Differential Diagnosis for Chest Pain and Headache with History of Vasospasm

Single Most Likely Diagnosis

• Migraine with Vasospasm: This diagnosis is likely due to the patient's history of vasospasm, which can cause both chest pain and headache. Migraines are known to involve vasospasm, and the symptoms presented align with this condition.

Other Likely Diagnoses

• Vasospastic Angina: This condition involves chest pain caused by vasospasm of the coronary arteries, which could also contribute to headache. Given the patient's history of vasospasm, this is a plausible diagnosis.
• Temporomandibular Joint (TMJ) Disorder: TMJ disorders can cause both headache and referred pain to the chest, and vasospasm in the facial or neck muscles could exacerbate these symptoms.
• Tension-Type Headache with Referred Chest Pain: Tension headaches can cause significant pain and may refer pain to the chest area, potentially exacerbated by vasospasm.

Do Not Miss Diagnoses

• Myocardial Infarction (MI): Although less likely given the context of vasospasm and headache, MI is a critical diagnosis that must not be missed. Chest pain is a key symptom of MI, and it can occasionally be accompanied by headache.
• Subarachnoid Hemorrhage: A severe headache (often described as "the worst headache of my life") can be accompanied by chest pain due to the body's stress response. Vasospasm is a known complication of subarachnoid hemorrhage, making this a critical diagnosis to consider.
• Pulmonary Embolism: While headache is not a primary symptom, severe chest pain and the potential for systemic symptoms could include headache. Given the potential for vasospasm to affect any vascular bed, this diagnosis must be considered.

Rare Diagnoses

• Ergotamine-Induced Vasospasm: If the patient is using ergotamine for migraines, there's a rare possibility of inducing vasospasm, leading to both chest pain and headache.
• Primary Angiitis of the Central Nervous System (PACNS): This rare condition involves inflammation of the blood vessels in the brain and could potentially cause both headache and, less commonly, chest pain through various mechanisms, including vasospasm.
• Fibromuscular Dysplasia: A rare vascular disease that can cause vasospasm and affect multiple vascular beds, potentially leading to a variety of symptoms including chest pain and headache.