[19F] Experiencing migraines, body pain, weakness, and psychological distress

Patient Description

A 19-year-old female presents with a history of daily headaches that escalate to migraines, described as pressure and stabbing pain in the temples, exacerbated by light and rapid head movement. The migraines are severe, sometimes reaching a level of 9 or 10 in intensity, and are alleviated by resting in a dark, cold room. The patient also reports chronic body weakness, particularly at night, with joint pain and a sensation of heaviness, which has been ongoing for over two years. Additionally, the patient experiences nausea, dizziness, and lightheadedness upon standing, numbness in the feet and calves, and is constantly cold. The patient has been feeling extremely tired, with an inability to sleep or stay asleep, and suffers from severe depression and anxiety, including full-body shaking, high heart rate, panic attacks, and self-harm behaviors. The anxiety has been present since early childhood. The patient has a family history of severe migraines. Past medical history includes bursitis in the hips, IT band syndrome, and frequent strep throat leading to tonsillectomy. The patient was previously on medication for bipolar disorder, which she believes she does not have, and medications to aid sleep and manage panic attacks. The patient is not currently on any medications and has no known drug allergies.

Arora's Assessment

What might be happening

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

Chronic Migraines: Chronic migraines are headaches that occur on 15 or more days a month for at least three months. The headaches can be debilitating and are often accompanied by nausea, vomiting, and sensitivity to light and sound. The fact that you've had migraines since childhood and experience them daily suggests this condition.
- Treatment typically involves a combination of medications to relieve symptoms and prevent future migraines, as well as lifestyle changes and alternative therapies.
Fibromyalgia: This is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues. Your symptoms of body weakness, joint pain, and fatigue could be indicative of this condition.
- Treatment often involves a combination of medications, exercise, stress-management measures, and healthy lifestyle habits.
Anxiety Disorder: Chronic anxiety can cause physical symptoms such as shaking, rapid heart rate, nausea, and difficulty sleeping. Given your description of your anxiety symptoms, it's possible you're dealing with an anxiety disorder.
- Treatment typically involves psychotherapy (cognitive behavioral therapy is particularly effective), medications, and complementary health approaches.
Depression: You've described feelings of extreme sadness, thoughts of dying, and self-harming behaviors, which are serious symptoms of depression.
- Treatment typically involves psychotherapy (cognitive behavioral therapy and interpersonal therapy are effective), medications, and complementary health approaches.

Please note that these are potential explanations based on the information you've provided, and not a definitive diagnosis. It's important to consult with a healthcare provider for an accurate diagnosis and treatment.

What you can do

Seek immediate medical attention for your symptoms, particularly your migraines, body weakness, and mental health symptoms. These are serious and require professional medical evaluation and treatment.
Reach out to a trusted individual in your life about your feelings of depression and thoughts of dying. You don't have to go through this alone.
If you're in the U.S., consider contacting the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or use the Crisis Text Line by texting HOME to 741741.