Differential Diagnosis for 15-year-old Male with Headache
- Single most likely diagnosis
- Tension headache: This is the most likely diagnosis given the description of the headache as dull and frontal, and the fact that it was initially mild and then intensified. The patient's increased screen time and close proximity to the monitor may have contributed to eye strain, which can exacerbate tension headaches. The headache's response to Tylenol also supports this diagnosis.
- Other Likely diagnoses
- Migraine: Although the patient's headache does not have all the classic features of migraine (e.g., unilateral location, nausea, vomiting), the rapid intensification of the headache and its frontal location could suggest a migraine. The patient's age and the fact that he was able to sleep without problems do not rule out this diagnosis.
- Eye strain: Given the patient's increased screen time and close proximity to the monitor, eye strain is a possible contributing factor to his headache. This could be related to his recent eye exam in January, although no specific issues were mentioned.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage: Although extremely unlikely in a 15-year-old with no trauma history, a sudden and severe headache (often described as "the worst headache of my life") could be a sign of a subarachnoid hemorrhage. The fact that the patient's headache intensified rapidly and reached a high level of pain (8/10) warrants consideration of this diagnosis.
- Meningitis: The patient denies fever, rash, and respiratory symptoms, but meningitis can present with headache and neck stiffness. Although unlikely, this diagnosis should be considered, especially if the patient's condition worsens or if he develops additional symptoms.
- Brain tumor: A brain tumor could cause headaches, although this would be an extremely rare cause in a 15-year-old with no other symptoms (e.g., seizures, focal neurological deficits).
- Rare diagnoses
- Temporal arteritis: This condition is rare in adolescents and typically presents with jaw claudication, visual disturbances, and a tender temporal artery. Although unlikely, it should be considered if the patient has other systemic symptoms or if his headache does not respond to treatment.
- Idiopathic intracranial hypertension (IIH): This condition can cause headaches, vision changes, and papilledema. Although rare in males, IIH should be considered if the patient has other symptoms (e.g., vision changes, tinnitus) or if his headache does not respond to treatment.