Differential Diagnosis for Right-Sided Occipital Region Headache
Single Most Likely Diagnosis
- Chronic Cluster Headaches or Trigeminal Autonomic Cephalalgias: Given the frequency (approximately 20 times per hour) and location (right-sided occipital region) of the headaches, this diagnosis is plausible. Cluster headaches are known for their severe, recurring pain, often on one side of the head, and can occur in older adults, though they typically start at a younger age.
Other Likely Diagnoses
- Tension-Type Headaches: These are common and can occur frequently, though their severity and specific location might not fully align with the patient's symptoms. However, the absence of other significant medical history makes this a consideration.
- Occipital Neuralgia: This condition involves inflammation or irritation of the occipital nerves, leading to pain in the back and side of the head. The intermittent but frequent nature of the pain could fit this diagnosis.
- Cervicogenic Headaches: These headaches are referred from the cervical spine and can present with unilateral pain, including in the occipital region, due to cervical spine dysfunction or disease.
Do Not Miss Diagnoses
- Giant Cell Arteritis (GCA): Although less common, GCA is a critical diagnosis to consider in an elderly patient due to its potential for serious complications, including vision loss. The new onset of headache in an older adult warrants consideration of GCA.
- Subarachnoid Hemorrhage or Other Intracranial Bleeds: Though the intermittent and frequent nature of the headaches might not classically suggest a hemorrhagic event, any new or severe headache in an elderly patient necessitates consideration of intracranial pathology due to the potential for catastrophic outcomes.
- Temporal Arteritis: Similar to GCA, temporal arteritis can present with headache and is a condition that requires prompt diagnosis and treatment to prevent serious complications.
Rare Diagnoses
- Hemicrania Continua: A rare form of headache disorder characterized by a continuous, often unilateral headache with periods of exacerbation. It's an unlikely but possible diagnosis given the description.
- Primary Thunderclap Headache: Characterized by a very severe headache that reaches its maximum intensity within a minute, this could be considered if the patient's headaches have a sudden, severe onset, though the frequency described is unusual for this condition.
- Chiari Malformation: A structural defect in the cerebellum that controls balance, could potentially cause headaches, especially those that are worsened by coughing or straining. However, this would be an unusual presentation without other neurological symptoms.