Differential Diagnosis for Sudden Onset Headache
- Single most likely diagnosis
- Migraine: The sudden onset of a severe headache, bilateral temple pain, neck pain, chills, and nausea are consistent with a migraine. The significant reduction in pain after taking Tylenol and ibuprofen also supports this diagnosis, as migraines often respond to over-the-counter pain medications.
- Other Likely diagnoses
- Tension headache: Although the pain is severe, the bilateral temple pain and neck pain could also be indicative of a tension headache. However, the sudden onset and associated symptoms like chills and nausea are less typical for tension headaches.
- Cluster headache: The severe pain and sudden onset could suggest a cluster headache, but the bilateral nature and the presence of chills and nausea are not typical for cluster headaches, which usually present unilaterally and without systemic symptoms like chills.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage (SAH): Although the CT head without contrast is negative, it's crucial to consider SAH, especially given the sudden onset of a severe headache. A lumbar puncture might be necessary to rule out SAH, as the CT scan can miss small bleeds, especially if the scan is done early after the onset of symptoms.
- Meningitis: The presence of chills, nausea, and a severe headache could suggest meningitis. This diagnosis is critical to consider and rule out promptly due to its potential for severe morbidity and mortality.
- Cervical artery dissection: This condition can present with sudden onset headache and neck pain. It's a critical diagnosis to consider because it can lead to stroke if not recognized and treated promptly.
- Rare diagnoses
- Temporal arteritis: This condition typically presents in older adults with a new onset of headache, often accompanied by jaw claudication and visual disturbances. It's less likely given the patient's symptoms but should be considered in the appropriate demographic.
- Primary thunderclap headache: A rare condition characterized by a very severe headache that reaches its maximum intensity within a minute, often without other symptoms. The diagnosis is one of exclusion, after ruling out other causes of thunderclap headache, such as SAH.