[30F] Experiencing constant head pressure and neck pain

Patient Description

A 30-year-old female has been experiencing constant head pressure in the forehead, top, and back of the head for almost a week, with an intensity of 4 out of 10, worsening when standing or sitting up. Relief is found when applying physical pressure or scrunching eyebrows. There is also pressure in the nose and between the eyebrows, accompanied by lightheadedness and minor neck pain described as a pulling or cramping sensation on the back right side, extending from the base of the skull to the right shoulder. The patient has a history of diabetes, PCOS, depression, anxiety, PTSD, asthma, and a past heart attack with a stent placed in the LAD artery. Current medications include losartan, atorvastatin, ceterizine, metformin, aspirin, farxiga, escitalpram, bupropion, and a medication for acid reflux. The patient has an allergy to Amoxicillin, which causes a rash.

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Arora's Assessment

What might be happening

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

  • Tension Headache: This is a common type of headache characterized by a dull, aching sensation all over the head. It is often described as a feeling of a tight band around your forehead or at the back of your head. It is typically associated with stress, anxiety, or depression.

    • Treatment usually involves over-the-counter pain relievers, stress management, and regular physical exercise.
  • Sinusitis: This is an inflammation or swelling of the tissue lining the sinuses. It can cause headaches, pressure in the eyes, nose or cheek area, or on one side of the head. People with sinusitis often feel worse while standing up or bending over.

    • Treatment usually involves antibiotics, nasal decongestants, and pain relievers.
  • Cervicogenic Headache: This is a secondary headache, which means that it's caused by another illness or physical issue. In the case of cervicogenic headache, the cause is a disorder of the cervical spine and its component bone, disc, and/or soft tissue elements. Your neck pain and the fact that physical manipulation of your neck provides some relief point towards this diagnosis.

    • Treatment usually involves physical therapy, medications, and in some cases, surgery.

Please note that these are just possible diagnoses. You should consult with a healthcare professional who can evaluate your symptoms and medical history in order to provide a definitive diagnosis.

What you can do

  1. Over-the-counter pain relievers: Non-prescription medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) may help relieve your headache and neck pain.

  2. Rest and relaxation: Try to rest in a quiet, dark room. Stress management techniques such as deep breathing, yoga, and meditation may also help relieve your symptoms.

  3. Stay hydrated: Dehydration can sometimes cause headaches. Make sure you're drinking enough water each day.

  4. Avoid triggers: If you notice that certain foods or activities make your symptoms worse, try to avoid them.

What you should look out for

You should seek immediate medical attention if:

  • Your headache or neck pain is severe or doesn't improve with rest or over-the-counter medications.
  • You have a high fever along with your headache.
  • You have sudden, severe headaches.
  • You have other symptoms such as vision changes, difficulty speaking, weakness on one side of your body, or loss of balance.

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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11 mo ago

People Also Ask


What are the common symptoms of a tension headache?

Common symptoms of a tension headache include a dull, aching sensation all over the head, a feeling of tightness or pressure across the forehead or on the sides and back of the head, and tenderness in the scalp, neck, and shoulder muscles.


How can sinusitis be distinguished from other types of headaches?

Sinusitis can be distinguished from other types of headaches by symptoms such as facial pain or pressure, nasal congestion, a reduced sense of smell, and a headache that worsens when bending over or lying down. It is often accompanied by other symptoms like a runny nose or fever.


What are the typical treatments for cervicogenic headaches?

Typical treatments for cervicogenic headaches include physical therapy to improve neck posture and strength, medications such as pain relievers or muscle relaxants, and in some cases, interventional procedures like nerve blocks or surgery if conservative treatments fail.


When should someone with a headache seek immediate medical attention?

Immediate medical attention should be sought if a headache is severe or sudden, does not improve with rest or over-the-counter medications, is accompanied by a high fever, or if there are other symptoms such as vision changes, difficulty speaking, weakness on one side of the body, or loss of balance.


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