Differential Diagnosis for Severe Headache and Nausea/Vomiting
Single Most Likely Diagnosis
- Migraine: This is often the first consideration for severe headaches accompanied by nausea and vomiting, especially if the patient has a history of similar episodes. Migraines can be extremely painful and are frequently associated with gastrointestinal symptoms.
Other Likely Diagnoses
- Tension Headache: While typically less severe than migraines, tension headaches can cause significant discomfort and may be accompanied by nausea, especially if the headache is severe or persistent.
- Viral Gastroenteritis: Although primarily causing gastrointestinal symptoms, severe cases of viral gastroenteritis can lead to headaches due to dehydration and electrolyte imbalances.
- Sinusitis: Inflammation of the sinuses can cause severe headaches, often accompanied by nausea and vomiting, especially if there is significant pressure or infection.
Do Not Miss Diagnoses
- Subarachnoid Hemorrhage: A life-threatening condition that requires immediate medical attention. It presents with a sudden, severe headache (often described as "the worst headache of my life") and can be accompanied by nausea and vomiting.
- Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, which can present with severe headache, nausea, vomiting, and fever. It is critical to diagnose and treat promptly to prevent serious complications or death.
- Brain Tumor: Although less common, a brain tumor can cause severe headaches, nausea, and vomiting, especially if it increases intracranial pressure or causes obstructive hydrocephalus.
Rare Diagnoses
- Idiopathic Intracranial Hypertension (IIH): A condition characterized by increased pressure within the skull without a detectable cause. It can lead to severe headaches, nausea, and vomiting, often accompanied by visual disturbances.
- Cerebral Venous Sinus Thrombosis: A rare condition involving a blood clot in the brain's venous sinuses, which can cause severe headache, nausea, and vomiting, and requires prompt anticoagulation therapy.
- Temporal Arteritis: An inflammation of the blood vessels in the head, which can cause severe headaches and is more common in older adults. It can lead to blindness if not treated promptly.