Differential Diagnosis for Whole Head Pounding and Vision Changes in a 60-Year-Old
Single Most Likely Diagnosis
- Tension Headache: This is often characterized by a band-like pressure around the head, which could be described as whole head pounding. Vision changes can sometimes accompany tension headaches due to the general increase in muscle tension, including the muscles around the eyes. The age and the nature of the symptoms make this a plausible first consideration.
Other Likely Diagnoses
- Migraine: Migraines can cause pounding headaches and are often associated with visual disturbances, including auras. While migraines are more common in younger populations, they can occur at any age, and the visual changes mentioned could align with migraine symptoms.
- Hypertension: High blood pressure can lead to headaches and, if severely elevated, can cause changes in vision due to the effect on the blood vessels in the eyes. Given the age of the patient, hypertension is a common condition that could explain these symptoms.
- Sinusitis: Inflammation of the sinuses can cause headaches and, due to the proximity of the sinuses to the eyes, can lead to vision changes or pressure sensations around the eyes.
Do Not Miss Diagnoses
- Giant Cell Arteritis: This condition, which involves inflammation of the arteries, can cause headaches and vision changes, including blindness if not promptly treated. It's more common in older adults, making it a critical diagnosis not to miss.
- Subarachnoid Hemorrhage: Although less common, a sudden, severe headache (often described as "the worst headache" of one's life) with possible vision changes could indicate a subarachnoid hemorrhage, which is a medical emergency.
- Temporal Arteritis: Similar to giant cell arteritis, temporal arteritis can cause headaches and vision changes. It's essential to consider this diagnosis due to the risk of permanent vision loss if left untreated.
Rare Diagnoses
- Idiopathic Intracranial Hypertension (IIH): This condition involves increased pressure within the skull without a detectable cause. It can lead to headaches and vision changes, including papilledema. While less common, it should be considered, especially if other diagnoses are ruled out.
- Cervicogenic Headache: These headaches originate from the cervical spine and can refer pain to the head, potentially causing a pounding sensation. Vision changes could occur if the headache affects the nerves that control eye movement or if there's associated muscle tension.
- Occipital Neuralgia: Inflammation of the occipital nerves can cause severe headaches and, due to the nerves' location, might lead to vision changes or sensitivity to light. This is less common but could be considered if other diagnoses do not fit.