[19F] With recurrent severe headaches, nausea, and shortness of breath

Patient Description

A 19-year-old female presents with severe headaches, nausea, shortness of breath, and ear pain. The headaches, described as deep pain behind the eyes, occur once every 1 to 3 months and last for 1 to 2 weeks, typically worsening in the morning. The pain intensity is rated 9 out of 10. Triggers include opening her phone and eyes in the morning, while relief is found through sleep and relaxation. Stress and having too many tasks exacerbate the headaches, which start suddenly. The patient has been diagnosed with migraines and experiences visual disturbances, sensitivity to light, and nausea during episodes, but not sensitivity to sound or vomiting. Tylenol provides symptom relief. Shortness of breath, rated 6 out of 10, accompanies the headaches. The patient has a history of kidney failure, was on dialysis for 3 years, and underwent a kidney transplant. Current medications include Prograf (8mg twice daily), Bactrim (80mg on Mon, Tues, Wed), Myfortic (180mg twice daily), Sodium Bicarbonate (650mg twice daily), and Vitamin D (25 mcg daily). No known drug allergies.

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Arora's Assessment

What might be happening

Based on the information you have provided, the most likely diagnosis is:

  • Migraine: Migraines are a type of headache characterized by severe pain, often described as throbbing or pulsing, typically on one side of the head. They can be accompanied by nausea, vomiting, and sensitivity to light and sound. Visual disturbances, known as auras, can also occur before or during a migraine. Your symptoms of severe headache, visual disturbances, sensitivity to light, and nausea are consistent with migraines.
    • Treatment: Typical treatments for migraines include over-the-counter pain relievers like Tylenol (acetaminophen), NSAIDs like ibuprofen, and prescription medications such as triptans. Preventive medications may also be prescribed if migraines are frequent or severe. Lifestyle changes, such as stress management and avoiding known triggers, can also help.

Given your history of kidney failure and recent transplant, it's important to consider that some of your symptoms might be related to your medical history or medications. However, the pattern and nature of your headaches strongly suggest migraines.

What you can do

  1. Consult a Doctor: It's important to consult with your healthcare provider to confirm the diagnosis and discuss appropriate treatment options, especially considering your medical history and current medications.
  2. Medication Management: Continue taking Tylenol as it helps relieve your headache symptoms. However, discuss with your doctor if additional or alternative medications might be more effective.
  3. Lifestyle Adjustments: Try to identify and avoid triggers that may bring on your migraines, such as stress, certain foods, or lack of sleep. Keeping a headache diary can help you and your doctor identify patterns and triggers.
  4. Rest and Relaxation: Since sleep and relaxation help ease your pain, ensure you get adequate rest and practice relaxation techniques such as deep breathing, meditation, or gentle yoga.
  5. Use MDandMe: Utilize the MDandMe app to journal your symptoms, track your progress, and share longitudinal medical notes with your healthcare provider. This can provide valuable insights and help in managing your condition.

What you should look out for

Seek medical attention if you experience any of the following:

  • Severe or Sudden Changes: If your headache pattern changes significantly, becomes more severe, or is accompanied by new symptoms such as confusion, weakness, or vision loss.
  • Medication Side Effects: If you experience any side effects from your medications, such as unusual bruising, bleeding, or signs of infection.
  • Kidney Transplant Concerns: If you notice any signs of kidney transplant complications, such as fever, pain at the transplant site, or changes in urine output.

Remember, while I can provide information and suggestions, it's crucial to seek care from real health professionals to receive a formal diagnosis and appropriate treatment.

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6 mo ago

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People Also Ask


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

Common triggers for migraines include stress, certain foods (like chocolate, cheese, and processed meats), caffeine, alcohol, hormonal changes, and lack of sleep. Managing these triggers involves identifying them through a headache diary and making lifestyle adjustments such as stress management, dietary changes, and ensuring adequate rest.


How can migraines be differentiated from other types of headaches?

Migraines are typically characterized by severe, throbbing pain on one side of the head, often accompanied by nausea, visual disturbances (auras), and sensitivity to light and sound. Tension headaches, on the other hand, usually involve a dull, aching sensation all over the head, while cluster headaches cause intense pain around one eye. A healthcare provider can help differentiate these based on symptoms and patterns.


What are the potential side effects of migraine medications, especially for someone with a kidney transplant?

Migraine medications, such as triptans and NSAIDs, can have side effects like dizziness, fatigue, and nausea. For someone with a kidney transplant, it's crucial to consult a healthcare provider to ensure that medications do not interfere with transplant medications or affect kidney function. Monitoring for unusual symptoms or side effects is important.


How can lifestyle changes help in managing migraine symptoms?

Lifestyle changes can significantly help in managing migraines. Regular exercise, maintaining a consistent sleep schedule, practicing relaxation techniques like yoga or meditation, and avoiding known triggers can reduce the frequency and severity of migraine attacks. Keeping a headache diary can also help in identifying effective lifestyle adjustments.


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