Differential Diagnosis for 13-year-old with Worst Headache of Life

Single Most Likely Diagnosis

• Viral meningitis: This is a common cause of severe headache in adolescents, often accompanied by fever, neck stiffness, and photophobia. The diagnosis is likely due to the age of the patient and the presentation of the headache.

Other Likely Diagnoses

• Tension headache: Although typically less severe, tension headaches can be debilitating and are common in adolescents, often related to stress, poor posture, or other factors.
• Migraine: Migraines can cause severe headaches and are prevalent in the adolescent population, sometimes triggered by specific factors such as certain foods, stress, or hormonal changes.
• Sinusitis: Infections of the sinuses can lead to severe headaches, especially if the sinuses are obstructed or infected, and are a common issue in adolescents.

Do Not Miss Diagnoses

• Subarachnoid hemorrhage: Although rare, a subarachnoid hemorrhage is a medical emergency that can present with a sudden, severe headache (often described as "the worst headache of my life") and requires immediate attention.
• Brain tumor: While less common, brain tumors can cause severe headaches due to increased intracranial pressure, especially if they obstruct the flow of cerebrospinal fluid.
• Idiopathic intracranial hypertension (IIH): Also known as pseudotumor cerebri, IIH can cause severe headaches due to increased pressure within the skull without any obvious cause, and it's crucial not to miss this diagnosis due to its implications for vision and brain health.
• Meningococcal meningitis: This is a severe, potentially life-threatening infection that requires immediate medical attention, characterized by a severe headache, fever, and stiff neck.

Rare Diagnoses

• Arteriovenous malformation (AVM): A rare condition where there's an abnormal connection between arteries and veins in the brain, which can cause a severe headache if it ruptures.
• Pituitary apoplexy: A rare condition where there's sudden hemorrhage or infarction of the pituitary gland, leading to a severe headache, often accompanied by visual disturbances and acute hormonal deficiencies.
• Cerebral venous sinus thrombosis: A rare cause of headache due to a blood clot in the venous sinuses of the brain, which can be life-threatening and requires prompt diagnosis and treatment.