What is the likely diagnosis and treatment for a 23-year-old male with a 2-day history of upper respiratory-like illness, presenting with a generalized headache in the upper temporal region that worsens with pressure and lasts about an hour?

Likely Diagnosis: Migraine Without Aura (Not Tension-Type Headache)

This presentation is most consistent with migraine without aura, not tension-type headache, and naproxen is an appropriate first-line treatment for acute management. 1, 2

Why This Is Migraine, Not Tension-Type Headache

The key diagnostic feature that distinguishes this case is aggravation by routine physical activity (stretching, heavy lifting), which is a cardinal feature of migraine but explicitly absent in tension-type headache 1:

• Migraine diagnostic criteria require headache that is "aggravated by or causing avoidance of routine physical activity" 1
• Tension-type headache is characterized by pain that is not aggravated by routine physical activity and is described as pressing/tightening (like a "tight band"), not worsened by movement 3, 4

Additional features supporting migraine:

• Duration of approximately one hour fits within the 4-72 hour range for migraine attacks 1
• Temporal region involvement is consistent with unilateral location typical of migraine 1
• Association with URI suggests possible viral trigger, which can precipitate migraine attacks 1

Appropriate Acute Treatment Strategy

NSAIDs like naproxen are recommended as first-line therapy for acute migraine 1, 2:

• The American Academy of Neurology and Nature Reviews Neurology guidelines recommend NSAIDs (including naproxen, ibuprofen, diclofenac) as first-line acute treatment for migraine 1, 2
• Naproxen 500-550 mg is an appropriate dose for acute migraine management 1
• Consider adding an antiemetic if nausea develops, as this potentiates analgesic effects 4

Critical Management Pitfall to Avoid

Do not use analgesics more than 2 days per week to prevent medication overuse headache and progression to chronic daily headache 4, 5:

• Using pain relievers more than twice weekly significantly increases risk of chronic daily headache 4
• If headaches occur ≥2 days per month causing disability, preventive therapy should be considered rather than increasing acute medication frequency 2

When to Escalate Treatment

If naproxen fails after 3 consecutive attacks, the American College of Physicians recommends adding a triptan to the NSAID regimen for moderate to severe migraine 1:

• Combination therapy (triptan + NSAID) is superior to monotherapy for patients not responding adequately to NSAIDs alone 1
• This represents a strong recommendation with moderate-certainty evidence 1

Red Flags That Would Change Management

This patient does not have concerning features requiring urgent neuroimaging, but be vigilant for 6:

• Positional worsening when lying down (suggests increased intracranial pressure)
• Failure to respond to multiple medication classes with different mechanisms
• New neurological deficits
• Sudden onset "thunderclap" pattern