Differential Diagnosis for Dull Intermittent Left-Sided Facial Pain and Headache
Single Most Likely Diagnosis
- Migraine: This is often characterized by unilateral headaches, which can be accompanied by facial pain. The fact that the pain is worse in the morning could be related to migraine patterns, as some people experience migraine attacks at specific times of the day, including morning.
Other Likely Diagnoses
- Tension-Type Headache: These headaches are often described as a band or a squeezing sensation around the forehead, usually bilateral but can be unilateral, and may involve facial pain. Morning worsening could be due to increased muscle tension during sleep.
- Temporomandibular Joint (TMJ) Disorder: TMJ disorders can cause pain in the face, jaw, and temples, which can be worse in the morning due to clenching or grinding teeth during sleep.
- Sinusitis: Although typically associated with more nasal symptoms, sinusitis can cause facial pain and headache, especially if the sinuses on one side are more affected. Morning worsening could be due to increased mucous production overnight.
Do Not Miss Diagnoses
- Giant Cell Arteritis: Although less common, this condition can cause unilateral headaches and facial pain, especially in older adults. It's crucial to consider this diagnosis due to the risk of vision loss if not promptly treated.
- Temporal Lobe Epilepsy: Rarely, seizures can manifest as unilateral headaches or facial pain. The morning worsening could be coincidental or related to sleep patterns.
- Cranial Arteritis or Other Vasculitides: These conditions can cause headaches and facial pain, often with other systemic symptoms. They are important to diagnose early to prevent complications.
Rare Diagnoses
- Trigeminal Neuralgia: Characterized by sudden, severe, shock-like pain around the eyes, lips, or nose, usually on one side of the face. It's less likely given the description of "dull intermittent" pain but should be considered if the pain pattern changes.
- Raeder’s Syndrome: A rare condition involving facial pain, usually accompanied by other symptoms like ptosis and miosis. It's a diagnosis of exclusion and would require further investigation.
- Occipital Neuralgia: Involves pain in the distribution of the occipital nerves, which could potentially cause unilateral headache and facial pain, though it's more typically described as sharp and stabbing.