Differential Diagnosis for a Headache that Moves Around the Skull and Intermittently Zaps

• Single Most Likely Diagnosis
  • Migraine: This condition is characterized by recurrent episodes of severe headaches that can move around the skull, often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound. The "zapping" sensation could be attributed to the aura phase of a migraine, which can include neurological symptoms like tingling or flashing lights.
• Other Likely Diagnoses
  • Tension Headache: While typically described as a band or a squeezing sensation around the forehead, some individuals may experience tension headaches that move around the skull. The "zapping" could be due to muscle spasms.
  • Cluster Headache: Known for their severe, piercing pain, cluster headaches can occur on one side of the head and might be perceived as moving. However, they are usually more localized and accompanied by other symptoms like nasal congestion or eye watering.
  • Occipital Neuralgia: This condition involves inflammation of the occipital nerves, leading to pain that can feel like it's moving around the back and top of the skull. The "zapping" could be due to the direct irritation of these nerves.
• Do Not Miss Diagnoses
  • Subarachnoid Hemorrhage: Although less common, a sudden, severe headache (often described as "the worst headache of my life") could be indicative of bleeding in the brain. The moving, zapping sensation could be due to the initial bleed or subsequent irritation of brain tissues.
  • Temporal Arteritis: This condition, involving inflammation of the blood vessels in the head, can cause severe, moving headaches and should be considered, especially in older adults, due to the risk of vision loss if not promptly treated.
  • Meningitis: Inflammation of the protective membranes covering the brain and spinal cord can cause severe headache, fever, and stiff neck. The headache can be diffuse and might be perceived as moving.
• Rare Diagnoses
  • Trigeminal Neuralgia: Characterized by sudden, severe, shock-like pain around the eyes, lips, or nose due to irritation of the trigeminal nerve. While not typically described as moving around the entire skull, it could be considered if the pain is localized and has a "zapping" quality.
  • Hemicrania Continua: A rare form of headache disorder that involves continuous pain on one side of the head, with periods of exacerbation. It might be perceived as moving and could include autonomic symptoms like tearing or redness of the eye.
  • Idiopathic Stabbing Headache: Involves short, sharp stabs of pain that can occur anywhere in the head and might be perceived as "zapping." However, these are typically very brief and not necessarily moving around the skull.