[29F] With severe migraine, dizziness, and mouth bleeding

Patient Description

A 29-year-old female has been experiencing a severe migraine for over six weeks, accompanied by dizziness, sharp and throbbing eye pain, and fatigue. The migraine makes it difficult for her to lay flat or sleep, and her eyes sometimes get blurry, feeling like they might pop out. Additionally, she has been experiencing mouth bleeding, which started today and seems to come from the top of her mouth. She reports feeling lightheaded, especially when sitting or standing up quickly, causing her to fall. Laying at an angle helps make the pain more bearable. She has experienced nausea and vomiting with this migraine, and her left hand has been shaking, making it hard to open things. She also has difficulty finding words during conversations and has been more clumsy than usual. The patient has a history of intracranial hypertension, hyperinsulinemia (diagnosed 4 months ago), a heart attack (incidentally found), and a subarachnoid hemorrhage in 2016. She is currently taking Metformin, acetazolamide, fluoxetine, Vyvanse, clonidine, diazepam, Meloxicam, acetaminophen, and diphenhydramine for conditions such as hyperinsulinemia, intracranial hypertension, PTSD, chest pain, insomnia, and chronic pain. She has no known side effects from these medications. She also has a history of anaphylaxis to aspirin and latex. Additionally, she has been experiencing edema (swelling) in her ankles and feet for the past 5 weeks, gaining roughly 5 pounds per week since the pain started. Her feet are stiff but squish when she walks, and her ankles have a lasting indent when pressed or when she wears socks for any period of time.

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Arora's Assessment

What might be happening

Based on the information you’ve provided, several serious conditions could be contributing to your symptoms:

  1. Intracranial Hypertension: Given your history of intracranial hypertension, the severe and prolonged headache, along with dizziness, eye pain, and visual disturbances, could indicate a worsening of this condition. Intracranial hypertension can lead to increased pressure in the brain, causing these symptoms.

  2. Subarachnoid Hemorrhage: Your history of subarachnoid hemorrhage and the sudden onset of a severe headache that has persisted for over six weeks is concerning. This could indicate a recurrence or another type of brain bleed, which is a medical emergency.

  3. Migraine with Complications: While migraines can be severe, the duration and additional symptoms like mouth bleeding, dizziness, and neurological changes (such as difficulty finding words and clumsiness) suggest that this might be more than a typical migraine.

  4. Cardiovascular Issues: The edema in your ankles and feet, along with rapid weight gain, could indicate heart-related issues, especially given your history of a heart attack. This could be a sign of heart failure or another cardiovascular problem.

  5. Other Neurological Conditions: The combination of symptoms, including the shaking in your hand, difficulty with speech, and clumsiness, could indicate a neurological condition that requires immediate attention.

What you can do

  1. Seek Immediate Medical Attention: Given the severity and duration of your symptoms, it is crucial to seek immediate medical attention. Go to the nearest emergency room or call 911. The combination of severe headache, neurological symptoms, and mouth bleeding is very concerning and needs urgent evaluation.

  2. Do Not Drive Yourself: If possible, have someone else drive you to the hospital or call an ambulance. Your dizziness and risk of falling make it unsafe for you to drive.

  3. Prepare Your Medical Information: Bring a list of your current medications, medical history, and any recent changes in your health to the hospital. This will help the medical team provide the best care.

  4. Monitor Your Symptoms: While waiting for medical help, try to stay calm and monitor your symptoms. If you experience any worsening of symptoms, such as increased bleeding, severe dizziness, or loss of consciousness, inform the medical team immediately.

  5. Avoid Certain Medications: Given your history of anaphylaxis to aspirin, avoid taking any medications containing aspirin or NSAIDs unless directed by a healthcare professional.

Remember, I am not a doctor, and this advice is based on the information you have provided. It is essential to seek care from real health professionals to receive a formal diagnosis and appropriate treatment. Your symptoms are serious and require immediate medical attention.

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5 mo ago

People Also Ask

What are the symptoms of intracranial hypertension?

Symptoms of intracranial hypertension can include severe headaches, visual disturbances, dizziness, nausea, vomiting, and sometimes ringing in the ears. It occurs when there is increased pressure inside the skull.

Can migraines cause neurological symptoms like difficulty finding words and clumsiness?

Yes, migraines can sometimes cause neurological symptoms, known as aura, which can include visual disturbances, difficulty speaking, and clumsiness. However, the presence of these symptoms for an extended period, as described, may indicate a more serious condition.

What could cause sudden mouth bleeding?

Sudden mouth bleeding can be caused by a variety of factors, including trauma, gum disease, or more serious conditions like a bleeding disorder or a vascular issue. It is important to seek medical evaluation to determine the cause.

What are the signs of heart failure related to edema and rapid weight gain?

Signs of heart failure can include swelling (edema) in the ankles, feet, or legs, rapid weight gain due to fluid retention, shortness of breath, fatigue, and difficulty exercising. These symptoms require medical evaluation to confirm and treat the underlying cause.

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