Differential Diagnosis for Headaches
When evaluating headaches, it's crucial to consider a wide range of potential causes to ensure accurate diagnosis and appropriate treatment. The differential diagnosis can be organized into the following categories:
- Single Most Likely Diagnosis
- Tension headache: This is the most common type of headache and is often characterized by a band-like pressure around the forehead, back of the neck, or both. It's usually related to stress, poor posture, or muscle tension.
- Other Likely Diagnoses
- Migraine: A neurological condition characterized by intense, debilitating headaches, often accompanied by nausea, vomiting, and sensitivity to light or sound.
- Cluster headache: A rare but severe type of headache that occurs in cycles or clusters, often waking the patient from sleep and typically affecting one side of the head.
- Sinus headache: Caused by inflammation or infection of the sinuses, leading to pain and pressure in the face and head.
- Medication overuse headache: Also known as rebound headache, this occurs when frequent or excessive use of headache medications leads to worsening headache frequency or intensity.
- Do Not Miss Diagnoses
- Subarachnoid hemorrhage: A life-threatening condition caused by bleeding into the space surrounding the brain, often presenting with a sudden, severe headache (thunderclap headache).
- Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, which can be caused by infection and presents with headache, fever, and stiff neck.
- Temporal arteritis: Inflammation of the blood vessels in the head, which can lead to blindness if not promptly treated, presenting with headache, jaw claudication, and visual disturbances.
- Brain tumor: Although rare, headaches can be a symptom of brain tumors, especially if they are large or located in areas that affect cranial nerves or brain structures.
- Rare Diagnoses
- Trigeminal neuralgia: A chronic pain condition that affects the trigeminal nerve, causing intense shock-like or stabbing pain in parts of the face.
- Occipital neuralgia: Inflammation of the occipital nerves, leading to pain in the back and top of the head.
- Hypnic headache: A rare type of headache that occurs only during sleep and wakes the patient, typically affecting older adults.
- New daily persistent headache: A rare type of chronic headache that starts suddenly and persists daily, often without any identifiable cause.
Each of these diagnoses has distinct characteristics and requires careful consideration based on the patient's symptoms, medical history, and physical examination findings.