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Differential Diagnosis for Episode of Headache with Vomiting in a 70-year-old Male

Single Most Likely Diagnosis

  • Tension Headache: This is a common condition in the elderly, often presenting with a band-like pressure around the head, and can be accompanied by vomiting, especially if the headache is severe. The age and symptoms align with this diagnosis, making it a plausible first consideration.

Other Likely Diagnoses

  • Migraine: Although migraines are more common in younger populations, they can occur at any age. A migraine could present with headache and vomiting, and the late onset of migraines is not uncommon.
  • Gastrointestinal Issues: Conditions like gastroesophageal reflux disease (GERD), gastritis, or even food poisoning could lead to vomiting and might be accompanied by a headache due to pain or dehydration.
  • Urinary Tract Infection (UTI): In the elderly, UTIs can present with atypical symptoms, including headache and vomiting, especially if the infection has progressed to involve the kidneys (pyelonephritis).

Do Not Miss Diagnoses

  • Subarachnoid Hemorrhage: Although less likely, this is a critical diagnosis to consider due to its high mortality and morbidity. The sudden onset of a severe headache (often described as "the worst headache of my life") with vomiting could indicate a subarachnoid hemorrhage.
  • Meningitis: Infection of the meninges can present with headache, fever, and vomiting. In the elderly, the classic triad of symptoms (headache, fever, and neck stiffness) might not all be present, making diagnosis more challenging.
  • Brain Tumor: A new onset of headache with vomiting in an elderly individual could be indicative of a brain tumor, especially if there are other symptoms like seizures, confusion, or focal neurological deficits.

Rare Diagnoses

  • Temporal Arteritis (Giant Cell Arteritis): This condition, more common in individuals over 50, can cause headaches and might lead to vomiting if severe. It's also associated with jaw claudication, visual disturbances, and polymyalgia rheumatica.
  • Pituitary Apoplexy: A rare condition where there is sudden hemorrhage or infarction of the pituitary gland, which can present with a severe headache, vomiting, and visual disturbances.
  • Idiopathic Intracranial Hypertension (IIH): Although more common in young, obese females, IIH can occur in any demographic and presents with headache and vomiting, often worsened by maneuvers that increase intrathoracic pressure.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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