Differential Diagnosis for Recurring Painful Headache
Single Most Likely Diagnosis
- Tension Headache: This is the most likely diagnosis due to the location of the pain in the occipital lobe, the recurrent nature, and the temporary relief provided by ibuprofen. Tension headaches are common and often involve the occipital region.
Other Likely Diagnoses
- Migraine: Although migraines are typically unilateral and can involve other symptoms like nausea and photophobia, some variants can present with occipital pain and respond to ibuprofen. The waking from sleep in pain could also suggest migraine.
- Cervicogenic Headache: Given the occipital location, cervicogenic headache is a possibility. This type of headache is referred from the cervical spine and can be exacerbated by certain neck movements or postures.
- Occipital Neuralgia: This condition involves inflammation of the occipital nerves and can cause severe, sharp pain in the occipital region. It might wake patients from sleep and could be temporarily relieved by ibuprofen.
Do Not Miss Diagnoses
- Subarachnoid Hemorrhage: Although less likely given the recurrent and temporarily relievable nature of the pain, subarachnoid hemorrhage is a critical diagnosis that must be considered, especially if there's a sudden onset of severe headache.
- Giant Cell Arteritis: This condition can cause severe headaches, often in the temporal region but potentially in the occipital region, and is a medical emergency due to the risk of vision loss.
- Meningitis: Infection of the meninges can cause severe headache, fever, and neck stiffness. Although the symptoms described don't fully align, meningitis is a diagnosis that cannot be missed due to its severity.
Rare Diagnoses
- Chiari Malformation: A structural defect in the cerebellum that can cause headaches, often occipital, due to compression of the cerebellum and brainstem.
- Trigeminal Neuralgia: While typically involving the face, in rare cases, the pain can radiate to the occipital region, causing severe, stabbing pain.
- Hypnic Headache: A rare headache disorder that wakes patients from sleep, typically occurring in older adults, and can be located in any region of the head, including the occipital lobe.