[19F] With severe and sudden headaches causing nausea

Patient Description

A 19-year-old female presents with severe and sudden headaches that cause nausea. These headaches start in the neck and wrap around to behind the eyes, occurring daily for the last 3-4 days. The headaches can last from a few minutes to several hours and sometimes recur quickly. The patient has not identified any specific triggers, and aspirin and Tylenol have not provided relief. Taking a bath and eating ice seem to help somewhat. The patient also reports dizziness, sensitivity to light and sound, and occasionally seeing little sparkles when the headaches are severe. There is no history of migraines or other types of headaches, and no substance use or recent travel. The patient has mental health issues, Tourette's syndrome, joint pain, and unexplained excessive exhaustion. These conditions were diagnosed at different times: mental health issues since age 13, Tourette's at 14, and joint pain and exhaustion diagnosed this year but occurring for much longer. The patient is allergic to certain psychiatric medications and is currently taking Fluoxetine (20mg daily), Meloxicam (15mg daily), Lamictal (200mg daily), Guanfacine (1mg daily), and Omeprazole as needed. The patient is currently on her period, which has been particularly bad this week. Her periods are irregular and very severe with debilitating cramps that start a week before bleeding, with pain levels ranging from 4 to 9 on a scale of 1-10. The high pain levels cause significant nausea, similar to the nausea from the migraines. She has also experienced more frequent urination, diarrhea, and night sweats, which she attributes to her mattress cover. There is no family history of migraines, menstrual disorders, or other significant medical conditions, and she has not been evaluated by a healthcare provider for her severe menstrual cramps and irregular periods.

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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, nausea, dizziness, and sensitivity to light and sound. They can sometimes be triggered by hormonal changes, such as those that occur during your menstrual cycle. The visual disturbances you described, like seeing sparkles, are also common in migraines.

    • 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.
  • Tension Headache: These headaches often start in the neck and can wrap around to the front of the head. They can be triggered by stress, poor posture, or muscle tension.

    • Treatment: Tension headaches can often be managed with over-the-counter pain relievers, relaxation techniques, and improving posture.
  • Menstrual-Related Headaches: Hormonal changes during your menstrual cycle can trigger headaches or migraines. Given that your period has been particularly bad this week, it's possible that your headaches are related to your menstrual cycle.

    • Treatment: Managing menstrual-related headaches can involve hormonal treatments, pain relievers, and lifestyle changes.
  • Cervicogenic Headache: This type of headache originates from issues in the neck and can cause pain that radiates to the head and behind the eyes.

    • Treatment: Treatment may include physical therapy, medications, and sometimes injections to relieve pain.

What you can do

While it's important to consult a healthcare provider for a formal diagnosis and treatment plan, here are some steps you can take to help manage your symptoms:

  1. Keep a Headache Diary: Track your headaches, including their frequency, duration, intensity, and any potential triggers. This can help your healthcare provider identify patterns and develop a treatment plan. You can use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

  2. Stay Hydrated: Dehydration can worsen headaches, so make sure you're drinking plenty of water throughout the day.

  3. Practice Relaxation Techniques: Stress and tension can contribute to headaches. Try relaxation techniques such as deep breathing, meditation, or gentle yoga.

  4. Maintain a Regular Sleep Schedule: Poor sleep can trigger headaches, so aim for a consistent sleep schedule and create a relaxing bedtime routine.

  5. Apply Heat or Cold: Applying a warm compress to your neck or a cold pack to your forehead can help relieve headache pain.

  6. Consider Dietary Changes: Some foods and drinks can trigger headaches. Pay attention to what you eat and drink, and try to identify any potential triggers.

  7. Consult a Healthcare Provider: Given the severity and frequency of your headaches, it's important to see a healthcare provider for a thorough evaluation and appropriate treatment.

What you should look out for

Seek medical attention more urgently if you experience any of the following:

  • Severe or Sudden Onset: If your headache is the worst you've ever had or comes on very suddenly, seek immediate medical attention.
  • Neurological Symptoms: If you experience weakness, numbness, difficulty speaking, or changes in vision that persist, seek medical attention.
  • Fever or Stiff Neck: If you have a fever or a stiff neck along with your headache, it could be a sign of a more serious condition.
  • Persistent or Worsening Symptoms: If your symptoms do not improve with over-the-counter treatments or continue to worsen, see a healthcare provider.

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.

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5 mo ago

People Also Ask


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

Common symptoms of migraines include severe headache pain, nausea, dizziness, and sensitivity to light and sound. Visual disturbances like seeing sparkles can also occur. Management often involves medications to relieve pain and prevent future attacks, as well as lifestyle changes to avoid triggers.


How can hormonal changes during the menstrual cycle affect headaches?

Hormonal changes during the menstrual cycle can trigger headaches or migraines, often referred to as menstrual-related headaches. These can be managed with hormonal treatments, pain relievers, and lifestyle changes to help reduce the frequency and severity of the headaches.


What are some effective treatments for tension headaches?

Tension headaches can often be managed with over-the-counter pain relievers, relaxation techniques, and improving posture. Stress reduction and regular physical activity can also help prevent tension headaches.


When should someone seek medical attention for severe headaches?

Medical attention should be sought for severe headaches if they are the worst you've ever had, come on very suddenly, are accompanied by neurological symptoms like weakness or numbness, or if there is a fever or stiff neck. Persistent or worsening symptoms that do not improve with over-the-counter treatments also warrant a healthcare provider's evaluation.


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