Differential Diagnosis for Intractable Headache
Single Most Likely Diagnosis
- Tension-Type Headache: This is often the most common cause of intractable headache, characterized by a dull, aching pain on both sides of the head, typically without other symptoms. It's related to muscle tension and stress.
Other Likely Diagnoses
- Migraine: A common cause of severe, recurrent headaches, often accompanied by sensitivity to light, sound, or nausea. Migraines can be intractable if not properly managed.
- Chronic Daily Headache: This includes a variety of headache disorders that occur 15 days or more per month, such as chronic migraine, chronic tension-type headache, and new daily persistent headache.
- Medication Overuse Headache: Also known as rebound headache, this occurs when frequent or excessive use of headache medications leads to worsening headache frequency and intensity.
- Sinusitis: Inflammation or infection of the sinuses can cause headaches, often accompanied by facial pain, nasal congestion, and fever.
Do Not Miss Diagnoses
- Subarachnoid Hemorrhage: A life-threatening condition caused by bleeding into the space surrounding the brain, often presenting with a sudden, severe headache (thunderclap headache).
- Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, which can cause severe headache, fever, and stiff neck.
- Temporal Arteritis: Inflammation of the blood vessels in the head, which can cause severe headache, visual disturbances, and jaw claudication, particularly in older adults.
- Brain Tumor: Although rare, a tumor in the brain can cause intractable headache, often accompanied by other neurological symptoms such as seizures, confusion, or focal deficits.
- Idiopathic Intracranial Hypertension: Increased pressure within the skull without a detectable cause, leading to headache, vision changes, and sometimes papilledema.
Rare Diagnoses
- Trigeminal Neuralgia: A chronic pain condition that affects the trigeminal nerve, causing intense, shock-like or stabbing pain in parts of the face.
- Hemicrania Continua: A rare headache disorder characterized by a continuous, one-sided headache with periods of exacerbation.
- Cervicogenic Headache: A headache caused by referred pain from the cervical spine, often accompanied by neck pain and limited range of motion.
- Pseudotumor Cerebri: Similar to idiopathic intracranial hypertension but with a known cause, such as a medication side effect or certain medical conditions.
- Eagle Syndrome: A rare condition where an elongated styloid process or calcified stylohyoid ligament causes headache, often accompanied by facial pain and dysphagia.