Differential Diagnosis for Headache and Associated Symptoms
The patient presents with a severe headache, neck pain, chills, and nausea. Considering these symptoms, the differential diagnosis can be categorized as follows:
Single Most Likely Diagnosis
- Tension headache: This is often characterized by bilateral temple pain, neck pain, and can be severe. The presence of chills and nausea, however, is less typical but can occur in more severe cases or if the headache is exacerbated by other factors such as stress or lack of sleep.
Other Likely Diagnoses
- Migraine: Although migraines are typically unilateral, some patients may experience bilateral pain. The severity of the headache, presence of nausea, and potential for neck pain as a migraine trigger or associated symptom make migraine a plausible diagnosis.
- Viral meningitis: The combination of severe headache, neck pain (which could be indicative of nuchal rigidity), chills, and nausea could suggest a diagnosis of viral meningitis, especially if the patient has been exposed to someone with a similar illness.
- Sinusitis: If the headache is primarily in the temples and forehead, sinusitis could be a consideration, especially with associated symptoms like chills and nausea, although neck pain would be less commonly a primary complaint.
Do Not Miss Diagnoses
- Subarachnoid hemorrhage: Although less likely given the absence of a reported "thunderclap" headache onset, this condition is critical to rule out due to its high morbidity and mortality. Severe headache, neck pain, and nausea could be presenting symptoms.
- Meningitis (bacterial): Similar to viral meningitis but with potentially more severe consequences if not promptly treated. The presence of chills could indicate a bacterial infection.
- Encephalitis: Inflammation of the brain tissue, which could present with severe headache, fever, chills, and nausea, among other symptoms.
Rare Diagnoses
- Temporal arteritis: This condition, more common in older adults, involves inflammation of the blood vessels in the temples and can cause severe headache, but it would be unusual for it to present with chills.
- Occipital neuralgia: Involves the nerves that run from the base of the skull to the scalp and could cause severe headache and neck pain, but typically does not present with systemic symptoms like chills and nausea.
- Brain tumor: Although extremely rare as a cause of new-onset headache without other neurological deficits, it is a diagnosis that must be considered, especially if the headache is persistent and worsening over time.