Differential Diagnosis for Headache
- Single most likely diagnosis
- Migraine: The patient's history of occasional migraines, symptoms of headache worsened by bright lights and loud sounds, and "out of focus vision" are all consistent with a migraine diagnosis. The fact that ibuprofen provided some relief also supports this diagnosis, as migraines often respond to over-the-counter pain medications.
- Other Likely diagnoses
- Tension headache: The description of the headache as circumferential and radiating down the neck is consistent with tension headaches. However, the worsening of symptoms with sitting up, standing up, and the presence of "out of focus vision" are less typical for tension headaches.
- Cervicogenic headache: The worsening of pain when turning the head suggests a possible cervical origin of the headache, which could be related to musculoskeletal issues in the neck.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage: Although the patient's symptoms do not strongly suggest a subarachnoid hemorrhage (e.g., no report of a sudden, severe headache), this diagnosis must always be considered in the differential for headache, especially if there are any "red flag" symptoms such as sudden onset, worsening over time, or associated neurological deficits.
- Meningitis: The presence of headache, worsened by bright lights (photophobia), could suggest meningitis, although other typical symptoms such as fever, stiff neck, and altered mental status are not mentioned.
- Rare diagnoses
- Occipital neuralgia: This condition involves inflammation of the occipital nerves and can cause headache, especially in the back of the head, which might radiate to the sides. However, it is less common and typically presents with more localized pain and specific triggers such as pressure on the nerve.
- Chiari malformation: A structural defect in the cerebellum that can cause headaches, especially with coughing, sneezing, or straining, and can be worsened by certain positions. The "out of focus vision" and worsening pain with head movement could be suggestive, but this diagnosis would be less likely without other specific symptoms such as ataxia or lower cranial nerve dysfunction.