5th August 2024

Notable differentials

There are many conditions that can present with headache. Below are a few differentials to consider.

Condition	Presentation and key information
Sinusitis	Nasal congestion and sinus tenderness.
Temporomandibular joint (TMJ) dysfunction	TMJ pain, TMJ click and limited mandibular movement.
Dental caries	Pain on consumption of sweet, hot or cold food or drink. Caries may be visible.
Otitis media	Ear pain. A bulging tympanic membrane may be present on otoscopy.
Acute angle-closure glaucoma	Eye pain, blurred vision, redness of the sclera and vomiting.
Hypertensive encephalopathy	Headache, nausea, change in mental status or visual changes in the context of a raised blood pressure. There may be evidence of end-organ damage on examination.
Pre-eclampsia	Usually presents after 20 weeks gestation. Patients will have a raised BP and proteinuria. The presence of a headache is suggestive of severe disease. If not treated the patient can develop eclampsia.
Carbon monoxide poisoning	Morning headaches, dizziness, ataxia and nausea. Oxygen saturations are usually normal but ABG will show raised carboxyhaemoglobin levels.
Malaria	Malaria and other vector-borne infections such as Dengue fever, Chikungunya and Zika virus can present with headache.
Stroke	Very rarely strokes can present with headache.

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