Differential Diagnosis for Occipital Headache with Hypertension

• Single most likely diagnosis
  • Hypertensive headache: This is the most likely diagnosis because occipital headaches are often associated with hypertension, and the headache can be a direct result of elevated blood pressure.
• Other Likely diagnoses
  • Tension headache: Although tension headaches are typically bilateral and affect the frontal and temporal regions, they can also occur in the occipital region and may be exacerbated by hypertension.
  • Cervicogenic headache: This type of headache is referred from the cervical spine and can be felt in the occipital region, often accompanied by neck pain and stiffness.
  • Migraine: Migraines can present with occipital headache and are sometimes associated with hypertension, although the relationship is not fully understood.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Subarachnoid hemorrhage: Although less common, a sudden and severe occipital headache (often described as "the worst headache of my life") accompanied by hypertension could be indicative of a subarachnoid hemorrhage, which is a medical emergency.
  • Posterior reversible encephalopathy syndrome (PRES): This condition is associated with hypertension and can cause headaches, among other symptoms like seizures and visual disturbances. It requires prompt recognition and treatment to prevent permanent damage.
  • Hypertensive encephalopathy: A condition characterized by elevated blood pressure leading to brain edema, which can cause headache, confusion, and seizures. It is a medical emergency requiring immediate attention.
• Rare diagnoses
  • Occipital neuralgia: A condition characterized by inflammation of the occipital nerves, leading to severe, sharp, or stabbing pain in the occipital region. It is less common but should be considered in the differential diagnosis.
  • Giant cell arteritis: Although more commonly associated with temporal headaches, giant cell arteritis can occasionally present with occipital headache and is important to consider, especially in older adults, due to its potential to cause blindness if not treated promptly.