Differential Diagnosis for the 42-year-old Woman with Worsening Headaches
Single Most Likely Diagnosis
- Tension-Type Headaches or Medication Overuse Headaches: The patient's description of constant, pressure-like headaches localized behind the forehead and eyes, along with the recent increase in frequency and severity of headaches, suggests tension-type headaches. The daily use of acetaminophen and ibuprofen could also indicate medication overuse headaches, which often present with similar symptoms.
Other Likely Diagnoses
- Migraines: Given the patient's family history of migraines (her mother suffered from migraines), the throbbing nature of her headaches, and associated symptoms like nausea and vomiting, migraines are a plausible diagnosis. However, the lack of typical migraine features such as aura, photophobia, or phonophobia makes this less likely than tension-type or medication overuse headaches.
- Hypertension-Related Headaches: The patient's elevated blood pressure (155/98 mm Hg) could be contributing to her headaches, as hypertension is known to cause or exacerbate headache symptoms.
- Stress-Related Headaches: The patient's significant stress at work could be a contributing factor to her headaches, given the well-established link between stress and headache disorders.
Do Not Miss Diagnoses
- Brain Tumors (e.g., Meningioma): Although less likely, given the patient's mother had surgery for a meningioma, it's crucial to consider the possibility of a brain tumor, especially with symptoms like blurry vision and worsening headaches. Meningiomas can cause increased intracranial pressure, leading to headaches and visual disturbances.
- Idiopathic Intracranial Hypertension (IIH): The patient's symptoms of blurry vision, headaches, and the absence of other explanatory findings, along with her elevated BMI, suggest the possibility of IIH, a condition characterized by elevated intracranial pressure without a detectable cause.
- Giant Cell Arteritis: Although the patient is somewhat young for this condition, giant cell arteritis can cause headaches, visual disturbances, and is a medical emergency due to the risk of blindness if not promptly treated.
Rare Diagnoses
- Pituitary Apoplexy or Pituitary Tumors: These conditions can cause sudden and severe headaches, visual disturbances, and are medical emergencies. However, they are less likely given the gradual onset of symptoms in this patient.
- Cervicogenic Headaches: Although possible, these headaches are less likely given the lack of specific cervical spine symptoms or findings on examination.
- Temporal Arteritis: Similar to giant cell arteritis but typically presents in older individuals, this condition could be considered but is less likely due to the patient's age.