[28F] With body-wide twitching and eye pain

Patient Description

A 28-year-old female presents with twitching all over her body and a dull ache behind her eyes. The eye pain has been occurring for the past 2-3 weeks, coming and going, with episodes lasting from 1 minute to 3 hours. The pain is sometimes accompanied by headaches and sensitivity to light, but there are no visual disturbances such as blurred vision, double vision, or seeing flashes of light. The patient does not experience nausea or vomiting with the eye pain. Additionally, she occasionally experiences dizziness or balance problems. She has not started any new medications or changed the dosage of existing medications recently. The patient consumes some caffeine but does not use alcohol or recreational drugs. Her medical history includes rheumatoid arthritis, diagnosed a year ago, and she is currently taking Ativan (1mg once a day) and Advil (200mg once a day). She has an allergy to sulfa.

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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:

  • Tension Headaches: These are common and can cause a dull, aching pain behind the eyes. They can be triggered by stress, poor posture, or eye strain.

    • Treatment: Over-the-counter pain relievers like ibuprofen (Advil) can help. Stress management techniques, such as relaxation exercises, may also be beneficial.
  • Migraines: Migraines can cause a variety of symptoms, including a dull ache behind the eyes, sensitivity to light, and sometimes dizziness. They can last from a few hours to several days.

    • Treatment: Prescription medications are often required to manage migraines. Over-the-counter pain relievers may help with mild migraines. Avoiding known triggers, such as certain foods or stress, can also be helpful.
  • Eye Strain: Prolonged use of digital devices or reading without adequate breaks can cause eye strain, leading to a dull ache behind the eyes.

    • Treatment: Taking regular breaks from screens, ensuring proper lighting, and possibly using computer glasses can help alleviate symptoms.
  • Rheumatoid Arthritis (RA): Although RA primarily affects joints, it can also cause systemic symptoms, including eye pain and muscle twitching. Inflammation associated with RA could potentially contribute to your symptoms.

    • Treatment: Managing RA with appropriate medications and regular follow-ups with a rheumatologist is crucial. Eye symptoms should be evaluated by an eye specialist.
  • Caffeine Overuse: Consuming too much caffeine can lead to muscle twitching and headaches.

    • Treatment: Reducing caffeine intake gradually can help alleviate these symptoms.

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 in the meantime:

  1. Monitor and Record Symptoms: Use the MDandMe app to journal your symptoms, track their frequency and intensity, and note any potential triggers. This information can be valuable for your healthcare provider.
  2. Manage Stress: Practice relaxation techniques such as deep breathing, meditation, or yoga to help reduce stress, which can contribute to headaches and muscle twitching.
  3. Take Breaks from Screens: Follow the 20-20-20 rule: every 20 minutes, take a 20-second break and look at something 20 feet away to reduce eye strain.
  4. Stay Hydrated: Ensure you are drinking enough water throughout the day, as dehydration can contribute to headaches.
  5. Limit Caffeine: Gradually reduce your caffeine intake to see if it helps with the muscle twitching and headaches.
  6. Over-the-Counter Pain Relief: You can continue using Advil as needed for pain relief, but be mindful of the recommended dosage.

What you should look out for

Seek medical attention if you experience any of the following:

  • Severe or Worsening Symptoms: If the pain behind your eyes becomes severe, persistent, or is accompanied by other concerning symptoms like vision changes, seek medical care promptly.
  • New or Unusual Symptoms: If you develop new symptoms such as significant dizziness, balance problems, or muscle weakness, consult a healthcare provider.
  • Ineffective Over-the-Counter Medications: If over-the-counter pain relievers are not providing relief, it may be necessary to seek medical advice for stronger or alternative treatments.

Remember, while this information can help guide you, it is not a substitute for professional medical advice. Please consult a healthcare provider for a thorough evaluation and personalized treatment plan.

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6 mo ago

People Also Ask


What are the common causes of a dull ache behind the eyes?

A dull ache behind the eyes can be caused by tension headaches, migraines, eye strain, or sinus issues. Stress, poor posture, and prolonged screen time are common triggers.


Can rheumatoid arthritis cause symptoms like eye pain and muscle twitching?

Yes, rheumatoid arthritis can cause systemic symptoms beyond joint pain, including eye pain and muscle twitching due to inflammation. It's important to manage RA with appropriate treatment and consult specialists as needed.


How can I manage tension headaches at home?

To manage tension headaches at home, you can use over-the-counter pain relievers like ibuprofen, practice stress management techniques such as deep breathing or yoga, and ensure proper posture and screen breaks to reduce eye strain.


What are the effects of caffeine on muscle twitching and headaches?

Excessive caffeine consumption can lead to muscle twitching and headaches. Reducing caffeine intake gradually can help alleviate these symptoms. It's important to monitor your caffeine consumption and adjust as needed.


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