Differential Diagnosis for Headache in the Frontal Region Worsening with Head Movement and Bending

• Single Most Likely Diagnosis
  • Tension headache: This is the most common type of headache and is often described as a band or a squeezing sensation around the forehead, worsening with head movement and bending due to increased muscle tension.
• Other Likely Diagnoses
  • Sinusitis: Inflammation of the sinuses can cause pain in the frontal region, which may worsen with head movement and bending due to increased pressure in the sinuses.
  • Migraine: Although migraines are typically unilateral, some patients may experience bilateral frontal pain, especially if the migraine is in its early stages or if it's a variant form. Movement can exacerbate migraine pain.
  • Cervicogenic headache: These headaches are referred from the cervical spine and can be exacerbated by movement, including head bending, due to the mechanical stress on the cervical structures.
• Do Not Miss Diagnoses
  • Subarachnoid hemorrhage: Although typically presenting with a sudden, severe headache (often described as "the worst headache of my life"), some cases might have a more gradual onset. Worsening with movement could be due to increased intracranial pressure.
  • Meningitis: Inflammation of the meninges can cause headache, fever, and stiff neck. The headache can worsen with movement due to irritation of the meninges.
  • Temporal arteritis: This condition, more common in older adults, involves inflammation of the blood vessels and can cause severe, unilateral headaches, but sometimes the pain can be bilateral and located in the frontal region. Jaw claudication and visual symptoms are red flags.
• Rare Diagnoses
  • Idiopathic intracranial hypertension (IIH): Characterized by increased intracranial pressure without a detectable cause, IIH can cause headaches that worsen with movement or bending due to increased cerebrospinal fluid pressure.
  • Chiari malformation: A structural defect in the cerebellum that controls balance can cause headaches, especially with coughing, sneezing, or straining, due to increased pressure on the brainstem and cerebellum.