[25F] Experiencing insomnia and daily headaches

Patient Description

A 25-year-old female has been experiencing insomnia for the past couple of weeks, characterized by waking up at least once during the night for about 10 minutes. Despite sleeping through the night and taking naps after work, she still feels tired. She typically gets at least 6 hours of sleep each night but does not have a consistent sleep schedule. She has not tried any relaxation techniques or sleep hygiene practices to improve her sleep quality. Additionally, she experiences headaches almost every day, starting in the afternoon, sometimes accompanied by nausea and sensitivity to light and sound. There are no visual disturbances, blurred vision, double vision, dizziness, or balance problems. She does not consume caffeine, alcohol, or recreational drugs. Her current medications include 40 mg of fluoxetine once a day, a birth control pill (Norethindrone 1/28), and vitamins B12 and D (Vitamin D3 50mcg). There have been no recent changes in her fluoxetine dosage or any new medications added to her regimen. Her diet typically consists of fried foods, starches, and some vegetables. She has a family history of autoimmune disease, diabetes, cancer, and schizophrenia. She was diagnosed with PTSD, depression, and anxiety at around age 15, and with Epstein-Barr Virus (EBV) last year. She does not have any allergies or adverse reactions to medications.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

  • Insomnia: Your difficulty staying asleep and feeling tired despite getting some sleep could be due to insomnia. Insomnia can be caused by various factors, including stress, anxiety, depression, and poor sleep habits. Your history of anxiety, depression, and PTSD may contribute to this condition.

    • Treatment: Treatment for insomnia often includes improving sleep hygiene, cognitive-behavioral therapy for insomnia (CBT-I), and sometimes medications prescribed by a healthcare provider.
  • Migraine: The headaches you experience almost every day, accompanied by nausea and sensitivity to light and sound, suggest that you might be experiencing migraines.

    • Treatment: Migraine treatment can include lifestyle changes, avoiding known triggers, over-the-counter pain relievers, and prescription medications to prevent or reduce the frequency and severity of migraines.
  • Chronic Fatigue: Feeling tired despite sleeping and napping could be a sign of chronic fatigue, which can be associated with conditions like depression, anxiety, and Epstein-Barr Virus (EBV) infection.

    • Treatment: Managing chronic fatigue often involves addressing the underlying conditions, improving sleep hygiene, and sometimes medications or supplements as recommended by a healthcare provider.

What you can do

While it's important to consult a healthcare provider for a formal diagnosis and treatment plan, here are some steps you can take to help manage your symptoms:

  1. Improve Sleep Hygiene:

    • Establish a consistent sleep schedule by going to bed and waking up at the same time every day, even on weekends.
    • Create a relaxing bedtime routine, such as reading a book or taking a warm bath.
    • Make your sleep environment comfortable, quiet, and dark.
    • Avoid screens (phones, tablets, computers) at least an hour before bedtime.
  2. Manage Stress and Anxiety:

    • Practice relaxation techniques such as deep breathing, meditation, or yoga.
    • Consider talking to a therapist or counselor to help manage anxiety, depression, and PTSD.
  3. Monitor Your Diet:

    • Try to incorporate more balanced and nutritious foods into your diet, including fruits, vegetables, lean proteins, and whole grains.
    • Stay hydrated by drinking plenty of water throughout the day.
  4. Track Your Symptoms:

    • Use MDandMe to journal your symptoms, track your progress, and get insights. This can help you identify patterns and triggers and provide useful information to your healthcare provider.

What you should look out for

Reasons to see a doctor more urgently include:

  • If your headaches become more severe or frequent.
  • If you experience any new or worsening symptoms, such as visual disturbances, dizziness, or balance problems.
  • If you continue to feel excessively tired despite making lifestyle changes.
  • If you experience any side effects from your medications.

Remember, while these suggestions can help manage your symptoms, it's important to seek care from real health professionals to receive a formal diagnosis and appropriate treatment.

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4 mo ago

People Also Ask


What are some effective sleep hygiene practices to improve insomnia?

Effective sleep hygiene practices include establishing a consistent sleep schedule, creating a relaxing bedtime routine, making your sleep environment comfortable, and avoiding screens at least an hour before bedtime.


How can migraines be managed or treated effectively?

Migraines can be managed by identifying and avoiding triggers, using over-the-counter pain relievers, and taking prescription medications as needed. Lifestyle changes such as stress management and regular sleep can also help.


What lifestyle changes can help reduce chronic fatigue symptoms?

To reduce chronic fatigue symptoms, focus on improving sleep hygiene, managing stress through relaxation techniques, maintaining a balanced diet, and staying hydrated. Addressing underlying conditions like depression and anxiety is also important.


When should I see a doctor about my headaches?

You should see a doctor if your headaches become more severe or frequent, if you experience new symptoms like visual disturbances or dizziness, or if lifestyle changes do not improve your symptoms.


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