Differential Diagnosis for Severe Episodic Unilateral Headaches
Single Most Likely Diagnosis
- Migraine with Aura: This condition is characterized by severe, episodic headaches, often unilateral, and can be accompanied by aura symptoms such as blurry vision and dizziness. The worsening of symptoms with stress and masturbation can be attributed to the triggering of migraine attacks by various factors, including emotional and physical stress. The history of traumatic brain injuries (TBIs) may also contribute to the development or exacerbation of migraines.
Other Likely Diagnoses
- Cluster Headaches: These are severe, unilateral headaches that occur in clusters or cycles, and can be accompanied by autonomic symptoms. While they are more common in men, the triggers and associated symptoms described could fit this diagnosis, although the blurry vision and dizziness are less typical.
- Tension-Type Headaches: Although typically bilateral, tension-type headaches can occasionally present unilaterally and be exacerbated by stress. However, they are usually less severe than migraines and less likely to be associated with blurry vision and dizziness.
- Post-Traumatic Headaches: Given the patient's history of TBIs, post-traumatic headaches are a consideration. These can be similar to migraines or tension-type headaches in presentation and can be exacerbated by stress.
Do Not Miss Diagnoses
- Subarachnoid Hemorrhage (SAH): Although less likely given the episodic nature and the presence of triggers, SAH can present with sudden, severe headache and should always be considered, especially in the context of a history of head trauma.
- Temporal Arteritis: This condition can cause severe, unilateral headaches and visual disturbances, including blurry vision. It is more common in older adults but should be considered due to the potential for serious complications, including blindness.
- Pituitary Apoplexy: A rare but potentially life-threatening condition that can cause sudden, severe headache, visual disturbances, and other symptoms. The history of TBIs and the presence of triggers do not directly suggest this diagnosis, but it should be considered due to its severity.
Rare Diagnoses
- Trigeminal Neuralgia: Characterized by sudden, severe, unilateral facial pain, which can sometimes be mistaken for headache. It is less likely given the description of the pain as a headache and the associated symptoms.
- Hemicrania Continua: A rare headache disorder characterized by a continuous, unilateral headache with periods of exacerbation. It is less likely given the episodic nature of the headaches described.
- Sexual Headache: A rare condition that can cause severe headache in association with sexual activity. While masturbation is mentioned as a trigger, the other symptoms and the episodic nature of the headaches make this a less likely diagnosis.