[26F] Experiencing severe headache, diarrhea, and nausea

Patient Description

A 26-year-old female presents with a severe headache rated 8/10, located in the forehead, described as a constant pressure and exacerbated by sound, which has been occurring for 4 days. The headache is accompanied by light sensitivity and neck stiffness, but no fever or rash. The patient also reports new onset of loose diarrhea approximately five times a day and nausea, both starting today. There is no recent travel history or known food triggers. The patient has a family history of migraines, was around someone who was recently sick, and has a past medical history of Hashimoto's disease, diagnosed at age 17. Currently, the patient is on Levothyroxine 150mg, Zoloft 50mg, and Hydroxyzine 25mg taken nightly. No known drug allergies are reported.

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Arora's Assessment

What might be happening

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

  • Migraine: Migraines are a type of headache characterized by severe throbbing or pulsing pain, often on one side of the head. They can be accompanied by nausea, vomiting, and sensitivity to light and sound. The pressure you described in your forehead and your sensitivity to sound are common symptoms of migraines. Migraines can last for hours to days, and the pain can be so severe that it interferes with your daily activities.

    • Treatment typically involves pain-relieving medications and preventive medications.
  • Tension Headache: This is the most common type of headache and it causes a constant pressure or ache around the head, especially at the temples or back of the head and neck. They are often related to stress, depression, or anxiety. Over-the-counter treatments such as aspirin, ibuprofen, or acetaminophen (Tylenol) can be effective.

  • Gastroenteritis: This is an inflammation of the digestive tract, often caused by a viral, bacterial, or parasitic infection. Symptoms include diarrhea, nausea, and sometimes headache. It usually resolves on its own within a few days.

    • Treatment typically involves rest, hydration, and over-the-counter remedies.
  • Side effects of medication: Zoloft (sertraline) and Hydroxyzine are both medications that can potentially cause headaches and gastrointestinal side effects like diarrhea and nausea.

Please note that this is not an exhaustive list of all possible conditions, and these conditions may coexist. For example, you might be experiencing a migraine and also have gastroenteritis.

What you can do

  1. For your headache, try resting in a quiet, dark room. Over-the-counter pain relievers such as ibuprofen or acetaminophen may help. If these don't help, or your headache continues for more than a few days, you should consult a healthcare provider.
  2. For your diarrhea and nausea, stay hydrated. Water, broth, or an oral rehydration solution can help. Avoid foods that are high in fat or sugar. If these symptoms continue for more than a few days, or if you become dehydrated (symptoms of dehydration include dry mouth, not urinating much, and feeling dizzy when you stand up), you should seek medical attention.
  3. Keep track of your symptoms and anything that seems to make them better or worse. This information will be helpful if you decide to seek medical attention.

What you should look out for

Reasons to seek medical attention urgently include:

  • Severe headache or headache that worsens after coughing, exertion, straining, or a sudden movement
  • Headache that is accompanied by confusion, fainting, high fever, or trouble speaking
  • Headache after a head injury, especially if the headache gets worse
  • Chronic, progressive headache that is worse when you wake up
  • Diarrhea for more than a few days, or diarrhea that is accompanied by high fever or blood
  • Signs of dehydration, such as not urinating much, dry mouth, or feeling dizzy when you stand up

Please remember that while I strive to provide accurate information, I'm not a doctor and this advice should not replace a consultation with a healthcare provider.

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9 mo ago


People Also Ask


What are the common symptoms of a migraine?

Common symptoms of a migraine include severe throbbing or pulsing pain, often on one side of the head, sensitivity to light and sound, nausea, and sometimes vomiting. Migraines can last for hours to days and can significantly interfere with daily activities.


Can Zoloft or Hydroxyzine cause headaches or gastrointestinal issues?

Yes, both Zoloft (sertraline) and Hydroxyzine can potentially cause headaches and gastrointestinal side effects such as diarrhea and nausea. If you suspect your medication is causing these symptoms, consult your healthcare provider.


What are the typical treatments for gastroenteritis?

Typical treatments for gastroenteritis include rest, staying hydrated with water, broth, or oral rehydration solutions, and avoiding foods high in fat or sugar. Over-the-counter remedies may also help alleviate symptoms. Most cases resolve on their own within a few days.


When should I seek medical attention for a headache?

You should seek medical attention for a headache if it is severe, worsens with coughing or movement, is accompanied by confusion, fainting, high fever, or trouble speaking, occurs after a head injury, or if it is chronic and progressively worsening. Additionally, if diarrhea persists for more than a few days or is accompanied by high fever or blood, medical attention is advised.

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