[19F] Experiencing severe migraines with eye twitching

Patient Description

A 19-year-old female has been experiencing severe migraines and headaches around her right eye and sinus for the past two weeks. The headaches are described as sharp, throbbing, and aching, with an intensity rated as 9 out of 10. The headaches worsen with not eating, using her phone, and lack of sleep, and are somewhat relieved by pain pills. This is a new issue for her. Along with the headaches, she experiences a burning sensation when she breathes and twitching in her upper eyelid, which occurs during the migraines and has been happening for the past three weeks, rated as 8 out of 10 in severity. She does not experience nausea, vomiting, visual disturbances, weakness, or numbness in her face or limbs. She has no history of sinus infections or other sinus-related issues and does not use tobacco, alcohol, or recreational drugs. She tries to eat regular meals and stay hydrated but only takes pain medication when she gets a headache. She stays up late, often until 5am, and has difficulty falling and staying asleep every day. She has no pre-existing conditions or chronic illnesses and is not currently taking any medications. There have been no recent injuries to her eye or head, changes in vision, stress, anxiety, or recent travel.

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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 type of headache that can cause severe pain, often on one side of the head. They can be accompanied by sensitivity to light and sound, and sometimes nausea. The fact that your headaches are severe, throbbing, and associated with sensitivity to light and sound suggests that migraines could be a likely cause.

    • Treatment: Migraines are often treated with medications to relieve pain and prevent future attacks. These can include over-the-counter pain relievers, prescription medications, and sometimes lifestyle changes to avoid triggers.
  • Sinusitis: Sinusitis is an inflammation of the sinuses that can cause headaches, especially around the eyes and forehead. The burning sensation when you breathe and the location of your headache around the sinus area could suggest sinusitis.

    • Treatment: Sinusitis can be treated with decongestants, nasal sprays, and sometimes antibiotics if a bacterial infection is present. Keeping hydrated and using a humidifier can also help.
  • Eye Strain: Spending a lot of time on your phone or other screens can cause eye strain, which might contribute to headaches and eye twitching.

    • Treatment: Reducing screen time, taking regular breaks, and ensuring proper lighting can help alleviate eye strain.
  • Sleep Deprivation: Not getting enough sleep can trigger headaches and migraines. Your pattern of staying up late until 5am and having difficulty falling and staying asleep could be contributing to your symptoms.

    • Treatment: Establishing a regular sleep schedule, creating a relaxing bedtime routine, and ensuring a comfortable sleep environment can help improve sleep quality.

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. Maintain a Regular Sleep Schedule: Try to go to bed and wake up at the same time every day, even on weekends. Aim for 7-9 hours of sleep per night.
  2. Limit Screen Time: Reduce the amount of time you spend on your phone or other screens, especially before bedtime. Take regular breaks to rest your eyes.
  3. Stay Hydrated and Eat Regular Meals: Ensure you are drinking enough water and eating balanced meals throughout the day to prevent headaches triggered by dehydration or hunger.
  4. Use Over-the-Counter Pain Relievers: Medications like ibuprofen or acetaminophen can help relieve headache pain. Follow the dosage instructions on the label.
  5. Practice Relaxation Techniques: Stress can exacerbate headaches. Try relaxation techniques such as deep breathing, meditation, or gentle yoga.
  6. Track Your Symptoms: Use MDandMe to journal your symptoms, track your progress, and get insights. This information can be valuable when you consult with your healthcare provider.

What you should look out for

Seek medical attention if you experience any of the following:

  • Severe or Sudden Headache: If your headache is the worst you've ever had or comes on very suddenly, seek immediate medical attention.
  • Changes in Vision: If you experience any changes in your vision, such as blurriness or double vision, consult a healthcare professional.
  • Persistent or Worsening Symptoms: If your symptoms do not improve with over-the-counter treatments or lifestyle changes, or if they worsen, see a doctor.
  • New or Unusual Symptoms: If you develop new symptoms, such as weakness, numbness, or difficulty speaking, seek medical care promptly.

Remember, while this advice can help manage your symptoms, it is important to consult with a healthcare professional for a formal diagnosis and appropriate treatment.

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6 mo ago

People Also Ask


What are common triggers for migraines and how can they be avoided?

Common triggers for migraines include stress, lack of sleep, certain foods and drinks, hormonal changes, and sensory stimuli like bright lights or loud noises. Avoiding these triggers involves identifying personal triggers through a headache diary, managing stress, maintaining a regular sleep schedule, and avoiding known food or drink triggers.


How can sleep deprivation contribute to headaches and what are some tips for improving sleep quality?

Sleep deprivation can lead to headaches by increasing stress levels and reducing the body's ability to manage pain. Improving sleep quality involves establishing a regular sleep schedule, creating a relaxing bedtime routine, limiting screen time before bed, and ensuring a comfortable sleep environment.


What are the symptoms of sinusitis and how is it typically treated?

Symptoms of sinusitis include headaches, facial pain or pressure, nasal congestion, and a burning sensation when breathing. Treatment typically involves decongestants, nasal sprays, and sometimes antibiotics if a bacterial infection is present. Staying hydrated and using a humidifier can also help alleviate symptoms.


How does eye strain cause headaches and what can be done to alleviate it?

Eye strain can cause headaches due to prolonged screen time or poor lighting, leading to muscle fatigue around the eyes. To alleviate eye strain, reduce screen time, take regular breaks using the 20-20-20 rule (every 20 minutes, look at something 20 feet away for 20 seconds), and ensure proper lighting in your environment.


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