[25F] Experiencing intense head pressure, migraines, and full body tremors

Patient Description

A 25-year-old female is reporting intense, intermittent head pressure that is exacerbated by movements such as bending over. This pressure is associated with significant pain, ear involvement, and occasional left eye bulging. These symptoms have been present for two months. Additionally, the patient experiences full body tremors that have been worsening over the past six months, affecting her arms, hands, legs, head, and neck. The tremors are constant with varying intensity. She also suffers from intense migraines that incapacitate her to the point of being unable to sit up and has been experiencing vertigo. Visual disturbances include blurriness and a history of floaters, but no speech changes have been reported. The patient has a history of polycystic ovary syndrome (PCOS) diagnosed at age 19 and hypothyroidism diagnosed at age 24. She has a known allergy to sulfa drugs. Current medications include bupropion 150 mg, lithium carbonate 600 mg, quetiapine 100 mg, gabapentin 200 mg, levothyroxine 0.5 mg, vitamin B12 injections, cymbalta 30 mg, and slynd birth control. No new medications have been reported.

Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

Migraines: Migraines are a type of headache characterized by severe throbbing pain or a pulsing sensation, usually on one side of the head. It's often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days, and the pain can be so severe that it interferes with your daily activities.
- Treatment for migraines can involve a combination of medications, lifestyle changes, and sometimes cognitive behavioral therapy.
Benign intracranial hypertension (BIH): Also known as pseudotumor cerebri, BIH is a condition where the pressure inside your skull (intracranial pressure) increases for no obvious reason. Symptoms can include headaches, vision problems, and occasionally, bulging of the eye.
- Treatment for BIH can involve medications to reduce the pressure, and in some cases, surgery.
Thyroid eye disease: This is a condition where the muscles and fatty tissues behind your eye become inflamed. This can cause a variety of symptoms, including bulging eyes, double vision, and pain in the eyes. Given your history of hypothyroidism, this could be a consideration.
- Treatment for thyroid eye disease can involve medications to reduce inflammation, and in some cases, surgery.
Essential tremor: This is a nervous system (neurological) disorder that causes involuntary and rhythmic shaking. It can affect almost any part of your body, but the trembling occurs most often in your hands.
- Treatment for essential tremor can involve medications, physical therapy, and in some cases, surgery.

Please note that these are potential diagnoses based on the symptoms you've described. It's important to consult with a healthcare professional for an accurate diagnosis.

What you can do

Schedule an appointment with your primary care doctor to discuss these symptoms. They may refer you to a neurologist for further evaluation.
Keep a symptom diary. This can help your healthcare provider identify patterns and triggers for your symptoms.
Try to maintain a healthy lifestyle. Regular exercise, a balanced diet, and adequate sleep can help manage some of your symptoms.

What you should look out for

Seek immediate medical attention if:

Your symptoms worsen or become more frequent.
You experience sudden vision loss or double vision.
You have severe headaches that are not relieved by over-the-counter pain relievers.
You experience new or worsening tremors.

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 accurate information.

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11 mo ago

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