Differential Diagnosis for 30 y/o with Orbital Headache
- Single most likely diagnosis:
- Cluster headache: The patient's symptoms of sharp, stabbing, and radiating pain to the cheek and jaw, worsened by alcohol, along with ptosis, miosis, and anhydrosis, are classic for cluster headaches. The presence of photophobia and the specific characteristics of the pain also support this diagnosis.
- Other Likely diagnoses:
- Migraine: Although migraines typically present with more diffuse headaches, some variants can cause localized pain. The presence of photophobia, phonophobia, and potential scotoma could suggest a migraine, especially if the patient experiences aura symptoms.
- Trigeminal neuralgia: This condition causes sharp, stabbing pain in the face, which could radiate to the jaw and cheek. However, it typically does not cause the autonomic symptoms (ptosis, miosis, anhydrosis) seen in this patient.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Temporal arteritis: Although less common in a 30-year-old, temporal arteritis can cause severe headaches and should be considered due to its potential for serious complications, including vision loss.
- Cavernous sinus thrombosis: This rare but life-threatening condition can cause headache, ptosis, and other cranial nerve deficits. Its consideration is crucial due to the high morbidity and mortality associated with it.
- Rare diagnoses:
- Raeder's syndrome: A rare condition characterized by a combination of migraine, trigeminal neuralgia, and sympathetic dysfunction, which could explain some of the patient's symptoms.
- SUNCT (Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing) or SUNA (Short-lasting Unilateral Neuralgiform headache attacks with cranial autonomic features): These are rare headache disorders that could present with some of the symptoms described, including sharp pain and autonomic features.