Differential Diagnosis for Posterior Headache
- Single most likely diagnosis
- Tension headache: This is the most common type of headache and often presents with a band-like pressure or tightness around the head, including the posterior region, usually due to muscle tension.
- Other Likely diagnoses
- Cervicogenic headache: Originates from the cervical spine and is referred to the posterior head due to the convergence of cervical and trigeminal nerve pathways.
- Occipital neuralgia: Involves the irritation of the occipital nerves, leading to sharp, stabbing pain in the posterior head.
- Migraine: Although migraines can present with unilateral pain, they can also be bilateral and include the posterior head, often accompanied by other symptoms like nausea and sensitivity to light.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage: A life-threatening condition that can present with a sudden, severe headache, often described as "the worst headache" of the patient's life, which may initially be posterior due to the distribution of blood in the subarachnoid space.
- Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, which can cause headache, including posterior headache, along with fever, neck stiffness, and altered mental status.
- Cervical spine fracture or instability: Especially in the context of trauma, which can lead to posterior headache due to the involvement of cervical structures.
- Rare diagnoses
- Chiari malformation: A structural defect in the cerebellum that controls balance, can cause posterior headache, especially with coughing or straining.
- Posterior fossa tumors: Although rare, tumors in this area can cause posterior headache due to increased intracranial pressure or direct compression of pain-sensitive structures.