[18F] Experiencing severe headache and chest tightness

Patient Description

An 18-year-old female is reporting severe headaches that are sharp and throbbing, centered on the face and forehead, persisting for the past two days. She also experiences chest tightness described as a squeezing sensation with sharp pain in the middle of the chest, lasting for approximately one to two hours. The patient notes that the chest pain is alleviated by laying down. Additionally, she reports occasional difficulty breathing, heart palpitations, and feeling unusually cold in a temperate environment. The patient has a history of frequent headaches and depression, diagnosed a few years ago. She is currently on Metformin (50mg), Trazodone (50mg), and birth control containing 3mg of drospirenone, taken once daily at night. She also has Polycystic Ovary Syndrome (PCOS). No known allergies or family history of heart disease. No recent substance use, head injury, nausea, vomiting, or pain radiation to other areas.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, here are a few possibilities:

  • Migraine: This is a type of headache that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It's often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days, and the pain can be so severe that it interferes with your daily activities.

    • Treatment typically includes pain relievers, triptans, ergots, anti-nausea medications, and preventive medications.
  • Anxiety or Panic Attack: Anxiety can cause physical symptoms like rapid heart rate, chest pain, and a variety of other symptoms. Panic attacks can cause sudden and intense physical symptoms that can include a pounding heart, shortness of breath, dizziness, numbness, or tingling sensation in your hands and fingers, and can be very frightening.

    • Treatment typically involves psychotherapy, medications, and self-care strategies.
  • Heart conditions: Given your chest pain and heart palpitations, it's important to rule out conditions like heart disease or a heart attack. Although less common in young women, they can still occur, especially with certain risk factors.

    • Treatment depends on the specific heart condition but may include lifestyle changes, medication, or surgery.
  • Hypothyroidism: This is a condition in which your thyroid gland doesn't produce enough of certain crucial hormones. Hypothyroidism may not cause noticeable symptoms in the early stages, but over time, untreated hypothyroidism can cause a number of health problems, such as obesity, joint pain, infertility, and heart disease. Feeling cold and fatigue are common symptoms.

    • Treatment typically involves daily use of the synthetic thyroid hormone levothyroxine.

What you can do

Given the severity of your symptoms, it's important that you seek medical attention as soon as possible. While waiting for your appointment, here are a few things you can do:

  1. Rest and stay hydrated.
  2. Avoid triggers that may worsen your symptoms, such as stress, certain foods, or lack of sleep.
  3. Keep a symptom diary: note down when your symptoms occur, what you're doing at the time, and any potential triggers. This can help your healthcare provider diagnose your condition.

What you should look out for

Seek immediate medical attention if:

  • Your chest pain or headache becomes severe or unbearable.
  • You experience difficulty breathing.
  • You have symptoms of a heart attack, such as chest pain that spreads to your jaw, neck, or arm, or if you have shortness of breath, sweating, or nausea.
  • You have symptoms of a stroke, such as sudden numbness or weakness in the face, arm, or leg, especially on one side of the body, sudden confusion, trouble speaking or understanding speech, sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, loss of balance or coordination, or sudden severe headache with no known cause.

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for appropriate examination, testing, and care recommendations.

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9 mo ago


People Also Ask


What are the common symptoms of a migraine and how can they be managed?

Common symptoms of a migraine include severe throbbing or pulsing pain, usually on one side of the head, nausea, vomiting, and sensitivity to light and sound. Management can include pain relievers, triptans, ergots, anti-nausea medications, and preventive medications.


How can anxiety or panic attacks manifest physically, and what are some treatment options?

Anxiety or panic attacks can cause physical symptoms such as rapid heart rate, chest pain, shortness of breath, dizziness, and numbness or tingling in the hands and fingers. Treatment options include psychotherapy, medications, and self-care strategies.


What are the signs of a heart condition in young women, and when should one seek medical attention?

Signs of a heart condition in young women can include chest pain, heart palpitations, shortness of breath, and fatigue. Immediate medical attention should be sought if there is severe chest pain, pain spreading to the jaw, neck, or arm, or symptoms of a heart attack.


What are the symptoms of hypothyroidism and how is it treated?

Symptoms of hypothyroidism include feeling unusually cold, fatigue, weight gain, and depression. It is treated with daily use of the synthetic thyroid hormone levothyroxine.

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