Differential Diagnosis for Headaches Behind Eyes at Night, Worsened by Temperature Changes
- Single Most Likely Diagnosis
- Migraines: Often characterized by headaches that can occur at any time, including night, and can be exacerbated by various factors including temperature changes. The pain is typically unilateral but can be bilateral and is often described as being behind the eyes.
- Other Likely Diagnoses
- Tension Headaches: While typically less severe than migraines, tension headaches can occur at night and may worsen with stress or environmental changes, including temperature.
- Sinusitis: Inflammation of the sinuses can cause pain behind the eyes, especially if the ethmoid sinuses are involved. Temperature changes can exacerbate sinus pressure.
- Cluster Headaches: These are severe headaches that occur in clusters or cycles, often waking the patient from sleep. They are typically one-sided and can be felt behind the eye.
- Do Not Miss Diagnoses
- Temporal Arteritis (Giant Cell Arteritis): Although less common, this condition is critical to diagnose due to the risk of blindness. It typically presents with headache, jaw claudication, and visual disturbances, and can be exacerbated by temperature changes.
- Acute Angle-Closure Glaucoma: A medical emergency that can cause severe eye pain, often described as being behind the eye, and can be associated with nausea, vomiting, and blurred vision. Temperature changes or other factors that affect intraocular pressure can precipitate an attack.
- Rare Diagnoses
- Trigeminal Neuralgia: Characterized by sudden, severe, shock-like pain around the eyes, lips, or nose mainly because of abnormal blood vessels pressing on the trigeminal nerve in the head. It's less likely to be directly related to temperature changes but can be considered in the differential for severe, episodic facial pain.
- Idiopathic Intracranial Hypertension (IIH): Can cause headaches that worsen with recumbency and may have visual disturbances. While not directly linked to temperature changes, it's a rare condition that could potentially cause the described symptoms.