[23F] Experiencing chronic upper back, neck pain, and headaches

Patient Description

A 23-year-old female has been experiencing chronic pain in the upper back described as muscle contractions for one week, a constant dull headache with intermittent severe shooting pains up the right side of the head for two months, and neck pain for one week. The back pain worsens with sitting for long periods, walking, and lifting, and does not respond to rest or other interventions. The headache is usually rated at a severity of 3 but can spike to an 8, and is accompanied by occasional confusion and a slight worsening of vision. The patient has a history of anxiety diagnosed at age 13 and reactive hypoglycemia diagnosed at age 16. She is currently taking 20 mg of Prozac and one pill of Junel daily for the past five years, with no reported side effects. The patient denies any known drug allergies and is not taking any over-the-counter medications, vitamins, or supplements. She reports chronic stress due to her job but no changes in mood or behavior, and no recent injuries.

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Arora's Assessment

What might be happening

Based on the information you have provided, possible diagnoses include:

  • Tension-type headaches: These are common and can be brought on by stress, anxiety, or strain. They are often described as a constant ache that affects both sides of the head, as if a tight band is stretched around it. This could explain your dull headache and the shooting pains up the right side of your head.

    • Treatment typically involves over-the-counter pain relievers, stress management, and lifestyle changes.
  • Musculoskeletal pain: This is pain that affects the muscles, ligaments and tendons, and bones. The pain can be localized in one area, or widespread. This could be the cause of your upper back and neck pain.

    • Treatment often involves physical therapy, pain relievers, and lifestyle changes.
  • Stress and Anxiety: Chronic stress and anxiety can cause a variety of physical symptoms, including muscle tension, headaches, and dizziness. This could be contributing to your symptoms.

    • Treatment typically involves stress management techniques, therapy, and medication.
  • Vision changes: Changes in vision can be due to a variety of causes, including refractive errors, migraines, or more serious conditions like glaucoma. It's important to have any changes in vision checked out by a healthcare professional.

    • Treatment depends on the underlying cause and can range from corrective lenses to medication or surgery.

Please note that these are potential explanations based on the information you provided, and not a definitive diagnosis.

What you can do

  1. Try to manage your stress levels. This could involve taking breaks during your study sessions, practicing mindfulness or relaxation techniques, or speaking to a counselor or therapist.
  2. Maintain a healthy lifestyle. This includes getting regular exercise, eating a balanced diet, and ensuring you get enough sleep.
  3. Over-the-counter pain relievers may help with your headaches and musculoskeletal pain. However, these should be used as directed and not for long periods of time without consulting a healthcare professional.
  4. Consider seeing an optometrist or ophthalmologist to have your vision checked.

What you should look out for

Reasons to see a doctor more urgently:

  • If your headache becomes more severe or changes in nature
  • If your vision changes suddenly or significantly
  • If your dizziness worsens or is accompanied by other symptoms like fainting
  • If your back or neck pain worsens or does not improve with rest and over-the-counter pain relievers

Remember, it's important to consult with a healthcare professional who can evaluate your symptoms and medical history in order to provide a definitive diagnosis and treatment plan.

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10 mo ago

People Also Ask


What are tension-type headaches and how can they be managed?

Tension-type headaches are common headaches often caused by stress, anxiety, or muscle strain. They are typically described as a constant ache or pressure around the head. Management includes over-the-counter pain relievers, stress management techniques, and lifestyle changes such as regular exercise and adequate sleep.


What causes musculoskeletal pain and what are the treatment options?

Musculoskeletal pain can be caused by injury, overuse, or strain of muscles, ligaments, tendons, or bones. Treatment options include physical therapy, pain relievers, and lifestyle modifications such as ergonomic adjustments and regular exercise to strengthen muscles.


How can stress and anxiety contribute to physical symptoms like headaches and muscle tension?

Chronic stress and anxiety can lead to physical symptoms like headaches and muscle tension due to the body's stress response, which can cause muscle tightening and increased sensitivity to pain. Managing stress through relaxation techniques, therapy, and sometimes medication can help alleviate these symptoms.


What should I do if I experience changes in vision along with headaches?

If you experience changes in vision along with headaches, it is important to consult a healthcare professional, such as an optometrist or ophthalmologist, to rule out any serious conditions. Treatment will depend on the underlying cause and may include corrective lenses, medication, or other interventions.


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