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 :
Ans. is 'a' i.e.,. Temporal Arteritis 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.A migraineAge - Females after pubertySex - Females > malePresentationLateralised*usually frontotemporalPain preceded by Aura*Builds up gradually*May lasts for several hoursUsually throbbing but may be dull*Onset is after awakening & quietened by Sleep*.* Associated symptoms includeNausea, vomiting, Diarrhoea, photophobia* & Visual disturbance*Paresthesia with tingling and numbness*Other focal neurological symptoms such as clumsiness & weakness *.Cluster HeadacheMen 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 SymptomsHomolateral lacrimation*Reddening of eye*Nasal stuffiness*Ptosis*Nausea*Trigeminal Neuralgia> 40 YearsOccurs 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 ArteritisMedian age 75 yrs*Female (Account for 65% cases)*Unilateral or Bilateral located temporarily in 50% patients*Usually appear graduallyOccasionally 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 symptomsHeadache, fever, weight lossJaw claudication*Polymyalgia Rheumatica*ESR Increase*Anemia*Blindness d/t ophthalmic artery involvement*.A tension HeadacheAt all agesFemalesBilateral Frontal area *Builds up slowlyFluctuates in severityPersists continuously for many days.A headache may be episodic or chronic.A tight band like discomfort*Associated symptomsNot prominentSometimes post neck muscles are tight*May be associated with anxiety & depression*.
Temporal arteritis
A migraine
Cluster headache
Sinusitis