Differential Diagnosis for Sudden Onset Headache
- Single most likely diagnosis
- Migraine: Although migraines typically have a more gradual onset, some individuals may experience an abrupt start. The bilateral temple pain, nausea, and high pain intensity are consistent with migraine symptoms. However, the presence of neck pain and chills is less typical.
- Other Likely diagnoses
- Tension headache: The bilateral temple pain and neck pain could suggest a tension headache, but the sudden onset and severity of the pain are unusual for this condition.
- Cluster headache: Cluster headaches are known for their severe, unilateral pain, but some cases can present with bilateral pain. The sudden onset and high pain intensity are consistent with cluster headaches.
- Sinus headache: The bilateral temple pain and presence of chills could suggest a sinus headache, possibly due to an acute sinus infection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage (SAH): A sudden, severe headache (often described as "the worst headache of my life") can be a symptom of SAH. Although the bilateral temple pain is not typical, the sudden onset and high pain intensity warrant consideration of this diagnosis.
- Meningitis: The presence of chills, neck pain, and severe headache could suggest meningitis, especially if the patient has a fever or other signs of infection.
- Temporal arteritis: This condition can cause severe, sudden-onset headaches, often accompanied by jaw claudication, visual disturbances, and systemic symptoms like fever and chills.
- Rare diagnoses
- Thunderclap headache due to reversible cerebral vasoconstriction syndrome (RCVS): This condition is characterized by a sudden, severe headache, often accompanied by neurological symptoms. It is a rare but important consideration in patients with sudden-onset headaches.
- Cervicogenic headache: This type of headache is caused by referred pain from the cervical spine and can present with sudden onset, severe pain, and neck pain. However, it is less likely to be accompanied by systemic symptoms like chills.