A 64-year-old lady Kamla complains of severe unilateral headache on the right side and blindness for 2 days. On examination, there is a thick cord-like structure on the lateral side of the head. The ESR is 80 mm/hr. in the first hour. The most likely diagnosis is :
The symptom and the laboratory examination of the patients almost confirm the diagnosis of temporal arteritis.
This question has been asked too frequently in various PGME examination you are required to be well versed with the differential diagnosis of a headache.
Let's see the diagnostic features of various headaches.

Migraine Age - Females after puberty Sex - Females > male Presentation Lateralised* usually frontotemporal Pain preceded by Aura* Builds up gradually* May lasts for several hours Usually throbbing but may be dull* Onset is after awakening & quietened by Sleep*.
Associated symptoms include Nausea, vomiting, Diarrhoea, photophobia* & Visual disturbance* Paresthesia with tingling and numbness*
Other focal neurological symptoms such as clumsiness & weakness *.
Cluster Headache Men in 20 - 50* Male > F (7 to 8 times)* Lateralised* Periorbital* Pain(periodic attacks 1-2/days)*
Begins without warning. Reach crescendo within 5 min last for 45 minutes * Excruciating deep, explosive but only rarely pulsatile*.
Commonly awakens the patients from sleep*. Associated Symptoms Homolateral lacrimation* Reddening of eye* Nasal stuffiness* Ptosis* Nausea*
Trigeminal Neuralgia > 40 Years Occurs along the distribution of Maxillary nerve* Electric in character* Episodic each episode lasts 2-4 min.
The typical course is relapsing-remitting over several years. Temporal Arteritis Median age 75 yrs* Female (Account for 65% cases)*
Unilateral or Bilateral located temporarily in 50% patients* Usually appear gradually Occasionally it is explosive. Dull and boring in character,
Seldom throbbing. Scalp tenderness* Patients also complains of pain in jaw* Headache is usually worse at night. Associated symptoms Headache,
fever, weight loss Jaw claudication* Polymyalgia Rheumatica* ESR Increase* Anaemia * Blindness d/t ophthalmic artery involvement*.
A tension Headache At all ages Females Bilateral Frontal area * Builds up slowly Fluctuates in severity Persists continuously for many days.
A headache may be episodic or chronic. A tight band like discomfort * Associated symptoms Not prominent Sometimes post neck muscles are tight*
May be associated with anxiety & depression
Temporal arteritis
Migraine
Cluster headache
Sinusitis