[34F] Experiencing chronic neurological and pain symptoms

Patient Description

A 34-year-old female presents with a constellation of symptoms persisting for 1 year and 4 months, including chronic fatigue, ear pain with a sensation of fullness, tinnitus with a high-pitched sound and occasional pulsatile component, head pressure, unilateral headaches, scalp pain with neuralgia-like features, eye pain with pressure and flashing lights, tachycardia with heart rate above 100 bpm, and neck pain described as full and achy. The patient also reports constant unsteadiness, likened to a 'sober mind in a drunk body,' which is present throughout the day and is not exacerbated by head movements or changes in position but is alleviated by rest. The patient has a history of ear trauma in childhood and past exposure to physical abuse. Current medications include Emgality (120mg monthly), Trazodone (50mg nightly), and Rizatriptan (10mg up to three times weekly as needed). No known drug allergies, no fever or chills, and no family history of similar symptoms.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are several possible conditions that could be causing your symptoms:

  • Chronic Migraine: This condition is characterized by headaches that occur on 15 or more days per month for at least three months. The headaches have the features of migraine headache on at least 8 days per month. The symptoms you've described, including one-sided headache, sensitivity to touch on the scalp, and seeing flashing lights, are common in migraines. The medications you're taking (Emgality and Rizatriptan) are also commonly used to treat migraines.

    • Treatment typically involves a combination of medications to reduce the frequency and severity of migraines, as well as lifestyle changes to avoid migraine triggers.
  • Meniere's Disease: This is a disorder of the inner ear that can lead to dizzy spells (vertigo) and hearing loss. In most cases, Meniere's disease affects only one ear. It can cause severe dizziness, a roaring sound in your ears (tinnitus), hearing loss that comes and goes, and the feeling of ear pressure or pain. It usually affects just one ear and is a common cause of hearing loss.

    • Treatment typically involves a combination of medications, physical therapy, and sometimes surgery to manage symptoms.
  • Temporomandibular Joint Disorders (TMJ): These are a group of conditions that cause pain and dysfunction in the jaw joint and the muscles that control jaw movement. It can also cause referred pain in the ear, face, and neck, as well as headaches and tinnitus.

    • Treatment typically involves a combination of medications, physical therapy, and sometimes surgery to manage symptoms.
  • Vestibular Neuritis or Labyrinthitis: These are inflammations caused by a viral infection that result in dizziness and loss of balance. It's often associated with an upper respiratory infection, such as the flu. Symptoms can include dizziness, loss of balance, and tinnitus.

    • Treatment typically involves medications to control dizziness and inflammation, as well as physical therapy to help improve balance.

Please note that these are potential explanations for your symptoms based on the information you've provided, but they are not definitive diagnoses. It's important to consult with a healthcare provider for an accurate diagnosis and treatment.

What you can do

  1. Continue taking your prescribed medications as directed by your healthcare provider.
  2. Try to identify any triggers for your symptoms, such as certain foods, stress, lack of sleep, etc., and avoid them if possible.
  3. Practice good sleep hygiene, which includes maintaining a regular sleep schedule, creating a comfortable sleep environment, and avoiding caffeine and electronic screens before bedtime.
  4. Consider physical therapy, which can help manage symptoms of vertigo and improve balance.
  5. If you smoke, consider quitting, as smoking can worsen symptoms of vertigo and tinnitus.

What you should look out for

Please seek immediate medical attention if you experience any of the following:

  • A sudden, severe headache
  • Sudden hearing loss
  • Symptoms that are progressively worsening
  • Symptoms that are not improving with treatment
  • New symptoms, such as weakness, numbness, difficulty speaking, or difficulty walking.

Remember, while I strive to provide accurate and helpful information, I'm not a doctor. Always consult with a healthcare provider for a formal diagnosis and treatment.

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10 mo ago

People Also Ask


What are the common symptoms of chronic migraine?

Common symptoms of chronic migraine include headaches on 15 or more days per month, sensitivity to light and sound, nausea, and visual disturbances such as flashing lights. Treatment often involves medications to reduce frequency and severity, as well as lifestyle changes to avoid triggers.


How is Meniere's disease diagnosed and treated?

Meniere's disease is diagnosed through a combination of medical history, hearing tests, and balance assessments. Treatment may include medications to reduce dizziness, dietary changes, physical therapy, and in some cases, surgery.


What are the symptoms and treatment options for temporomandibular joint disorders (TMJ)?

Symptoms of TMJ disorders include jaw pain, difficulty chewing, clicking or locking of the jaw, and referred pain in the ear, face, and neck. Treatment options include medications, physical therapy, dental splints, and sometimes surgery.


What is vestibular neuritis and how is it treated?

Vestibular neuritis is an inflammation of the inner ear, often caused by a viral infection, leading to dizziness and balance issues. Treatment typically involves medications to control dizziness and inflammation, along with physical therapy to improve balance.


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