[19F] With headaches, scalp tenderness, vision blackouts, and random bruising

Patient Description

A 19-year-old female has been experiencing frequent, pounding headaches in the front of her head for the past week and a half. These headaches occur almost daily, lasting from 30 minutes to two hours, and are rated as 6 or 7 out of 10 in intensity. They tend to occur in the afternoon to nighttime and come on suddenly. The patient also reports constant tension in the back of her head, which is uncomfortable but does not interfere with daily activities. Additionally, she experiences constant scalp tenderness, making it painful to move her hair. The patient has had full vision blackouts lasting for multiple minutes, which are extremely concerning to her. One notable episode occurred while walking, resulting in complete blindness for around five minutes, which resolved upon sitting down. She has also noticed small, dark bruises appearing on her arms and legs without any apparent cause, though these bruises are not painful. There is no history of nausea, vomiting, visual disturbances like flashes of light or blind spots, or sensitivity to light or sound associated with the headaches. The patient has not had any recent head injuries, surgeries, or significant changes in diet or hydration habits, although she has been drinking slightly less water than usual. She does not use substances such as alcohol, tobacco, or recreational drugs, and has not started any new medications or supplements recently. Her family history includes heart disease, stroke, diabetes, some cancers, and multiple psychiatric illnesses, but she does not have any pre-existing conditions or chronic illnesses herself.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

Headaches, Tension, and Scalp Tenderness

  • Tension-Type Headaches: These are common and can cause a constant ache or pressure around the head, particularly at the back and front. They can be triggered by stress, poor posture, or muscle tension.
  • Migraine: Although your symptoms don't fully match, migraines can sometimes present with pounding headaches and scalp tenderness. Migraines can also cause visual disturbances, though typically not complete blackouts.

Vision Blackouts

  • Transient Ischemic Attack (TIA): This is a temporary period of symptoms similar to those of a stroke. A TIA doesn't cause permanent damage but is a warning sign of a possible future stroke.
  • Ocular Migraine: This can cause temporary vision loss or visual disturbances, but usually not complete blackouts.
  • Orthostatic Hypotension: A sudden drop in blood pressure when standing up can cause temporary vision blackouts. This might be related to your hydration status.

Random Bruising

  • Coagulation Disorders: Conditions that affect blood clotting can cause unexplained bruising. This could be due to a variety of factors, including vitamin deficiencies or more serious conditions like blood disorders.
  • Nutritional Deficiencies: Lack of certain vitamins, such as Vitamin C or K, can lead to easy bruising.

What you can do

Vision Blackouts

  • Seek Immediate Medical Attention: Given the severity and potential seriousness of your vision blackouts, you should see a doctor as soon as possible. This could be a sign of a TIA or another serious condition that needs prompt evaluation.
  • Stay Hydrated: Ensure you are drinking enough water throughout the day to avoid dehydration, which can contribute to orthostatic hypotension.

Headaches, Tension, and Scalp Tenderness

  • Consult a Healthcare Provider: A doctor can help determine the cause of your headaches and scalp tenderness. They may recommend imaging studies or refer you to a specialist.
  • Over-the-Counter Pain Relief: Medications like ibuprofen or acetaminophen can help alleviate headache pain. Be sure to follow the dosage instructions.
  • Stress Management: Techniques such as deep breathing, meditation, or yoga can help reduce stress and tension.
  • Proper Posture: Ensure you maintain good posture, especially if you spend long periods sitting or working at a computer.

Random Bruising

  • Consult a Healthcare Provider: Unexplained bruising should be evaluated by a doctor to rule out any underlying conditions.
  • Monitor Your Diet: Ensure you are getting enough vitamins and nutrients, particularly Vitamin C and K, which are important for blood clotting.

What you should look out for

Given the severity of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Sudden, Severe Headache: Especially if it is the worst headache you've ever had.
  • Persistent Vision Changes: Any ongoing or worsening vision problems.
  • New or Worsening Symptoms: Such as weakness, numbness, or difficulty speaking.
  • Increased Frequency or Severity of Bruising: Or if you notice any unusual bleeding.

Remember, while I can provide information and suggestions, I am not a doctor. It's important to consult with a healthcare professional to receive a formal diagnosis and appropriate treatment. You can also use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

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4 mo ago


People Also Ask


What could be causing my frequent, pounding headaches?

Frequent, pounding headaches could be due to tension-type headaches, which are common and can be triggered by stress, poor posture, or muscle tension. Migraines are another possibility, although your symptoms don't fully match typical migraine patterns.


Why am I experiencing vision blackouts?

Vision blackouts could be caused by a transient ischemic attack (TIA), which is a temporary period of symptoms similar to a stroke. Other possibilities include ocular migraines or orthostatic hypotension, which is a sudden drop in blood pressure when standing up.


What might be the reason for the unexplained bruises on my arms and legs?

Unexplained bruises could be due to coagulation disorders, which affect blood clotting, or nutritional deficiencies, such as a lack of Vitamin C or K. It's important to consult a healthcare provider to rule out any serious conditions.


How can I manage the tension and scalp tenderness I'm feeling?

To manage tension and scalp tenderness, consider stress management techniques like deep breathing, meditation, or yoga. Maintaining proper posture and using over-the-counter pain relief medications like ibuprofen or acetaminophen can also help alleviate symptoms.


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