[28F] Experiencing migraines, joint and back pain, and unintentional weight loss

Patient Description

A 28-year-old female has been experiencing uninterrupted, continuous migraines for the past 6 months, with the pain primarily located on the right side of her head, including her right eye, the back of her head, and her ears. The severity of these migraines is rated as 8 out of 10. Physical activity and concentration seem to trigger or worsen her migraines, and she has not found anything that provides relief. In addition to migraines, she has been dealing with throbbing joint pain in her knees, hips, feet, and hands for several years, with the pain being worse in the morning and rated as 8 out of 10 in severity. She also experiences severe, throbbing back pain, making it difficult to get comfortable in any position. Recently, she has noticed unintentional weight loss and has experienced severe headaches, a stiff neck, weakness, numbness, and trouble speaking, but no recent head injury or trauma. She was diagnosed with endometriosis and fibromyalgia 10 years ago and is currently taking Effexor and Trazodone for 3 years, and Aimovig for the past 6 months for migraine prevention.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible conditions that could explain your symptoms:

  • Chronic Migraine: Your continuous, right-sided headaches accompanied by light sensitivity, confusion, and sometimes nausea could be indicative of chronic migraines. Chronic migraines are characterized by headaches occurring on 15 or more days per month for at least three months. The exact cause is unknown, but it can be triggered by various factors such as stress, certain foods, or hormonal changes.

    • Treatment typically involves preventive measures (like the Aimovig you're already taking) and pain-relieving medications.
  • Fibromyalgia: This is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. It can also cause migraines and joint pain. Your history of fibromyalgia could explain your joint pain, back pain, and migraines.

    • Treatment typically involves a combination of medications, exercise, stress management measures, and healthy lifestyle habits.
  • Endometriosis: This condition involves the growth of endometrial tissue outside the uterus. While it primarily causes pelvic pain and menstrual irregularities, it can sometimes be associated with non-gynecological symptoms like low back pain.

    • Treatment options include pain relievers, hormone therapy, and in some cases, surgery.
  • Unintentional weight loss, lightheadedness, and syncope (fainting or passing out) can be symptoms of many different conditions, ranging from metabolic disorders to cardiovascular diseases. It's difficult to pinpoint a specific cause without further testing.

What you can do

It's important to consult with your healthcare provider about your symptoms. They may want to adjust your current medications or suggest new ones to better manage your symptoms. They may also want to order some tests to investigate your unintentional weight loss and other symptoms.

In the meantime, here are some things you can do to manage your symptoms:

  1. Keep a symptom diary: Note down when your migraines occur, their severity, and any potential triggers. This can help you and your healthcare provider identify patterns and develop a treatment plan.
  2. Stay hydrated and maintain a balanced diet: This is particularly important given your unintentional weight loss.
  3. Regular exercise: While it might be difficult due to your pain, regular gentle exercise can help manage symptoms of fibromyalgia and improve overall health.
  4. Mindfulness and relaxation techniques: These can help manage pain and reduce stress, which can trigger migraines.

What you should look out for

Seek immediate medical attention if you experience:

  • A sudden, severe headache unlike any you've had before
  • Headache accompanied by fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or difficulty speaking
  • A sudden, severe headache after a head injury
  • A headache accompanied by shortness of breath

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 appropriate examination, diagnosis, and treatment.

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10 mo ago

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People Also Ask


What are the common triggers for chronic migraines?

Common triggers for chronic migraines include stress, hormonal changes, certain foods and drinks, changes in sleep patterns, and environmental factors like bright lights or strong smells. Identifying and avoiding these triggers can help manage migraines.


How can fibromyalgia affect daily life and what are some management strategies?

Fibromyalgia can cause widespread pain, fatigue, and cognitive difficulties, often referred to as 'fibro fog.' Management strategies include medications, regular exercise, stress management techniques, and maintaining a healthy lifestyle.


What are the potential causes of unintentional weight loss in someone with chronic pain conditions?

Unintentional weight loss in someone with chronic pain conditions could be due to a variety of factors, including metabolic disorders, gastrointestinal issues, or the side effects of medications. It's important to consult a healthcare provider for a thorough evaluation.


How does endometriosis potentially contribute to non-gynecological symptoms like back pain?

Endometriosis can cause inflammation and pain that may extend beyond the pelvic region, potentially leading to back pain. This is due to the growth of endometrial tissue outside the uterus, which can affect surrounding organs and tissues.


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1 Comments


Janice#4034

10 mo ago

Unintentional weight loss with a severe headache, trouble speaking, and neck pain is pretty concerning. Have you gotten any imaging of your head like an MRI? Everything will probably be fine but better to be safe

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