[33F] Experiencing severe headache, neck and upper back pain, nausea

Patient Description

A 33-year-old female reports severe headache, neck and upper back pain, and nausea. The headache, described as both throbbing and sharp, affects the back and front of the head and has significantly impaired vision. This headache has occurred once before and worsens with movement. Neck pain, rated 7/10, is achy and sharp, predominantly on the right side, extending into the shoulder. Upper back pain, rated 8/10, originates at the right shoulder. Both neck and upper back pain have been present since 5 am. The patient has vomited and experiences some sensitivity to light due to the headache. There is no fever, but the neck is stiff and painful to move. The patient has a history of Hashimoto's disease, diagnosed in 2014, and is currently on levothyroxine and oral birth control. Allergies include Flagyl and Zolpidem. No recent medication changes or new prescriptions reported.

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Arora's Assessment

What might be happening

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

  • Migraine: Migraines are a type of headache characterized by severe throbbing or pulsing sensations, often on one side of the head. They can be accompanied by nausea, vomiting, and sensitivity to light and sound. The pain can be so severe that it interferes with your daily activities.

    • Treatment typically involves medications to relieve symptoms and prevent future migraines. Lifestyle changes, such as stress management and avoiding certain foods, can also help.
  • Tension Headache: This is a common type of headache characterized by a dull, aching sensation all around your head. It's often described as a tight band around your head or constant pressure at the temples or back of the head. The pain can radiate to the neck and shoulders.

    • Treatment typically involves over-the-counter pain relievers. Lifestyle changes, such as regular physical activity, relaxation techniques, and adequate sleep, can also help.
  • Cluster Headache: These are severe headaches that occur in a pattern or clusters. They are one of the most painful types of headache. The pain is usually on one side of the head and often around the eye.

    • Treatment typically involves medications to reduce the severity of the headache, prevent future headaches, and relieve symptoms.
  • Cervicogenic Headache: This is a secondary headache, meaning 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.

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

Please note that this is not an exhaustive list and other diagnoses are also possible.

What you can do

  1. Rest in a quiet, dark room. This can often help with migraines and tension headaches.
  2. Apply a warm compress to your neck and shoulders. This can help relax the muscles and alleviate pain.
  3. Stay hydrated. Dehydration can often contribute to headaches.
  4. Avoid known triggers. If certain foods or situations trigger your headaches, try to avoid them.

What you should look out for

You should seek immediate medical attention if:

  • Your headache is severe and sudden, and unlike any you've had before.
  • You have a headache accompanied by confusion, fainting, high fever, stiff neck, weakness, numbness, or difficulty speaking.
  • You have a headache after a head injury.
  • Your headache is worsening despite rest and medication.

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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10 mo ago

People Also Ask


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

Common symptoms of a migraine include severe throbbing or pulsing pain, often on one side of the head, nausea, vomiting, and sensitivity to light and sound. Management typically involves medications to relieve symptoms and prevent future migraines, as well as lifestyle changes like stress management and avoiding known triggers.


How can I differentiate between a tension headache and a migraine?

A tension headache is usually characterized by a dull, aching sensation all around the head, often described as a tight band or constant pressure. In contrast, a migraine is more severe, with throbbing pain, often on one side, and may include nausea and sensitivity to light. Tension headaches can often be managed with over-the-counter pain relievers and lifestyle changes.


What are cervicogenic headaches and how are they treated?

Cervicogenic headaches are secondary headaches caused by a disorder of the cervical spine and its components. They often involve neck pain and can be treated with physical therapy, medications, and sometimes surgery.


When should I seek immediate medical attention for a headache?

You should seek immediate medical attention if your headache is severe and sudden, unlike any you've had before, or if it's accompanied by confusion, fainting, high fever, stiff neck, weakness, numbness, or difficulty speaking. Also, seek help if the headache follows a head injury or worsens despite rest and medication.


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