[21F] Experiencing persistent headache, dizziness, eye strain, and bone pain

Patient Description

A 21-year-old female has been suffering from a persistent headache for 2 months, described as a constant pressure throughout the head, sometimes radiating to the neck, with an intensity of 7 out of 10. The headache is exacerbated by bowing down, coughing, and walking, and does not improve with rest. Paracetamol provides some relief. The patient also experiences eye pain with a severity of 9 out of 10, accompanied by eyelid pain and occasional double vision. Additionally, the patient reports bone pain in the arms and legs without engaging in strenuous activity, and sporadic chest pain described as a needle-like poking sensation with contraction, present for 3 years but occurring infrequently. Other symptoms include nausea, neck stiffness, and sensitivity to sounds with tinnitus. There is no history of similar headaches or migraines in the family, no recreational drug use, and no allergies or adverse reactions to medications. The patient has been taking levothyroxine 25 mg daily for a thyroid cyst for the past six months and has a past medical history of pneumonia, which has resolved. No side effects from levothyroxine have been noted, and no changes in symptoms or general health since starting the medication have been observed.

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Arora's Assessment

What might be happening

Based on the information you provided, the following conditions might be considered:

  • Migraine: This is a type of headache characterized by severe, throbbing pain, often accompanied by other symptoms such as nausea, sensitivity to light and sound, and sometimes visual disturbances like double vision. The pain can last for hours to days, and can be severe enough to interfere with daily activities.

    • Treatment typically involves medications to relieve symptoms and prevent future attacks. Lifestyle changes such as regular sleep, meals, and exercise, and avoiding known triggers can also help manage migraines.
  • Tension-Type Headache: This is the most common type of headache, characterized by a constant pressure or tightness around the head or neck. It can be associated with stress, anxiety, or eye strain.

    • Treatment usually involves over-the-counter pain relievers, stress management techniques, and sometimes prescription medications.
  • Thyroid Eye Disease: This is an autoimmune condition where the body's immune system attacks the tissues around the eyes. It's often associated with thyroid conditions like Graves' disease, but can occur in people with normal thyroid function. Symptoms can include eye pain, double vision, and swelling or redness around the eyes.

    • Treatment can involve managing the underlying thyroid condition, as well as specific treatments for the eye symptoms.
  • Chest Wall Pain: This is a common cause of chest pain, and can be due to conditions like costochondritis (inflammation of the cartilage in the chest wall), muscle strain, or injury. The pain is often sharp and may worsen with movement or deep breathing.

    • Treatment usually involves pain relievers and rest. Physical therapy can sometimes be helpful.
  • Fibromyalgia: This is a chronic condition characterized by widespread pain in the muscles and bones, often accompanied by fatigue, sleep problems, and mood issues. The cause is unknown, but it's thought to involve a variety of genetic and environmental factors.

    • Treatment usually involves a combination of medications, exercise, stress management techniques, and sometimes cognitive-behavioral therapy.

Please note that this is not an exhaustive list and other conditions could also explain your symptoms. It's also possible that you could have more than one of these conditions contributing to your symptoms.

What you can do

  1. Consult a healthcare provider: Given the duration and severity of your symptoms, it's important to seek medical attention. Your healthcare provider can perform a thorough evaluation, order necessary tests, and provide appropriate treatment.

  2. Keep a symptom diary: This can help you and your healthcare provider identify patterns and triggers, and can be useful in managing conditions like migraines and fibromyalgia.

  3. Practice good self-care: Regular exercise, a healthy diet, adequate sleep, and stress management can all contribute to overall health and may help manage your symptoms.

What you should look out for

Seek immediate medical attention if you experience:

  • Sudden, severe headache or a headache that is different from your usual headaches
  • Sudden or worsening double vision, especially if accompanied by other neurological symptoms like weakness or numbness
  • Severe chest pain, especially if it's accompanied by shortness of breath, sweating, nausea, or fainting

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for appropriate examination, diagnosis, and treatment.

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9 mo ago


People Also Ask


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

Migraines are characterized by severe, throbbing headaches often accompanied by nausea, sensitivity to light and sound, and sometimes visual disturbances like double vision. Management includes medications to relieve symptoms and prevent future attacks, as well as lifestyle changes such as regular sleep, meals, exercise, and avoiding known triggers.


How can tension-type headaches be distinguished from other types of headaches?

Tension-type headaches are typically described as a constant pressure or tightness around the head or neck, often associated with stress, anxiety, or eye strain. They differ from migraines, which are usually more severe and throbbing, and often accompanied by nausea and sensitivity to light and sound.


What is Thyroid Eye Disease and how is it related to thyroid conditions?

Thyroid Eye Disease is an autoimmune condition where the immune system attacks the tissues around the eyes, often associated with thyroid conditions like Graves' disease. Symptoms include eye pain, double vision, and swelling or redness around the eyes. It can occur even in people with normal thyroid function.


What are the possible causes of chest wall pain and how can it be treated?

Chest wall pain can be caused by conditions like costochondritis, muscle strain, or injury, and is often sharp, worsening with movement or deep breathing. Treatment typically involves pain relievers and rest, and physical therapy can sometimes be helpful.


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