Differential Diagnosis for Unilateral Headache Behind the Eye
- Single Most Likely Diagnosis + Migraine: This is often characterized by unilateral headaches, which can be localized behind the eye. The pain is typically throbbing and can be accompanied by sensitivity to light, sound, or nausea.
- Other Likely Diagnoses + Cluster Headache: Known for severe, unilateral pain often described as being behind or around the eye. It's usually accompanied by autonomic symptoms like nasal congestion or eye watering on the same side. + Tension-Type Headache: Although typically bilateral, tension-type headaches can occasionally present unilaterally and may cause pain that feels like it's behind the eye due to referral patterns from the neck and scalp muscles. + Sinusitis: Inflammation of the sinuses, especially the frontal or ethmoid sinuses, can cause pain that feels like it's behind the eye. This is often accompanied by other symptoms like nasal congestion, facial pressure, and fever.
- Do Not Miss Diagnoses + Temporal Arteritis (Giant Cell Arteritis): This condition can cause severe, unilateral headaches and is a medical emergency due to the risk of vision loss if not promptly treated. It typically affects older adults and may be accompanied by jaw claudication or visual disturbances. + Acute Angle-Closure Glaucoma: A sudden, severe headache behind the eye, often accompanied by blurred vision, nausea, and vomiting. This is an ophthalmologic emergency requiring immediate treatment to prevent permanent vision loss. + Cavernous Sinus Thrombosis: A rare but potentially life-threatening condition that can cause headache, often with additional symptoms like fever, proptosis, and cranial nerve deficits.
- Rare Diagnoses + Trigeminal Neuralgia: Characterized by sudden, severe, shock-like pain around the eye, which can be triggered by light touch or certain movements. It's a rare condition but important to consider due to its distinct presentation. + Occipital Neuralgia: Involves the nerves that run from the base of the skull to the scalp and can cause pain that feels like it's behind the eye, although it more commonly presents in the back of the head. + Raeder's Syndrome: A rare condition that presents with a combination of facial pain (often behind the eye), ptosis, and miosis, usually due to a lesion affecting the sympathetic nerves in the face.