Differential Diagnosis
- Single most likely diagnosis
- Migraines: The patient reports a bandlike, throbbing headache that is exacerbated by stress and has been ongoing for 7 years. The lack of associated symptoms such as double vision and the fact that the pain is not affected by time also points towards migraines.
- Other Likely diagnoses
- Tension headaches: The patient's description of a bandlike headache could also be consistent with tension headaches, especially given the stress exacerbation.
- Sinus headaches: Although the patient does not report any associated sinus symptoms, sinus headaches can sometimes present with similar characteristics.
- Hormonal headaches: The patient's report of having two menses this month and wondering if it's related to her IUD could suggest hormonal fluctuations, which can lead to headaches.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage: Although the patient's headache characteristics do not strongly suggest a "thunderclap" headache, it's essential to consider this diagnosis due to its high mortality rate.
- Temporal arteritis: The patient's age and lack of other symptoms make this less likely, but it's crucial to consider due to the potential for vision loss.
- Pseudotumor cerebri: The patient's report of bilateral swelling and ongoing lower extremity symptoms could be unrelated, but pseudotumor cerebri can cause headaches and vision changes.
- Rare diagnoses
- Occipital neuralgia: The patient's description of a bandlike headache could be consistent with occipital neuralgia, although this is a less common condition.
- Trigeminal neuralgia: Although the patient denies double vision, trigeminal neuralgia can cause severe, throbbing headaches, usually with other facial symptoms.