Differential Diagnosis for a 34-year-old Patient with Dizziness, Headache, and Blurry Vision

Single Most Likely Diagnosis

• Migraine: This condition is a common cause of dizziness, headache, and visual disturbances, including blurry vision, in young adults. The symptoms presented are classic for a migraine episode, which can include an aura phase with visual symptoms.

Other Likely Diagnoses

• Tension Headache: While typically less severe than migraines, tension headaches can cause dizziness and blurry vision, especially if the headache is severe or persistent.
• Sinusitis: Inflammation of the sinuses can lead to headaches and, less commonly, to dizziness and visual disturbances due to the pressure and potential involvement of surrounding structures.
• Benign Paroxysmal Positional Vertigo (BPPV): This condition causes dizziness and vertigo, which might be accompanied by headache and, in some cases, visual disturbances due to the intense vertigo experienced.

Do Not Miss Diagnoses

• Subarachnoid Hemorrhage: Although less common, a sudden, severe headache (often described as "the worst headache of my life") accompanied by dizziness and visual disturbances could indicate a subarachnoid hemorrhage, which is a medical emergency.
• Stroke or Transient Ischemic Attack (TIA): Dizziness, headache, and visual disturbances can be symptoms of a stroke or TIA, especially if there are other neurological deficits. Prompt recognition is crucial for timely intervention.
• Multiple Sclerosis: This condition can present with a wide range of neurological symptoms, including dizziness, headache, and visual disturbances. While less common, it's a diagnosis that should not be missed due to its significant implications for patient management and prognosis.
• Giant Cell Arteritis: This condition, more common in older adults but possible in younger individuals, can cause headaches and visual disturbances, including blurry vision, and is a medical emergency due to the risk of permanent vision loss.

Rare Diagnoses

• Vestibular Migraine: A subtype of migraine that predominantly features vertigo, which can be accompanied by headache and visual symptoms.
• Chiari Malformation: A structural defect in the cerebellum that can cause dizziness, headache, and visual disturbances, among other symptoms.
• Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain, which can cause dizziness, headache, and visual symptoms due to its location and potential to compress nearby structures.