[31F] With worsening headache, vision changes, and difficulty walking

Patient Description

A 31-year-old female presents with a worsening headache located at the back of the head above the neck, described as a pressure sensation, which has been ongoing for 2 months. The headache is exacerbated by looking up or down. The patient also reports vision changes, eye pain, muscle tightness, instability, balance problems, and clumsiness. She has been experiencing difficulty walking for a few weeks, which came on suddenly and is worsened by prolonged walking or squatting. The patient has a history of two herniated discs and reports intermittent weakness and numbness in the legs. No recent infections, illnesses, or new medications were noted prior to the onset of symptoms.

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Arora's Assessment

What might be happening

It sounds like you are experiencing a complex set of symptoms that may be related to multiple underlying issues. Here are some possible explanations:

Difficulty Walking, Instability, and Balance Problems

  • Herniated Discs: Given your history of two herniated discs, these could be compressing nerves that affect your legs, leading to weakness, numbness, and difficulty walking. This can also cause instability and balance problems.
  • Cervicogenic Headache: The pressure headache at the back of your head above your neck could be related to your herniated discs, especially if the discs are in the cervical spine. This type of headache can worsen with neck movements like looking up or down.

Headache, Vision Changes, and Eye Pain

  • Cervicogenic Headache: As mentioned, this type of headache can cause pain that radiates from the neck to the head and can be associated with vision changes and eye pain.
  • Migraine: Migraines can cause severe headaches, vision changes, and eye pain. They can also lead to muscle tightness and balance issues in some cases.

Muscle Tightness and Clumsiness

  • Nerve Compression: The herniated discs could be causing nerve compression, leading to muscle tightness and clumsiness.
  • Neurological Issues: Other neurological conditions could also be contributing to these symptoms, but further evaluation would be needed to determine this.

What you can do

Difficulty Walking, Instability, and Balance Problems

  • See a Doctor: Given the severity of your symptoms, it's important to consult a healthcare provider as soon as possible. They may recommend imaging studies like an MRI to assess the condition of your herniated discs and any nerve compression.
  • Physical Therapy: A physical therapist can help you with exercises to strengthen your muscles and improve your balance.
  • Avoid Strain: Try to avoid activities that worsen your symptoms, such as prolonged walking or squatting.

Headache, Vision Changes, and Eye Pain

  • Consult a Neurologist: A neurologist can help determine if your headaches are cervicogenic or migraine-related and recommend appropriate treatments.
  • Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen may help alleviate some of the pain, but consult your doctor before taking any medication.
  • Neck Support: Using a neck brace or practicing good posture can help reduce the strain on your neck and alleviate headaches.

Muscle Tightness and Clumsiness

  • Stretching Exercises: Gentle stretching exercises can help relieve muscle tightness. A physical therapist can guide you on the best exercises for your condition.
  • Heat Therapy: Applying a warm compress to tight muscles can help relax them.

What you should look out for

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

  • Severe or worsening weakness or numbness in your legs
  • Loss of bladder or bowel control
  • Severe headache that doesn't improve with medication
  • Sudden vision loss or severe eye pain

Remember, while I can provide some guidance, it's crucial to consult a healthcare professional for a formal diagnosis and treatment plan. You can also use MDandMe to journal your symptoms, track your progress, get insights, and share longitudinal medical notes with your provider.

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2 mo ago


People Also Ask


What are the possible causes of headaches located at the back of the head?

Headaches at the back of the head can be caused by tension headaches, cervicogenic headaches related to neck issues, or even migraines. It's important to consult a healthcare provider for an accurate diagnosis.


How can herniated discs affect walking and balance?

Herniated discs can compress nerves in the spine, leading to weakness, numbness, and difficulty in walking. This nerve compression can also affect balance and stability.


What are cervicogenic headaches and how do they differ from migraines?

Cervicogenic headaches originate from issues in the cervical spine and can cause pain that radiates to the head. They often worsen with neck movement. Migraines, on the other hand, are a type of headache disorder that can cause severe pain, vision changes, and other symptoms.


What steps can be taken to manage muscle tightness and clumsiness?

Managing muscle tightness and clumsiness can involve stretching exercises, physical therapy, and heat therapy. It's important to consult a healthcare provider for personalized advice and to rule out any underlying neurological issues.


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