[30F] With chronic headache, fatigue, and multiple systemic symptoms

Patient Description

A 30-year-old female has been experiencing a variety of symptoms, including a chronic headache for a year, primarily on the left side of her head. The headache is described as a stabbing pain and pressure behind the eye, sharp pain at the base of the skull, and a dull ache around the head, with an intensity of 7 out of 10. These episodes occur weekly and last from a few hours to a couple of days. Excedrine Migraine reduces the pain to a 3. The headache came on gradually, with no specific triggers identified. She also reports difficulty focusing and thinking clearly during these episodes, but no changes in vision. She has been feeling a severe lack of energy and difficulty focusing for years, significantly affecting her daily activities. She also experiences nausea, itching, anxiety, loss of appetite, and a general feeling of being unwell. Additional symptoms include body aches, ice-cold extremities sometimes, and swollen and red hands and feet at other times. She experiences gut pain around her belly button a few times a year, ranging from mild to extreme, with the worst pain being a 9 out of 10. She also reports diarrhea. She has had a cough for three weeks, which started as wet and has now become dry, with a severity of 2 out of 10. She had a sore throat and lost her voice last week. Blood work shows an elevated white blood cell count, but all viral tests are negative. She has a history of being sick since childhood without a clear diagnosis and was diagnosed with erythromyalgia this year. She has a family history of rheumatoid arthritis. Current medications include Lamictal (400mg), Doxycycline (50mg), Klonopin (0.50mg), Pantrapozol, Zenzedi (10mg), and supplements like turmeric and Align, all taken daily. She has no known allergies to medications. Her menstrual periods are not regular, and she hasn't had one recently.

Arora's Assessment

What might be happening

Based on the symptoms and history you've provided, here are some possible explanations for your condition:

1. Chronic Migraine or Cluster Headache

Rationale: Your description of a stabbing pain and pressure behind the eye, along with sharp pain at the base of the skull and a dull ache around the head, is consistent with chronic migraine or cluster headaches. These types of headaches can be debilitating and often occur without clear triggers.
Typical Treatments/Testing: Treatment may include prescription medications like triptans, preventive medications, and lifestyle changes. Imaging studies like MRI or CT scans may be recommended to rule out other causes.

2. Chronic Fatigue Syndrome (CFS)

Rationale: Your severe lack of energy, difficulty focusing, and overall feeling of being unwell for years could be indicative of Chronic Fatigue Syndrome. This condition is characterized by extreme fatigue that doesn't improve with rest and is often accompanied by other symptoms like muscle pain and cognitive difficulties.
Typical Treatments/Testing: There is no specific test for CFS, but your doctor may perform various tests to rule out other conditions. Treatment focuses on symptom management, including medications, cognitive behavioral therapy, and graded exercise therapy.

3. Autoimmune or Inflammatory Condition

Rationale: Given your family history of rheumatoid arthritis and your symptoms of body aches, swollen and red hands and feet, and elevated white blood cell count, an autoimmune or inflammatory condition like rheumatoid arthritis or lupus could be a possibility.
Typical Treatments/Testing: Blood tests to check for specific antibodies, imaging studies, and possibly a referral to a rheumatologist for further evaluation. Treatment may include anti-inflammatory medications, immunosuppressants, and lifestyle changes.

4. Gastrointestinal Issues

Rationale: Your abdominal pain around the belly button, diarrhea, and gut pain could be related to gastrointestinal issues such as Irritable Bowel Syndrome (IBS) or Inflammatory Bowel Disease (IBD).
Typical Treatments/Testing: Your doctor may recommend blood tests, stool tests, and possibly a colonoscopy or endoscopy. Treatment may include dietary changes, medications, and stress management techniques.

5. Erythromelalgia

Rationale: Your symptoms of ice-cold extremities sometimes and swollen and red hands and feet are consistent with erythromelalgia, a condition you were diagnosed with this year.
Typical Treatments/Testing: Management often includes medications to improve blood flow, pain relievers, and lifestyle modifications to avoid triggers.

What you can do

Headache and Fatigue

See a doctor: Given the severity and duration of your headaches and fatigue, it's important to consult a healthcare provider for a thorough evaluation and appropriate treatment.
Lifestyle changes: Ensure you are getting adequate sleep, staying hydrated, and managing stress. Regular exercise and a balanced diet can also help.
Symptom tracking: Use MDandMe to journal your symptoms, track progress, and share longitudinal medical notes with your provider.

Abdominal Pain and Gastrointestinal Issues

Dietary changes: Consider a low-FODMAP diet or other dietary modifications that may help alleviate symptoms. Avoid foods that trigger your symptoms.
Hydration: Stay well-hydrated, especially if you are experiencing diarrhea.
Consult a gastroenterologist: A specialist can help diagnose and manage your gastrointestinal symptoms.

Autoimmune or Inflammatory Symptoms

See a rheumatologist: Given your family history and symptoms, a rheumatologist can provide a more detailed evaluation and treatment plan.
Anti-inflammatory diet: Consider adopting an anti-inflammatory diet rich in fruits, vegetables, whole grains, and healthy fats.

Erythromelalgia

Avoid triggers: Identify and avoid triggers that worsen your symptoms, such as heat or prolonged standing.
Medication adherence: Continue taking your prescribed medications and discuss any concerns with your doctor.

General Well-being

Mental health: Address your anxiety and sleep issues by practicing relaxation techniques, such as mindfulness or meditation. Consider speaking with a mental health professional.
Regular check-ups: Keep up with regular medical check-ups to monitor your condition and adjust treatments as needed.

What you should look out for

Given the complexity and severity of your symptoms, it's important to seek medical care as soon as possible. Reasons to seek care more urgently include:

Severe or worsening symptoms: If your pain becomes unbearable or if you experience new, severe symptoms.
Neurological changes: Any sudden changes in vision, speech, or motor function.
Signs of infection: Fever, chills, or other signs of infection,