[30F] With persistent throbbing headaches and neck pain post-surgery

Question

What else could be causing this?

Patient Description

A 30-year-old female has been experiencing throbbing headaches for the last 3-4 weeks, which sometimes escalate into migraines accompanied by nausea, fatigue, and neck pain. The headaches are most intense in the temples and at the base of the head near the neck, with an intensity rating of 9 out of 10 during migraines. Activities such as working, cleaning, and taking care of her children exacerbate the pain, and neither prescription nor over-the-counter medications have provided relief. The neck pain, described as a dull ache that sometimes feels stiff, has been present for almost a month and is rated 7 out of 10 in severity. The onset of the headache was sudden, and there have been no recent head or neck injuries. The patient underwent a breast reduction surgery at the end of May and has since noticed increased fatigue, nausea, and body aches. She also reports sensitivity to light and sound during headaches, occasional changes in vision, numbness or tingling in her fingers when lying in certain positions, and sometimes difficulty with balance, coordination, and speech. There is no weakness in the arms or legs. The patient's medical history includes ADHD, anxiety, and depression, and she is currently taking Vyvanse (40 mg daily), Trazodone (50 mg at night), and occasionally Bulbutal for headaches, along with Tylenol as needed. There is a family history of neurological conditions, specifically a father who died of a brain aneurysm. The patient does not use alcohol, tobacco, or recreational drugs, and there are no specific dietary triggers for her headaches.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential diagnoses and conditions that could be contributing to your headaches, neck pain, and other symptoms:

  1. Migraines:

    • Migraines are a type of headache that can cause severe throbbing pain, usually on one side of the head. They are often accompanied by nausea, sensitivity to light and sound, and sometimes visual disturbances. Your description of throbbing headaches that turn into migraines with nausea and sensitivity to light and sound fits this pattern.
    • Typical treatments include prescription medications like triptans, over-the-counter pain relievers, and preventive medications. Lifestyle changes, such as stress management and avoiding known triggers, can also help.
  2. Tension Headaches:

    • These are often described as a dull, aching sensation all over the head, and can be accompanied by neck pain and stiffness. Stress is a common trigger for tension headaches.
    • Treatment usually involves over-the-counter pain relievers, stress management techniques, and sometimes physical therapy to address neck pain.
  3. Cervicogenic Headaches:

    • These headaches originate from issues in the cervical spine (neck) and can cause pain that radiates to the head. The dull ache and stiffness in your neck, along with the headache at the base of your head, suggest this could be a contributing factor.
    • Treatment may include physical therapy, medications, and sometimes interventions like nerve blocks.
  4. Post-Surgical Fatigue and Pain:

    • It's possible that your recent breast reduction surgery has contributed to your overall fatigue, body aches, and possibly even your headaches. Post-surgical recovery can sometimes be prolonged and complicated by stress and other factors.
    • Ensuring proper post-operative care, rest, and following up with your surgeon can help manage these symptoms.

What you can do

Migraines and Headaches:

  • See a doctor: Given the severity and duration of your headaches, it's important to consult a healthcare provider. They may recommend imaging studies or refer you to a neurologist.
  • Medication: Continue taking prescribed medications and discuss with your doctor if they are not effective. They may adjust your treatment plan.
  • Lifestyle changes: Try to identify and avoid potential triggers, maintain a regular sleep schedule, stay hydrated, and manage stress through relaxation techniques or therapy.

Neck Pain:

  • Physical Therapy: Consider seeing a physical therapist who can provide exercises and treatments to alleviate neck pain and improve mobility.
  • Home care: Apply heat or cold packs to your neck, practice good posture, and avoid activities that strain your neck.

Post-Surgical Recovery:

  • Rest: Ensure you are getting adequate rest and not overexerting yourself.
  • Follow-up: Keep in touch with your surgeon to discuss any ongoing symptoms and ensure proper healing.

General Health:

  • Stress Management: Given your history of anxiety and depression, consider speaking with a mental health professional to help manage stress, which can exacerbate physical symptoms.
  • Symptom Tracking: Use MDandMe to journal your symptoms, track progress, and share longitudinal medical notes with your provider. This can help in identifying patterns and triggers.

What you should look out for

Given the severity of your symptoms and the potential for serious underlying conditions, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Sudden, severe headache unlike any you've had before
  • Changes in vision, speech, or coordination
  • Numbness or weakness in your limbs
  • Persistent or worsening symptoms despite treatment

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and appropriate treatment. If you have more questions or need further assistance, feel free to continue the conversation.

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6 mo ago

People Also Ask


What are the common symptoms of migraines and how can they be managed?

Migraines often present with severe throbbing pain, usually on one side of the head, and can be accompanied by nausea, sensitivity to light and sound, and visual disturbances. Management includes medications like triptans, lifestyle changes such as stress management, and avoiding known triggers.


How can neck pain contribute to headaches, and what are some effective treatments?

Neck pain can lead to cervicogenic headaches, where pain originates from the cervical spine and radiates to the head. Effective treatments include physical therapy, medications, and sometimes interventions like nerve blocks to alleviate pain and improve mobility.


What is the relationship between stress and tension headaches?

Stress is a common trigger for tension headaches, which are characterized by a dull, aching sensation all over the head. Managing stress through relaxation techniques, therapy, and lifestyle changes can help reduce the frequency and severity of these headaches.


How can post-surgical recovery affect overall health and contribute to symptoms like fatigue and headaches?

Post-surgical recovery can lead to fatigue and body aches, which may exacerbate headaches. Ensuring proper rest, following post-operative care instructions, and managing stress can help mitigate these symptoms and promote healing.


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Arora (Bot)#28060

6 mo ago

In addition to the conditions already mentioned, other potential causes for your symptoms could include:

  1. Sinusitis: Inflammation of the sinuses can cause headaches, facial pain, and neck pain.
  2. Medication Overuse Headache: Frequent use of headache medications can sometimes lead to rebound headaches.
  3. Hormonal Changes: Fluctuations in hormones, especially in women, can trigger headaches and migraines.
  4. Sleep Disorders: Poor sleep quality or sleep disorders like sleep apnea can contribute to headaches and fatigue.
  5. Cervical Disc Issues: Problems with the discs in your cervical spine can cause neck pain and headaches.

It's important to discuss these possibilities with your healthcare provider to determine the exact cause and appropriate treatment.

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