Differential Diagnosis for 32-year-old Female with Headache and Visual Symptoms
Single Most Likely Diagnosis
- Migraine with Aura: This diagnosis is likely due to the patient's history of migraines and the presence of blurred vision, floaters, and dizziness, which can be associated with migraine auras. However, the duration of 5 days is longer than typical migraines, which may suggest a complication or a different diagnosis.
Other Likely Diagnoses
- Tension Headache: Although the patient has a history of migraines, the headache could be a tension headache, especially if it has been persistent for 5 days. Tension headaches can cause blurred vision and nausea.
- Sinusitis: Sinus infections can cause headaches, blurred vision, and nausea, especially if the sinuses are putting pressure on the eyes or brain.
- Benign Intracranial Hypertension (Idiopathic Intracranial Hypertension): This condition is characterized by increased intracranial pressure without a detectable cause, often presenting with headache, blurred vision, and transient visual obscurations.
Do Not Miss Diagnoses
- Subarachnoid Hemorrhage: Although less likely, a subarachnoid hemorrhage (bleeding in the space surrounding the brain) can present with a sudden, severe headache, blurred vision, and nausea. It is a medical emergency.
- Pituitary Apoplexy: A condition where the pituitary gland suddenly hemorrhages or becomes infarcted, which can cause severe headache, visual disturbances, and nausea.
- Giant Cell Arteritis: An inflammatory condition affecting the blood vessels, particularly in older adults, but can occur in younger individuals. It can cause headaches, visual disturbances, and systemic symptoms.
Rare Diagnoses
- Vitreous Detachment: A condition where the vitreous gel in the eye separates from the retina, causing floaters and blurred vision. While not typically associated with headache and nausea, it could be considered if other symptoms are prominent.
- Occipital Lobe Seizures: Seizures originating from the occipital lobe can cause visual disturbances, including blurred vision and floaters, along with headache and nausea.
- Cerebral Venous Thrombosis: A blood clot in the veins of the brain, which can cause headache, visual disturbances, and seizures. It is more common in individuals with hypercoagulable states or other risk factors.