[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.

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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

  1. 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.
  2. 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.
  3. 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.

What you should look out for

Seek immediate medical help if:

  • Your migraines become more severe or frequent
  • Your feelings of depression worsen or you begin to have thoughts of suicide
  • You experience severe anxiety or panic attacks
  • Your body weakness or joint pain becomes so severe that you can't move

Remember, it's important to consult with a healthcare provider for an accurate diagnosis and treatment.

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10 mo ago

People Also Ask


What are the common symptoms of chronic migraines and how can they be managed?

Common symptoms of chronic migraines include intense headache pain, nausea, vomiting, and sensitivity to light and sound. Management typically involves medications to relieve symptoms and prevent future migraines, lifestyle changes, and sometimes alternative therapies like acupuncture.


How is fibromyalgia diagnosed and what are the treatment options?

Fibromyalgia is diagnosed based on a history of widespread pain lasting more than three months, along with other symptoms like fatigue and sleep disturbances. Treatment options include medications, physical therapy, exercise, stress management, and healthy lifestyle habits.


What are the physical symptoms of anxiety disorders and how can they be treated?

Physical symptoms of anxiety disorders can include shaking, rapid heart rate, nausea, dizziness, and difficulty sleeping. Treatment often involves psychotherapy, such as cognitive behavioral therapy, medications, and complementary health approaches like mindfulness and relaxation techniques.


What steps can be taken to manage severe depression and prevent self-harm?

Managing severe depression involves seeking professional help, which may include psychotherapy, medications, and support groups. It's important to reach out to trusted individuals and mental health professionals, and in cases of self-harm or suicidal thoughts, immediate help from crisis services is crucial.


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