Examples of common headache differential diagnoses for clinicians.

📚 Quick Study Guide: Headache Differential Diagnoses

• 🧠 Primary Headaches: These are headaches that are not caused by an underlying condition. The headache itself is the primary problem.
• 🤕 Examples of Primary Headaches: Migraine, Tension-Type Headache, Cluster Headache, and other Trigeminal Autonomic Cephalalgias (TACs).
• 🚨 Secondary Headaches: These are symptoms of an underlying condition (e.g., infection, trauma, tumor, vascular issues). They often require urgent investigation.
• ⚠️ Red Flags for Secondary Headaches (SNOOP10 Mnemonic):
  • 📈 Systemic symptoms (fever, weight loss) or secondary risk factors (HIV, cancer).
  • 🧠 Neurologic symptoms (focal deficits, seizures, altered mental status).
  • ⚡ Onset sudden (thunderclap headache) or new/change in pattern (in older patients).
  • 👁️ Other associated conditions (papilledema, head trauma).
  • 🤕 Previous headache history (first or worst headache ever).
  • 👵 >50 years old: New onset headache.
  • 💊 Medication overuse, or new medication.
  • 🏃‍♀️ Positional headache (e.g., CSF leak).
  • 🤰 Pregnancy or postpartum.
  • 🩸 Painful eye or associated autonomic symptoms.
• 💥 Migraine: Typically unilateral, throbbing, moderate to severe pain, associated with nausea/vomiting, photophobia, and phonophobia. May have an aura.
• 📏 Tension-Type Headache: Bilateral, pressing/tightening (non-pulsating), mild to moderate intensity, not aggravated by routine physical activity. No nausea/vomiting, or only one of photophobia/phonophobia.
• 👁️‍🗨️ Cluster Headache: Severe unilateral orbital, supraorbital, or temporal pain, lasting 15-180 minutes, occurring in clusters. Associated with ipsilateral autonomic features (e.g., lacrimation, conjunctival injection, ptosis, miosis, nasal congestion, rhinorrhea, facial sweating).
• 🩸 Subarachnoid Hemorrhage (SAH): Sudden, severe "thunderclap" headache, often described as the "worst headache of life." May be accompanied by neck stiffness, altered consciousness.
• 👴 Temporal Arteritis (Giant Cell Arteritis - GCA): New onset headache in patients over 50, often unilateral temporal pain, scalp tenderness, jaw claudication, visual disturbances. Elevated ESR/CRP are key laboratory findings.
• 🌡️ Meningitis: Headache with fever, neck stiffness (nuchal rigidity), photophobia, and altered mental status.
• 🧠 Brain Tumor: Progressive, new onset in an older patient, focal neurological deficits, seizures, morning headache (worse with valsalva/coughing) are concerning features.

🧠 Practice Quiz

1. A 32-year-old female presents with recurrent, severe, unilateral throbbing headaches, accompanied by nausea, vomiting, and extreme sensitivity to light and sound. She sometimes sees flashing lights before the headache starts. What is the most likely diagnosis?

A) Tension-type Headache

B) Cluster Headache

C) Migraine with Aura

D) Subarachnoid Hemorrhage

2. Which of the following is considered a 'red flag' symptom requiring urgent investigation for a headache?

A) Mild, bilateral pressure in the temples.

B) Gradual onset of a dull, constant ache.

C) Sudden onset of the "worst headache of life."

D) Headache aggravated by lack of sleep.

3. A 68-year-old male complains of a new onset unilateral temporal headache, pain in his jaw when chewing, and some blurry vision. Physical exam reveals tenderness over the temporal artery. Which condition should be highly suspected?

A) Cluster Headache

B) Sinusitis

C) Temporal Arteritis

D) Trigeminal Neuralgia

4. A patient reports excruciating, short-lived, unilateral pain around their eye, occurring several times a day for a few weeks. These episodes are accompanied by tearing of the eye and nasal congestion on the same side. What is the most probable diagnosis?

A) Migraine

B) Tension-type Headache

C) Cluster Headache

D) Chronic Daily Headache

5. A headache described as a 'tight band around the head,' bilateral, mild-to-moderate in intensity, and not worsened by physical activity is most characteristic of which primary headache disorder?

A) Migraine

B) Cluster Headache

C) Tension-type Headache

D) Hemicrania Continua

6. A 25-year-old college student presents to the ER with a severe headache, high fever, stiff neck, and confusion. What is the most immediate concern that requires prompt diagnostic workup?

A) Migraine

B) Dehydration

C) Meningitis

D) Sinusitis

7. Which of the following is NOT classified as a primary headache disorder?

A) Migraine

B) Cluster Headache

C) Medication Overuse Headache

D) Tension-type Headache