Differential Diagnosis

The patient presents with a three-day history of headache, lightheadedness, and dizziness. Based on the symptoms and examination findings, the following differential diagnoses are considered:

• Single most likely diagnosis
  • Migraine: Although there is no family history, the patient's symptoms of a severe, constant frontal headache with a desire to lie down are consistent with migraine. The lack of nausea, vomiting, and visual disturbances does not rule out migraine, as these symptoms can vary widely between individuals.
• Other Likely diagnoses
  • Tension headache: The patient's headache is described as constant and frontal, which could be consistent with a tension headache. However, the severity of the headache (8/10) and the presence of lightheadedness and dizziness make migraine a more likely diagnosis.
  • Viral illness: The patient denies fever and rhinorrhoea, but a viral illness could still be a possible cause of the headache. However, the lack of other symptoms such as fatigue, sore throat, or body aches makes this less likely.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Subarachnoid hemorrhage: Although the patient has no history of head trauma and the headache is not described as "thunderclap," subarachnoid hemorrhage is a potentially life-threatening condition that must be considered. The presence of lightheadedness and dizziness could be indicative of increased intracranial pressure.
  • Meningitis: The patient denies fever, but meningitis can present with headache and lightheadedness. The lack of other symptoms such as neck stiffness, photophobia, or confusion makes this less likely, but it is still a critical diagnosis to consider.
  • Brain tumor: A brain tumor could cause headache, lightheadedness, and dizziness, especially if it is causing increased intracranial pressure. Although the patient has no other symptoms such as seizures, weakness, or changes in vision, a brain tumor is a possible diagnosis that must be considered.
• Rare diagnoses
  • Temporal arteritis: This condition is rare in children, but it can cause headache, lightheadedness, and dizziness. The patient's age and lack of other symptoms such as jaw claudication or visual disturbances make this diagnosis less likely.
  • Pseudotumor cerebri: This condition can cause headache, lightheadedness, and dizziness, especially in children. However, the patient has no other symptoms such as papilledema, visual disturbances, or tinnitus, making this diagnosis less likely.