[23F] Experiencing back pain, migraines, and persistent cough

Patient Description

A 23-year-old female is experiencing mid-back pain under the left shoulder blade near the spine, rated as 7 out of 10 in severity, with associated stiffness, soreness, and occasional throbbing. The pain radiates to the left side ribs, neck, and right shoulder, and is somewhat alleviated by ibuprofen and heat. She has been dealing with this pain for about a week. Additionally, she suffers from migraines once a week, characterized by intense pain above the eyebrows and in the eye, nausea, dizziness, and light sensitivity, rated 4 out of 10 in intensity. She also has a moderate cough that has been present for months, causing coughing fits that lead to gagging, particularly at night. Her medical history includes celiac disease, adenomyosis, inappropriate tachycardia, anxiety, ADHD, and migraines, all diagnosed in 2016. She reports adverse reactions to Prednisone, Buspar, and Vicodin. Her current medications include Citalopram, Mirena, Metoprolol, Methylphenidate, Vitamin D, and as needed, Sumatriptan, Zofran, Tylenol, Ibuprofen, Hydroxyzine, and recently Flexeril.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible explanations for your symptoms include:

  • Musculoskeletal Pain: This is a common cause of back pain and can be due to muscle strain, poor posture, or underlying conditions like arthritis. The pain can be localized or radiate to other areas, such as your ribs, neck, and shoulder.

    • Treatment typically involves pain management with over-the-counter pain relievers, physical therapy, and lifestyle modifications like improving posture and ergonomics.
  • Tension Headaches or Migraines: Your description of intense pain in the eye, nausea, dizziness, and sensitivity to light are common symptoms of migraines. Tension headaches, often related to stress or muscle strain, can cause pain in the neck and shoulders.

    • Treatment can include medications to relieve symptoms (like Sumatriptan you're already taking), preventive medications to reduce the frequency and severity of migraines, and lifestyle changes to manage triggers.
  • Chronic Cough: A cough lasting for more than a few weeks can be due to a variety of conditions, including postnasal drip, gastroesophageal reflux disease (GERD), asthma, or side effects of certain medications.

    • Treatment depends on the underlying cause and can range from lifestyle changes, medications to manage symptoms, or treating the underlying condition.

Please note that these are potential explanations based on the information provided, and not a definitive diagnosis. It's important to consult with a healthcare provider for a formal evaluation.

What you can do

  1. Continue to manage your pain with over-the-counter pain relievers as needed, but avoid exceeding the recommended dosages.
  2. Try to maintain good posture throughout the day, especially if you're working at a desk or doing other activities that require you to stay in one position for extended periods.
  3. Engage in regular physical activity and stretching exercises to keep your muscles flexible and strong.
  4. Monitor your symptoms and note any patterns or triggers for your migraines, such as certain foods, stress, lack of sleep, etc. This can help you manage your migraines more effectively.
  5. Stay hydrated and use a humidifier at night to help soothe your throat and reduce coughing fits.

What you should look out for

Seek immediate medical attention if you experience:

  • Severe pain that doesn't improve with rest or over-the-counter medications
  • Difficulty breathing or chest pain
  • Weakness or numbness in your arms or legs
  • Changes in vision, difficulty speaking, or confusion
  • A cough that produces blood or is associated with unexplained weight loss or night sweats

Remember, while I strive to provide accurate information, I'm an AI and not a substitute for professional medical advice. Always consult with a healthcare provider for a formal diagnosis and treatment.

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11 mo ago

People Also Ask


What are common causes of mid-back pain under the shoulder blade?

Common causes of mid-back pain under the shoulder blade include muscle strain, poor posture, or underlying conditions like arthritis. It can also be due to stress or tension in the muscles.


How can migraines be effectively managed or prevented?

Migraines can be managed by identifying and avoiding triggers, using medications like Sumatriptan for relief, and possibly taking preventive medications. Lifestyle changes such as regular sleep, hydration, and stress management can also help.


What could be causing a chronic cough that lasts for months?

A chronic cough lasting for months can be caused by postnasal drip, GERD, asthma, or side effects of medications. It's important to identify the underlying cause to treat it effectively.


What are the potential side effects of the medications I'm currently taking?

Potential side effects of medications like Citalopram, Metoprolol, and Methylphenidate can include nausea, dizziness, fatigue, and changes in mood or appetite. It's important to discuss any concerns with your healthcare provider.


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