Differential Diagnosis for 67-year-old Patient with Headache
- Single most likely diagnosis:
- Tension headache: The patient describes a bandlike headache with pressure that worsens with movement, which is consistent with tension headaches. The fact that tylenol helps alleviate the symptoms further supports this diagnosis.
- Other Likely diagnoses:
- Migraine: Although the patient denies radiation of pain and vision changes, some migraines can present without these typical features. The worsening of headache with eating certain foods (in this case, eggs) could be a trigger for migraines.
- Cervicogenic headache: The description of headache worsening with movement could suggest a cervicogenic component, where the headache is referred from the cervical spine.
- Hypertension-related headache: Given the patient's concern about cholesterol and request for a check, there might be an underlying concern about cardiovascular health. Hypertension can cause headaches, especially if it's uncontrolled.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Subarachnoid hemorrhage or other intracranial hemorrhages: Although the patient's symptoms have been present for 1-2 weeks, which makes an acute hemorrhage less likely, any new onset headache, especially in an older adult, warrants consideration of intracranial hemorrhage.
- Temporal arteritis: This condition is a medical emergency that can cause blindness if not promptly treated. The patient's age and the description of the headache could fit this diagnosis, although the absence of jaw claudication or visual disturbances makes it less likely.
- Brain tumor: A new onset headache in an older adult could be a symptom of a brain tumor. The fact that the headache worsens with movement could suggest increased intracranial pressure.
- Rare diagnoses:
- Occipital neuralgia: This condition involves inflammation of the occipital nerves and can cause severe headache, usually on one side of the head. It's less likely given the bandlike description of the headache.
- Trigeminal neuralgia: Although typically characterized by sharp, stabbing pains in the face, some variants could present with headache. The patient's denial of radiation of pain makes this less likely.