[21F] Experiencing back pain, migraines, and neurological symptoms

Patient Description

A 21-year-old female reports enduring back pain for several years, described as a constant dull ache with intermittent sharp pains, rated 9 out of 10 in severity. The pain is localized horizontally along the spine in the middle to lower back and is exacerbated by sitting upright, laying down, or bending, but somewhat relieved when laying on the side. The patient has also been experiencing daily migraines for a month, with a severity of 8 out of 10, that do not respond to food, water, medicine, or sleep, and are accompanied by nausea and sensitivity to light. Neurologically, the patient notes an absence of reflex on the left side, jerky reflexes on the right side, unequal pupil dilation, and struggles with urinary sensation. Additionally, there is reported weakness in the limbs. The patient has a medical history of thyroid and heart issues diagnosed two years ago and had a fall that might be related to the back pain. No current medications are being taken, and there are no known drug allergies.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are a few possibilities:

  • Herniated Disc: This condition occurs when one of the rubbery discs that sit between the bones of the spine (vertebrae) is damaged, causing it to press on the nerves in the spine. This can cause sharp, radiating pain, numbness and tingling, and weakness in the limbs. The fact that your pain is worse when sitting or bending, and better when lying on your side, is consistent with this condition.

    • Treatment typically involves pain management, physical therapy, and in some cases, surgery.
  • Migraines: You've described severe, daily headaches that are accompanied by nausea and light sensitivity. This is consistent with migraines.

    • Treatment typically involves medications to relieve symptoms and prevent future migraines, as well as lifestyle changes to avoid triggers.
  • Neurological Conditions: The combination of unequal pupil dilation, altered reflexes, and difficulty knowing when you need to urinate could suggest a neurological condition. This could range from a nerve disorder to a problem with the brain or spinal cord.

    • Treatment would depend on the specific condition and could range from medication to surgery.

Please note that these are possibilities based on the information you've provided and are not a definitive diagnosis. It's important to consult with a healthcare professional who can evaluate your symptoms in person.

What you can do

  1. Schedule an appointment with your healthcare provider as soon as possible. It's important to get a proper diagnosis for your symptoms, especially given their severity and the fact that they're affecting your daily life.

  2. In the meantime, try to rest and avoid activities that worsen your back pain. Over-the-counter pain relievers may help with your headaches and back pain, but they should not be used as a long-term solution.

  3. Keep a headache diary. Note when your headaches start, what you were doing at the time, how long they last and what, if anything, provides relief. This can help your healthcare provider diagnose your condition.

What you should look out for

Seek immediate medical attention if:

  • Your pain becomes unbearable
  • You experience sudden, severe headaches
  • You have difficulty walking or moving your limbs
  • You lose control of your bladder or bowels
  • You experience any other new or worsening symptoms

Remember, while I strive to provide accurate information, I'm not a doctor. Please consult with a healthcare professional for a formal diagnosis and treatment.

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11 mo ago

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People Also Ask


What are the common symptoms of a herniated disc?

Common symptoms of a herniated disc include sharp, radiating pain in the back or limbs, numbness or tingling, and weakness in the limbs. The pain often worsens with certain movements like sitting or bending and may improve when lying down.


How can migraines be effectively managed or treated?

Migraines can be managed with medications that relieve symptoms, such as pain relievers and anti-nausea drugs, and preventive medications that reduce the frequency of attacks. Lifestyle changes, such as identifying and avoiding triggers, maintaining a regular sleep schedule, and managing stress, can also help.


What neurological symptoms should prompt immediate medical attention?

Neurological symptoms that require immediate medical attention include sudden, severe headaches, loss of coordination or balance, difficulty walking, loss of bladder or bowel control, and any new or worsening symptoms like changes in vision or speech.


What lifestyle changes can help alleviate back pain?

Lifestyle changes that can help alleviate back pain include maintaining good posture, engaging in regular low-impact exercises like walking or swimming, using ergonomic furniture, applying heat or cold therapy, and practicing stress-reducing techniques such as yoga or meditation.


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