[21F] Experiencing severe migraines and excessive sweating

Patient Description

A 21-year-old female presents with severe migraines that occur a couple of times a week and have been present for a few years. The migraines gradually build up in intensity, starting in the neck and progressing to unilateral visual loss in the left eye and vomiting due to severe pain, rated 8 out of 10. The patient experiences visual disturbances, or 'aura', before the onset of the migraine and has noted sensitivity to light. Additionally, the patient suffers from excessive sweating, even in cold conditions, leading to multiple clothing changes per day. She also reports occasional stiff neck and rash, facial flushing, and confusion or difficulty speaking during or after headaches. Medical history includes von Willebrand’s disease, stage 2 kidney disease, high blood pressure, and insomnia. Current medications include Effexor 150mg, Losartan 25mg, iron supplements, and B12. The patient has a sulfa allergy. No new medications or supplements were reported.

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Arora's Assessment

What might be happening

Based on the information you've provided, the following conditions might be causing your symptoms:

  • Migraines: Your description of severe, throbbing headaches that start in your neck and progress to the point where you can't see out of one eye, accompanied by vomiting, light sensitivity, and visual disturbances, is consistent with migraines. Migraines can be triggered by various factors, including stress, certain foods, hormonal changes, and lack of sleep.

    • Treatment typically involves medications to relieve symptoms and prevent future attacks. Lifestyle changes, such as regular sleep, exercise, and stress management, can also help.
  • Hyperhidrosis: This condition, characterized by excessive sweating even when it's not hot, could explain your sweating symptoms. It's not clear why some people sweat excessively, but it can be related to other medical conditions or medications.

    • Treatment options include prescription antiperspirants, medications, iontophoresis (a procedure that uses electricity to temporarily turn off the sweat glands), and in severe cases, surgery.
  • Insomnia: Your difficulty sleeping could be due to insomnia, a sleep disorder that can make it hard to fall asleep, stay asleep, or cause you to wake up too early and not be able to get back to sleep. Insomnia can be caused by many things, including stress, anxiety, depression, certain medications, and certain medical conditions.

    • Treatment typically involves improving sleep habits, behavioral therapy, and/or medications.
  • Neck pain: This could be due to various causes, including poor posture, muscle strain, arthritis, or in rare cases, certain diseases or conditions.

    • Treatment depends on the cause, but can include rest, physical therapy, medications, and in some cases, surgery.

Please note that these are possible explanations for your symptoms based on the information you've provided, but they are not a definitive diagnosis. You should consult with a healthcare provider for a formal evaluation.

What you can do

Here are some steps you can take to manage your symptoms:

  1. For your migraines, try to identify and avoid any potential triggers. This could include certain foods, stress, lack of sleep, etc. Over-the-counter pain relievers may help, but if your migraines are severe or frequent, you should consult with a healthcare provider about prescription medications.

  2. For your excessive sweating, try using an over-the-counter antiperspirant. If this doesn't help, you should consult with a healthcare provider about other treatment options.

  3. For your insomnia, try to improve your sleep habits. This could include going to bed and waking up at the same time every day, making your sleeping environment comfortable and free of distractions, and avoiding caffeine and large meals before bedtime. If these measures don't help, you should consult with a healthcare provider about other treatment options.

  4. For your neck pain, try rest and over-the-counter pain relievers. If your pain is severe or persistent, you should consult with a healthcare provider.

What you should look out for

You should seek immediate medical attention if:

  • Your migraines become more severe or frequent
  • You have a severe headache that comes on suddenly (often described as "the worst headache of your life")
  • You have a headache accompanied by a high fever (above 101.5°F), stiff neck, mental confusion, seizures, double vision, weakness, numbness, or speaking difficulties
  • Your excessive sweating is accompanied by chest pain or rapid, pounding heartbeat
  • You have difficulty sleeping that persists despite trying to improve your sleep habits
  • Your neck pain is severe or persistent, or is accompanied by severe headache, shooting pain in your shoulder or arm, or numbness or loss of strength in your arms or hands.

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, testing, and care recommendations.

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11 mo ago

People Also Ask


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

Common triggers for migraines include stress, certain foods (like aged cheese and processed meats), hormonal changes, and lack of sleep. Managing migraines often involves identifying and avoiding these triggers, using medications to relieve symptoms, and making lifestyle changes such as maintaining a regular sleep schedule, exercising, and managing stress.


What are the treatment options for hyperhidrosis (excessive sweating)?

Treatment options for hyperhidrosis include prescription antiperspirants, oral medications, iontophoresis (a procedure that uses electricity to reduce sweating), Botox injections, and in severe cases, surgery to remove sweat glands or cut nerves that trigger sweating.


How can insomnia be effectively managed or treated?

Insomnia can be managed by improving sleep habits, such as maintaining a consistent sleep schedule, creating a comfortable sleep environment, and avoiding caffeine and large meals before bedtime. Behavioral therapy and medications may also be recommended by a healthcare provider if these measures are not effective.


What are the potential causes of neck pain and how can it be treated?

Neck pain can be caused by poor posture, muscle strain, arthritis, or other medical conditions. Treatment depends on the cause and may include rest, physical therapy, pain relievers, and in some cases, surgery. It's important to consult a healthcare provider for a proper diagnosis and treatment plan.


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Madelyn#4031

11 mo ago

Those migraines sound really disruptive! Do you take any pro-phylactic medication like an anticonvulsant or beta blocker medication?

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