Differential Diagnosis for Headache
Single most likely diagnosis
- Tension headache: This is the most common type of headache and is often characterized by a mild to moderate, band-like pressure around the head, including the posterior aspect and behind the eyes, which matches the patient's symptoms. The severity of 2/10 also aligns with typical presentations of tension headaches.
Other Likely diagnoses
- Migraine: Although migraines are typically more severe and often unilateral, some patients may experience mild or atypical migraines that could present with bilateral pain behind the eyes and in the posterior head.
- Cervicogenic headache: Given the location of the pain in the posterior head, a cervicogenic headache, which originates from the cervical spine, is a plausible diagnosis. These headaches can also refer pain to the eye region.
- Sinus headache: Sinusitis can cause headaches that are felt behind the eyes and in the facial area, although the posterior head involvement is less typical. The severity and duration could still fit a chronic or mild sinusitis picture.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Subarachnoid hemorrhage (SAH): Although the severity is low and the duration is long, which makes SAH less likely, any new headache deserves consideration of this diagnosis due to its high morbidity and mortality. Typically, SAH presents with a sudden, severe headache, but atypical presentations can occur.
- Brain tumor: A brain tumor could cause increased intracranial pressure leading to headaches. The gradual onset over weeks could fit this diagnosis, although the mild severity is less typical.
- Temporal arteritis: This condition, especially in older adults, can cause new-onset headaches and is a medical emergency due to the risk of vision loss. The headache is often unilateral but can be bilateral and may not always have the typical features of jaw claudication or visual symptoms.
Rare diagnoses
- Occipital neuralgia: This condition involves the nerves that run from the base of the skull to the scalp and can cause pain in the posterior head. It's less common and might not typically cause pain behind the eyes, but it could be considered in the differential.
- Chiari malformation: A structural defect in the cerebellum that controls balance can cause headaches, often worsened by coughing or straining. These are typically more severe and may have associated neurological symptoms, but mild cases could be considered in a broad differential.