a band or a squeezing sensation around the forehead, back of the neck, or both. It tends to be worse in the morning and evening, and can be exacerbated by stress, poor posture, or other factors. The fact that the headache improves with movement suggests a musculoskeletal component, which is consistent with tension headache.
- Other Likely diagnoses
- Cervicogenic headache: This type of headache is caused by referred pain from the cervical spine and is often worsened by certain movements or positions. The improvement with movement and worsening in the evening could be consistent with cervicogenic headache, especially if there is underlying cervical spine disease or strain.
- Occipital neuralgia: This condition involves irritation of the occipital nerves, which can cause pain in the back of the head. The pain can be exacerbated by certain movements or positions and may improve with activity, which could fit the described pattern.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage: Although less likely given the chronic nature of the symptoms, any new or severe headache warrants consideration of a subarachnoid hemorrhage, especially if there are accompanying symptoms such as sudden onset, severe intensity, or associated neurological deficits.
- Temporal arteritis: This condition, also known as giant cell arteritis, can cause headaches, especially in older adults. It is a medical emergency due to the risk of vision loss if not promptly treated. The headache can be constant but may vary in intensity throughout the day.
- Brain tumor: A brain tumor could cause headaches that worsen over time, potentially with a pattern that includes worsening in the evening due to increased intracranial pressure when lying down. However, other symptoms such as neurological deficits, seizures, or personality changes would typically accompany the headache.
- Rare diagnoses
- Chiari malformation: This is a structural defect in the cerebellum that can cause headaches, among other symptoms. The headaches can be exacerbated by certain positions or activities and may improve with movement, although this is less common.
- Hypnic headache: This is a rare type of headache that occurs exclusively during sleep and wakes the patient. While it doesn't perfectly match the described pattern of improvement with movement and worsening in the evening, it's an unusual headache disorder that could be considered in the differential diagnosis of headaches with a unique temporal pattern.