Differential Diagnosis for Headaches in a 22-year-old Female
Single Most Likely Diagnosis
- Tension Headache: This is the most common type of headache and is often described as a band or a squeezing sensation around the forehead and temples, which matches the patient's symptoms. The age and sex of the patient also align with the typical demographic for tension headaches.
Other Likely Diagnoses
- Migraine: Although migraines can be more severe and often unilateral, some patients may experience bilateral pain, including across the forehead and temples. The patient's age and sex are consistent with a migraine diagnosis.
- Sinusitis: Inflammation of the sinuses can cause pain across the forehead and temples, especially if the frontal sinuses are involved. This could be a consideration, especially if the patient has other symptoms like nasal congestion or facial pressure.
- Stress or Anxiety-related Headache: Given the patient's age, stress from work, school, or personal life could be contributing to headaches, which often manifest as tension-type headaches.
Do Not Miss Diagnoses
- Subarachnoid Hemorrhage: Although extremely rare in a young adult without risk factors, a sudden, severe headache (often described as "the worst headache of my life") could indicate a subarachnoid hemorrhage, which is a medical emergency.
- Temporal Arteritis: While more common in older adults, giant cell arteritis can cause headaches, especially in the temporal region, and is a diagnosis that should not be missed due to the risk of vision loss if not treated promptly.
- Idiopathic Intracranial Hypertension (IIH): This condition, also known as pseudotumor cerebri, can cause headaches that are often worse in the morning and can be associated with vision changes. It's more common in young, obese females.
Rare Diagnoses
- Trigeminal Neuralgia: This condition causes 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 common and usually presents with more localized pain.
- Hemicrania Continua: A rare form of headache that is continuous and typically affects one side of the head, though it could potentially cause pain across the forehead and temples if bilateral. It's often accompanied by autonomic symptoms like nasal congestion or eye watering.