[18F] With severe headache and dizziness

Patient Description

An 18-year-old female presents with a severe headache that feels like pressure on two points on her skull, worsening throughout the day. Tylenol has not provided any relief. She also reports severe dizziness, exacerbated by moving her head or standing up. She often experiences headaches, but they usually last no more than three hours, and this current headache is different from previous episodes. She denies changes in vision, numbness, weakness, recent head injuries, trauma, sensitivity to light or sound, neck stiffness, fever, changes in sleep patterns, or increased stress levels. She has not used substances like alcohol, drugs, or tobacco recently and has had no changes in diet or exposure to chemicals, toxins, or unusual environments. She has not traveled recently. Her family history includes diabetes, heart disease, and cancer. Her past medical history includes a neurocytoma removed in September, with no recurrence. She is allergic to latex but has no known medication allergies. Current medications include Tylenol as needed, birth control, vitamin D gummies, melatonin, and sertraline, all taken for over six months.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

  • Migraine: Migraines are a common type of headache that can cause severe pain, often described as throbbing or pulsing, typically on one side of the head. They can also be associated with dizziness, nausea, and sensitivity to light and sound. Migraines can be triggered by various factors, including stress, certain foods, and hormonal changes.

    • Treatment: Over-the-counter pain relievers like ibuprofen or aspirin can sometimes help, but prescription medications specifically for migraines may be necessary. Preventive medications and lifestyle changes to avoid triggers can also be beneficial.
  • Tension Headache: These are the most common type of headache and can cause a feeling of pressure or tightness around the head, often described as a band-like sensation. They can be associated with stress, poor posture, or muscle tension.

    • Treatment: Over-the-counter pain relievers, relaxation techniques, and stress management can help alleviate symptoms.
  • Vestibular Migraine: This type of migraine includes dizziness or vertigo as a prominent symptom, along with headache. It can be triggered by similar factors as other migraines.

    • Treatment: Similar to other migraines, treatment may include medications to relieve symptoms and preventive measures to avoid triggers.
  • Sinus Headache: Sinus headaches are caused by inflammation or infection of the sinuses and can cause pressure and pain in the forehead, cheeks, and around the eyes. They can also cause dizziness.

    • Treatment: Decongestants, antihistamines, and sometimes antibiotics (if a bacterial infection is present) can help relieve symptoms.

Given your history of a neurocytoma, it is also important to consider the possibility of any complications or recurrence, although you mentioned it hasn't grown back.

What you can do

While it's important to consult a healthcare professional for a formal diagnosis and treatment plan, here are some steps you can take to help manage your symptoms:

  1. Rest in a Quiet, Dark Room: Reducing sensory input can help alleviate headache symptoms, especially if you suspect a migraine.
  2. Stay Hydrated: Continue to drink plenty of water, as dehydration can worsen headaches.
  3. Over-the-Counter Pain Relievers: If Tylenol isn't helping, you might try ibuprofen or aspirin, but be cautious and follow the recommended dosages.
  4. Apply a Cold or Warm Compress: A cold compress on your forehead or a warm compress on the back of your neck can help relieve tension headaches.
  5. Relaxation Techniques: Practice deep breathing, meditation, or gentle yoga to help reduce stress and muscle tension.
  6. Track Your Symptoms: Use MDandMe to journal your symptoms, track your progress, and share longitudinal medical notes with your healthcare provider. This can help identify potential triggers and patterns.

What you should look out for

Seek medical attention more urgently if you experience any of the following:

  • Severe or Sudden Onset of Symptoms: If your headache or dizziness suddenly becomes much worse or is accompanied by other severe symptoms.
  • Neurological Symptoms: Any changes in vision, speech, weakness, or numbness.
  • Persistent or Worsening Symptoms: If your symptoms do not improve with over-the-counter treatments or continue to get worse.
  • Fever or Neck Stiffness: These could be signs of a more serious condition like meningitis.

Remember, while this advice can help manage your symptoms, it is not a substitute for professional medical care. Please consult a healthcare provider for a thorough evaluation and appropriate treatment.

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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 on one side of the head, nausea, dizziness, and sensitivity to light and sound. Management can include over-the-counter pain relievers, prescription medications, and lifestyle changes to avoid triggers.


How can tension headaches be distinguished from other types of headaches?

Tension headaches are typically characterized by a feeling of pressure or tightness around the head, often described as a band-like sensation. They are usually associated with stress, poor posture, or muscle tension, and can be managed with over-the-counter pain relievers, relaxation techniques, and stress management.


What is a vestibular migraine and what are its main symptoms?

A vestibular migraine is a type of migraine where dizziness or vertigo is a prominent symptom, along with headache. It can be triggered by similar factors as other migraines, and treatment may include medications to relieve symptoms and preventive measures to avoid triggers.


When should someone with a severe headache seek urgent medical attention?

Urgent medical attention should be sought if the headache or dizziness suddenly becomes much worse, is accompanied by neurological symptoms like changes in vision or speech, if symptoms persist or worsen despite treatment, or if there is a fever or neck stiffness, which could indicate a more serious condition.


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