Differential Diagnosis
The patient's symptoms of sudden dizziness, severe headache, and difficulty chewing on one side suggest a complex interplay of neurological and possibly vascular issues. Here's a categorized differential diagnosis:
Single most likely diagnosis
- Temporomandibular joint (TMJ) disorder or tension headache: The headache starting in the back of the head and radiating to the jaw and shoulder, along with difficulty chewing, could be indicative of a TMJ disorder or a tension headache, which often involves the muscles of mastication and can cause referred pain to the head and neck.
Other Likely diagnoses
- Migraine with aura: The severe headache and dizziness could be part of a migraine episode, especially if the patient has a history of migraines. The aura could manifest as neurological symptoms such as dizziness.
- Cervicogenic headache: Given the radiation of pain to the jaw and shoulder, a cervicogenic headache, which originates from the cervical spine, is a possibility. This type of headache can be accompanied by limited range of motion in the neck and pain on one side of the face.
- Trigeminal neuralgia: Although less common, the severe, stabbing pain on one side of the face, which could be triggered by chewing, might suggest trigeminal neuralgia, a chronic pain condition that affects the trigeminal nerve.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage: A sudden, severe headache (often described as "the worst headache of my life") could be indicative of a subarachnoid hemorrhage, which is a life-threatening condition requiring immediate medical attention.
- Stroke or transient ischemic attack (TIA): Dizziness and sudden onset of headache could be symptoms of a stroke or TIA, especially if accompanied by other neurological deficits such as weakness, numbness, or difficulty with speech.
- Temporal arteritis: This condition, characterized by inflammation of the blood vessels in the head, can cause severe headaches, jaw claudication (pain when chewing), and visual disturbances. It's a medical emergency due to the risk of blindness.
Rare diagnoses
- Eagle syndrome: This rare condition involves an elongated styloid process or calcified stylohyoid ligament, which can cause sharp, stabbing pain in the side of the throat, ear, and face, especially when swallowing or turning the head.
- Occipital neuralgia: Involves the nerves that run from the base of the skull to the scalp and can cause severe pain, often on one side of the head, which might be confused with other types of headaches or neuralgias.