Differential Diagnosis
- Single most likely diagnosis:
- Tension headache: The description of dull, persistent, but not debilitating headaches, primarily on the right side, which are relieved by Advil, suggests tension headaches. The recent increase in noticeability could be due to stress or other factors such as dehydration, which the patient acknowledges by stating they don't drink enough water.
- Other Likely diagnoses:
- Sinusitis: Given the sinus opacity found on dental imaging and the recommendation to use a neti pot, sinusitis is a possible cause of the headaches. However, the lack of significant nasal drainage or congestion makes this less likely.
- Migraine: Although the headaches are described as dull and not debilitating, some migraine variants can present with less severe pain. The unilateral nature of the headaches could also suggest migraines, but the lack of other migraine features (e.g., aura, nausea, photophobia) makes this less likely.
- Eustachian tube dysfunction: The patient's tinnitus, especially the description of a "very loud kind of tinnitus drone" that comes and goes, and the initial feeling of the neti pot solution in their ears, could suggest Eustachian tube dysfunction. This condition can also cause referred pain to the head and face.
- Do Not Miss diagnoses:
- Temporal arteritis: Although less likely given the patient's age and the nature of the headaches, temporal arteritis is a condition that should not be missed due to its potential for serious complications, including vision loss. The patient's history of an epiretinal membrane and visual distortion in one eye adds to the importance of considering this diagnosis.
- Brain tumor: Any new or changing headache pattern warrants consideration of a brain tumor, especially with the patient's report of increased noticeability of the headaches. The presence of tinnitus and the history of an epiretinal membrane, which could potentially be related to increased intracranial pressure, make this a critical diagnosis not to miss.
- Rare diagnoses:
- Chiari malformation: This condition can cause headaches, tinnitus, and other neurological symptoms. However, it is relatively rare and would typically be associated with more significant neurological findings.
- Trigeminal neuralgia: This condition causes intense pain in the face but can sometimes present with more dull, persistent pain. The unilateral nature of the headaches could suggest involvement of the trigeminal nerve, but the lack of characteristic sharp, stabbing pains makes this diagnosis less likely.