Differential Diagnosis for Intermittent Stabbing Pain in Top Right Side of Head
Single Most Likely Diagnosis
- Tension Headache: Given the description of intermittent stabbing pain and the absence of alarming features on the head CT, tension headache is a plausible diagnosis. It's common in the general population, and hypertension, while relevant for other conditions, doesn't directly point away from this diagnosis.
Other Likely Diagnoses
- Migraine: Although migraines are typically described as throbbing and unilateral, they can present with a variety of pain characteristics, including stabbing. The normal head CT helps but doesn't rule out migraine.
- Trigeminal Neuralgia: This condition is characterized by sudden, severe, stabbing pain typically in one side of the face, which could potentially be referred to the top of the head. It's more common in older adults.
- Hypertension-related Headache: While less common, severe hypertension can cause headaches, typically described as occipital, but could potentially be referred to other areas of the head.
Do Not Miss Diagnoses
- Temporal Arteritis (Giant Cell Arteritis): This is a critical diagnosis to consider in any patient over 50 with new-onset headache, given its potential to cause blindness if not promptly treated. The pain is often described as temporal and can be stabbing.
- Subarachnoid Hemorrhage or Other Intracranial Hemorrhage: Although the head CT is normal, it's essential to consider the possibility of a hemorrhage that might not be visible on a non-contrast CT, especially if the scan was done some time after the onset of pain.
- Stroke or Transient Ischemic Attack (TIA): Headache can be a feature of stroke or TIA, especially if related to hypertension. The sudden onset of stabbing pain could be a warning sign.
Rare Diagnoses
- Occipital Neuralgia: Involves the nerves that run from the base of the skull to the scalp and can cause stabbing pain, typically on one side of the head.
- Primary Thunderclap Headache: Characterized by a very severe headache that reaches its maximum intensity within a minute, often described as the worst headache of the patient's life. It's rare but can be associated with various conditions, including subarachnoid hemorrhage.
- Cervicogenic Headache: Refers to pain perceived in the head but originating from the cervical spine. The pain can be stabbing and is often related to specific movements or postures of the neck.