[27F] Experiencing severe musculoskeletal and headache pain

Patient Description

A 27-year-old female presents with severe, sharp musculoskeletal pain in the hips, lower legs, arms, and shoulders, as well as a severe stabbing headache behind the right ear. The pain is described as sharp and spreading, with the headache being exacerbated by light, noise, movement, and even when laying still. These symptoms have been present for approximately 4 hours. The patient also reports a fever and issues with alertness but no neck stiffness or rash. The patient has a medical history of Postural Orthostatic Tachycardia Syndrome and fluid around the heart, diagnosed 3 years ago. Current medications include Vraylar (3mg daily), hydrocortisone (5mg and 10mg daily), Keppra (1500mg twice daily), Prozac (80mg daily), and Topamax (100mg daily). There have been no recent changes to medication or the introduction of new over-the-counter drugs, vitamins, supplements, or herbal remedies.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possibilities:

  • Migraine: Your severe headache, sensitivity to light, and sudden onset may suggest a migraine. Migraines are a type of headache characterized by severe pain, often on one side of the head, and can be accompanied by other symptoms like sensitivity to light, sound, and movement.

    • Treatment usually involves over-the-counter or prescription medications to relieve the symptoms of a migraine. Preventive medications can also be prescribed if migraines are frequent or very severe.
  • Fibromyalgia: This is a condition characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues. It's more common in women and often starts in middle adulthood. However, it's usually a diagnosis of exclusion, meaning other potential causes of your symptoms need to be ruled out first.

    • Treatment typically includes both medication to help manage symptoms and lifestyle changes, like stress management and regular physical activity.
  • Viral illness: Given your fever, widespread body aches, and headache, it's possible you're experiencing a viral illness, such as the flu.

    • Treatment usually involves rest, hydration, and over-the-counter medication to manage symptoms.
  • Side effects of medication: Some of the medications you're taking, such as Vraylar, can cause body aches and pains as side effects.

    • If you suspect your symptoms are due to your medication, it's important to speak with your doctor before making any changes to your medication regimen.

What you can do

  1. Rest and hydrate: Regardless of the cause, rest and hydration are often beneficial when you're not feeling well.
  2. Over-the-counter pain relievers: Non-prescription medications like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can help with body aches and headaches. Be sure to follow the dosing instructions on the package.
  3. Consult your doctor: Given the severity of your symptoms, it's important to consult with a healthcare provider. They can evaluate your symptoms, consider your medical history, and possibly order tests or refer you to a specialist.

What you should look out for

Seek immediate medical attention if you experience:

  • A headache that is the worst you've ever experienced
  • Sudden, severe pain anywhere in your body
  • Difficulty breathing or chest pain
  • Altered mental status, such as confusion or difficulty staying awake
  • Any other symptoms that are severe or concerning to you

Remember, while I strive to provide accurate information, I'm not a doctor. Always consult with a healthcare provider for a formal diagnosis and treatment.

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1 yr ago

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People Also Ask


What are the common symptoms of a migraine and how can they be managed?

Common symptoms of a migraine include severe headache, often on one side of the head, sensitivity to light and sound, nausea, and sometimes visual disturbances. Management typically involves over-the-counter or prescription medications to relieve symptoms, and preventive medications may be used if migraines are frequent or severe.


How is fibromyalgia diagnosed and what are the typical treatments?

Fibromyalgia is diagnosed primarily through the exclusion of other conditions, as there is no specific test for it. It is characterized by widespread musculoskeletal pain, fatigue, and cognitive difficulties. Treatment often includes medications to manage pain and symptoms, as well as lifestyle changes like stress management and regular physical activity.


What are the signs of a viral illness and how can it be treated at home?

Signs of a viral illness can include fever, body aches, headache, fatigue, and sometimes respiratory symptoms. Treatment at home generally involves rest, staying hydrated, and using over-the-counter medications to alleviate symptoms.


Can medications like Vraylar cause musculoskeletal pain as a side effect?

Yes, medications like Vraylar can cause musculoskeletal pain as a side effect. If you suspect your symptoms are related to medication, it's important to consult with your doctor before making any changes to your medication regimen.


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