[32F] With intense throbbing headaches and associated symptoms

Patient Description

A 32-year-old female presents with an intense throbbing headache at the top front of her head, lasting for over 5 hours. The headache worsens with movement and talking, but is somewhat relieved by applying pressure to the head and avoiding noise. She has experienced similar headaches once or twice recently, although headaches are not usually common for her. Along with the headache, she reports difficulty concentrating, dizziness, body fatigue, and irritability, which has been ongoing for the past year. The irritability can escalate from frustration to rage and is often accompanied by feelings of hopelessness and defeat. The headache onset was sudden and is often triggered by extreme stress, burnout, and feeling depleted. She has tried Aleve without relief. She denies nausea or sensitivity to light or sound but has experienced brief visual disturbances like dizziness and seeing a 'glitch.' She also reports occasional weakness or numbness in her arms, which comes and goes. She has not had any recent head injuries but has been under extreme stress. She occasionally uses substances like alcohol or tobacco but did not specify the frequency. Her family history includes heart disease, type 1 diabetes, hypothyroidism, cancer, depression, OCD, and BPD. She has not had a menstrual period in years due to an IUD. Her past medical history includes tonsillectomy, appendicitis, several episodes of diabetic ketoacidosis (DKA), gastroparesis, autism, chronic kidney disease (stage 1, diagnosed a year ago), and neuropathy. She has allergies to Cefzil (causes a rash) and Phenergan (causes aggression). She is currently taking medications for depression with psychosis, anxiety, Novolog (on a sliding scale), and Lantus (30 units once a day). She takes the medications for depression and anxiety once a day but is unsure of their exact names and dosages. She is not taking any over-the-counter medications, supplements, or herbal remedies.

Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

Tension Headache: This is a common type of headache characterized by a dull, aching pain and a sensation of tightness or pressure across the forehead or on the sides and back of the head. Stress and burnout are common triggers.
- Treatment: Over-the-counter pain relievers like ibuprofen or acetaminophen can help. Stress management techniques, such as relaxation exercises, yoga, or meditation, may also be beneficial.
Migraine: Migraines can cause severe, throbbing headaches, often accompanied by visual disturbances, dizziness, and sensitivity to light and sound. Stress is a well-known trigger for migraines.
- Treatment: Prescription medications are often required to manage migraines. Lifestyle changes, such as maintaining a regular sleep schedule, staying hydrated, and avoiding known triggers, can also help.
Chronic Stress and Anxiety: Chronic stress and anxiety can manifest physically, leading to headaches, dizziness, fatigue, and irritability. Your description of feeling burnt out and depleted aligns with this.
- Treatment: Cognitive-behavioral therapy (CBT), stress management techniques, and medications prescribed by a healthcare provider can be effective.
Medication Overuse Headache: Frequent use of pain relievers can sometimes lead to rebound headaches.
- Treatment: Reducing the use of over-the-counter pain medications and consulting a healthcare provider for alternative treatments.

What you can do

Consult a Healthcare Provider: It's important to discuss your symptoms with a healthcare provider to get a formal diagnosis and appropriate treatment. They may recommend further tests or refer you to a specialist.
Stress Management: Practice stress-reducing activities such as deep breathing exercises, yoga, or meditation. Consider speaking with a mental health professional to address chronic stress and anxiety.
Hydration and Nutrition: Ensure you are staying hydrated and eating a balanced diet. Dehydration and poor nutrition can exacerbate headaches and fatigue.
Regular Sleep Schedule: Try to maintain a consistent sleep schedule to help manage stress and improve overall well-being.
Symptom Tracking: Use MDandMe to journal your symptoms, track progress, and get insights. This can help you and your healthcare provider identify patterns and triggers.

What you should look out for

Seek medical attention more urgently if you experience:

Sudden, severe headache unlike any you've had before
Headache accompanied by fever, stiff neck, confusion, or difficulty speaking
Persistent visual disturbances or significant changes in vision
Weakness or numbness in your arms or legs that worsens
Any new or worsening symptoms that concern you

Remember, while I can provide information and suggestions, I am not a substitute for a healthcare provider. Please consult with a real health professional to receive a formal diagnosis and appropriate treatment.

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4 mo ago

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