[22F] Experiencing severe photophobia with headache, nasal congestion, and watery eyes

Patient Description

A 22-year-old female has been experiencing severe sensitivity to light, described as painful when eyes are open in bright light, for the last 4 days. This photophobia is so intense that it prevents her from leaving her house and is only relieved by staying in a dark room or closing her eyes. Accompanying symptoms include an aching headache with a severity of 4 out of 10, located on the forehead, around the eyes, and at the back of the head, as well as nasal congestion that has progressed from a runny nose to complete nasal obstruction, rated at a severity of 7 out of 10. Additionally, she reports watery eyes that occur almost every time she opens them in bright light. The patient experiences these visual disturbances during her headaches, which she reports occur once or twice a year when she gets sick. She also reports chills but no fever. Her medical history is unremarkable with no known chronic illnesses or conditions, no known drug allergies, and the only medication she is taking is norethindrone for birth control.

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Arora's Assessment

What might be happening

Based on your symptoms, possible explanations include:

  • Migraine: This is a type of headache characterized by severe, throbbing pain usually on one side of the head. It is often accompanied by other symptoms such as sensitivity to light, sound, and smells, as well as nausea and vomiting.

    • Treatment typically involves medications to relieve the symptoms and prevent future attacks. Lifestyle changes such as regular sleep, meals, and exercise can also help.
  • Sinusitis: This is an inflammation or swelling of the tissue lining the sinuses, often caused by an infection. Symptoms can include a headache, nasal congestion, and watery eyes.

    • Treatment usually involves rest, hydration, and over-the-counter medications to relieve symptoms. If caused by a bacterial infection, antibiotics may be prescribed.
  • Cluster headache: These are severe headaches that occur in clusters or cyclical patterns. They are characterized by sudden, debilitating pain on one side of the head, often accompanied by a watery eye and nasal congestion on the same side.

    • Treatment involves medications to reduce the severity of the headache, as well as preventive medications to reduce the frequency and duration of the attacks.

What you can do

  1. Rest and hydrate: Make sure you're getting enough sleep and drinking plenty of fluids.
  2. Over-the-counter pain relievers: Non-prescription medications such as ibuprofen or acetaminophen can help relieve headache pain.
  3. Avoid triggers: If you notice certain foods, activities, or situations trigger your headaches, try to avoid them.
  4. Use a humidifier: This can help moisten your nasal and sinus passages and may relieve congestion.

What you should look out for

You should seek immediate medical attention if:

  • Your symptoms worsen or do not improve with rest and over-the-counter treatments.
  • You experience a sudden, severe headache like a "thunderclap".
  • You have a fever, stiff neck, or confusion along with your headache.
  • You have difficulty speaking, seeing, or moving.

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 causes photophobia and how can it be managed?

Photophobia, or sensitivity to light, can be caused by various conditions such as migraines, eye strain, or infections like sinusitis. Management includes staying in dimly lit environments, wearing sunglasses, and addressing the underlying cause with appropriate treatment.


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

Migraines often present with throbbing pain, sensitivity to light and sound, and sometimes nausea, while sinus headaches are usually accompanied by nasal congestion, facial pressure, and a dull, constant pain. A healthcare provider can help differentiate between the two based on symptoms and possibly imaging tests.


What are some effective home remedies for nasal congestion?

Effective home remedies for nasal congestion include using a humidifier, staying hydrated, inhaling steam, using saline nasal sprays, and applying warm compresses to the face. Over-the-counter decongestants may also provide relief.


When should I seek medical attention for a headache?

You should seek medical attention for a headache if it is sudden and severe, if it is accompanied by symptoms like fever, stiff neck, confusion, or neurological deficits, or if it does not improve with rest and over-the-counter treatments.


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