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
  • Tension headache: The headache is described as frontal, constant, and severe, which is consistent with a tension headache. The absence of nausea, vomiting, visual disturbances, and other neurological symptoms also supports this diagnosis. The patient's use of Nurofen, an over-the-counter pain reliever, may indicate a self-diagnosed tension headache.
• Other Likely diagnoses
  • Migraine: Although the patient denies any family history of migraines, it is still possible that this could be a migraine headache. The severity of the headache and the desire to lie down are consistent with migraine symptoms.
  • Viral illness: The patient's symptoms of headache, lightheadedness, and dizziness could be indicative of a viral illness, such as a viral upper respiratory tract infection.
  • Dehydration: The patient's symptoms could also be related to dehydration, particularly if they have not been drinking enough fluids.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Subarachnoid hemorrhage: Although the patient has no recent head trauma or injury, a subarachnoid hemorrhage is a potentially life-threatening condition that must be considered in the differential diagnosis.
  • Meningitis: The patient's symptoms of headache and lightheadedness could be indicative of meningitis, particularly if they have a fever, which is not present in this case.
  • Brain tumor: A brain tumor is a rare but potentially life-threatening condition that could cause headache, lightheadedness, and dizziness.
• Rare diagnoses
  • Temporomandibular joint disorder: This condition can cause headache and facial pain, but it is less likely given the patient's symptoms and examination findings.
  • Postural orthostatic tachycardia syndrome (POTS): This condition can cause dizziness, lightheadedness, and headache, but it is relatively rare and would require further evaluation to diagnose.
  • Chiari malformation: This is a rare condition that can cause headache, dizziness, and lightheadedness, but it is typically associated with other neurological symptoms and would require imaging studies to diagnose.