[21F] Experiencing severe headaches with neurological symptoms

Patient Description

A 21-year-old female presents with severe headaches characterized by sharp and throbbing pain in the right temple, rated at an intensity of 8 or 9 out of 10. These headaches began a week ago, initially occurring once or twice a day, and have progressively worsened in frequency and intensity, now causing constant pain. The patient also reports seeing smoke that isn't there, ear sensitivity, memory issues, facial flushing, altered depth perception, balance issues, inconsistent appetite, extreme nausea, irritability, and insomnia. Additionally, over the past three days, the patient has experienced difficulty reading, with letters and numbers becoming mixed up. The headaches seem to occur randomly without identifiable triggers and have significantly impacted concentration and sleep. No prior history of similar visual disturbances was noted.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few possible explanations for your condition:

  • Migraine with Aura: Your symptoms, including severe headaches, visual disturbances, and sensitivity to sound, are consistent with migraines, particularly those with aura. Migraines can cause throbbing pain, often on one side of the head, and may be accompanied by visual changes, nausea, and other neurological symptoms.

    • Treatment typically involves medications to relieve symptoms and prevent future attacks. Over-the-counter pain relievers or prescription medications may be recommended by a healthcare provider.
  • Cluster Headaches: These are severe headaches that occur in cyclical patterns or clusters. They can cause intense pain around one eye or temple and may be accompanied by symptoms like facial flushing and ear sensitivity.

    • Treatment may include medications to reduce the frequency and severity of attacks, as well as lifestyle changes to avoid potential triggers.
  • Tension-Type Headaches: Although less likely given the severity of your symptoms, tension headaches can cause a band-like pain around the head and may be associated with stress or poor posture.

    • Treatment often involves stress management techniques, physical therapy, and over-the-counter pain relief.

Given your history of undifferentiated connective tissue disease and fibromyalgia, it's also possible that these conditions could be contributing to your symptoms. However, the new onset of visual disturbances and severe headaches warrants further evaluation.

What you can do

  1. Consult a Healthcare Professional: It's important to see a doctor for a thorough evaluation and diagnosis. They may recommend imaging studies or other tests to rule out more serious conditions.
  2. Track Your Symptoms: Use MDandMe to journal your symptoms, noting their frequency, duration, and any potential triggers. This information can be valuable for your healthcare provider.
  3. Manage Stress: Practice relaxation techniques such as deep breathing, meditation, or yoga to help manage stress, which can exacerbate headaches.
  4. Maintain a Regular Sleep Schedule: Try to go to bed and wake up at the same time each day to improve your sleep quality.
  5. Stay Hydrated and Eat Regularly: Dehydration and irregular meals can trigger headaches, so ensure you're drinking enough water and eating balanced meals.

What you should look out for

Seek medical attention promptly if you experience any of the following:

  • Sudden, severe headache unlike any you've had before
  • Headache accompanied by fever, stiff neck, confusion, or difficulty speaking
  • Persistent visual disturbances or changes in vision
  • Weakness or numbness in any part of your body

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and appropriate treatment.

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29 d ago

People Also Ask


What are the common symptoms of a migraine with aura?

Common symptoms of a migraine with aura include severe throbbing pain on one side of the head, visual disturbances such as seeing flashes of light or blind spots, sensitivity to light and sound, nausea, and sometimes tingling or numbness in the face or hands.


How can I differentiate between a migraine and a cluster headache?

Migraines typically involve throbbing pain on one side of the head and may be accompanied by visual disturbances and nausea. Cluster headaches, on the other hand, cause intense pain around one eye or temple and occur in cyclical patterns. They may also cause symptoms like facial flushing and ear sensitivity.


What lifestyle changes can help manage severe headaches?

Lifestyle changes that can help manage severe headaches include maintaining a regular sleep schedule, staying hydrated, eating balanced meals at regular intervals, practicing stress management techniques like meditation or yoga, and avoiding known headache triggers.


When should I seek immediate medical attention for a headache?

You should seek immediate medical attention for a headache if it is sudden and severe, unlike any you've had before, or if it is accompanied by symptoms such as fever, stiff neck, confusion, difficulty speaking, persistent visual disturbances, or weakness or numbness in any part of your body.


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