Differential Diagnosis for Headaches
- Single most likely diagnosis + Tension-type headache: This is the most likely diagnosis due to the characteristics of pressure pain, location at the back of the head, and alleviation with ibuprofen. The duration and severity of the headaches also align with tension-type headaches.
- Other Likely diagnoses + Migraine: Although the patient denies blurry vision, the presence of nausea, vomiting, and aggravation with movement are consistent with migraine. The severity of the headaches (7-8/10) also supports this diagnosis. + Cervicogenic headache: The location of the pain at the back of the head and aggravation with bending over or movement suggest a possible cervicogenic origin.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.) + Subarachnoid hemorrhage: Although the patient's symptoms have been present for a year, it's essential to consider this diagnosis due to the potential for catastrophic consequences if missed. However, the gradual onset and lack of sudden, severe headache ("thunderclap headache") make this less likely. + Brain tumor: A brain tumor could cause headaches that worsen with movement or bending over. Although rare, this diagnosis should be considered to avoid missing a potentially life-threatening condition. + Temporal arteritis: This condition can cause headaches, nausea, and vomiting, especially in older adults. Although the patient's age is not specified, this diagnosis should be considered due to the potential for serious complications if left untreated.
- Rare diagnoses + Occipital neuralgia: This condition involves inflammation of the occipital nerve and can cause headaches at the back of the head. However, it is relatively rare and typically presents with more localized pain and tenderness. + Chiari malformation: A congenital condition that can cause headaches, especially with coughing, sneezing, or bending over. However, this diagnosis is rare and typically presents with other symptoms such as dizziness, weakness, or numbness.