Differential Diagnosis for Bilateral Temporal Headache
Single Most Likely Diagnosis
- Tension Headache: This is the most common type of headache and often presents with bilateral temporal pain, typically described as a band or a squeezing sensation around the head. The pain is usually mild to moderate but can be severe, as in this case with a pain level of 10 out of 10.
Other Likely Diagnoses
- Migraine: Although migraines are often unilateral, they can be bilateral, especially in women. The severe pain level and potential for significant disability align with migraine characteristics.
- Cluster Headache: These are extremely painful headaches that occur in cycles or clusters, often waking the patient from sleep. They are typically unilateral but can be bilateral and are characterized by severe, piercing pain.
- Sinusitis: Inflammation of the sinuses can cause pain in the temples, forehead, and cheeks, which can be severe. This diagnosis is more likely if accompanied by other symptoms like nasal congestion, fever, or facial pressure.
Do Not Miss Diagnoses
- Subarachnoid Hemorrhage (SAH): A life-threatening condition caused by bleeding into the space surrounding the brain. Although the headache is typically described as "the worst headache of my life" and is often sudden in onset, it's crucial to consider SAH in any severe headache presentation.
- Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, which can present with a severe headache, fever, and stiff neck. Early diagnosis is critical for effective treatment.
- Temporal Arteritis (Giant Cell Arteritis): An inflammation of the blood vessels in the head, which can cause severe headaches, typically in older adults. It's essential to consider this diagnosis due to the risk of vision loss if not promptly treated.
Rare Diagnoses
- Trigeminal Neuralgia: A chronic pain condition that affects the trigeminal nerve, which can cause intense shock-like or stabbing pain in parts of the face, including the temples.
- Hemicrania Continua: A rare headache disorder characterized by a continuous, often severe, headache on one side of the head, but can occasionally be bilateral.
- Cervicogenic Headache: A headache caused by referred pain from the cervical spine, which can present with bilateral temporal pain if multiple cervical segments are involved.
Each of these diagnoses has distinct features, but the severity and location of the pain, along with associated symptoms, are crucial for narrowing down the differential diagnosis. A thorough medical history, physical examination, and, when necessary, diagnostic tests are essential for making an accurate diagnosis.