[34F] With right-sided body pain, headache, eye pain, leg swelling, and abdominal ache

Patient Description

A 34-year-old female has been experiencing moderate to severe pain on the right side of her body for the past two weeks. The pain worsens with activity, upon waking, and when lying on her right side. It persists throughout the day, waxing and waning, and is not alleviated by any specific activities or positions. Over-the-counter medications like Tylenol and ibuprofen have not provided much relief. Additionally, she reports right-sided headache and eye pain, which has been constant and deep for the past two weeks, rated as 6 out of 10 in severity. She has experienced similar headaches before, but they are occurring more frequently now. She also has leg swelling, particularly in the right calf, which feels tight and stays indented when pressed, worsening with prolonged sitting. There is no redness, warmth, or discoloration in the swollen leg, and both legs get cold easily. She has not experienced shortness of breath, chest pain, unusual fatigue, or weakness. The patient has gained about 15 pounds over the last year. Her medical history includes PCOS (diagnosed 10 years ago), reactive hypoglycemia (diagnosed about a year ago), migraines (diagnosed 20 years ago), GERD (diagnosed 15 years ago), and fibromyalgia (diagnosed at age 18). She has a family history of heart disease. Current medications include Ajovy (monthly), Prozac (80mg daily), Protonix (40mg daily), Metoprolol (25mg daily), and Clonazepam (0.5mg as needed). She uses ibuprofen and Tylenol as needed. She has allergies to tricyclic antidepressants, zonisamide, and Imitrex. She vapes nicotine frequently and consumes a lot of salty and processed foods.

Arora's Assessment

What might be happening

It is likely that your symptoms are related to multiple issues, including existing diagnoses. If you have more questions, we can continue chatting.

Causes of your right-side body pain, including head and eye pain, and leg swelling:

Migraine with aura: Given your history of migraines, the right-side head and eye pain could be a severe migraine episode. Migraines can sometimes cause pain that radiates to other parts of the body.
Fibromyalgia: This condition can cause widespread pain, including in the head, eyes, and other parts of the body. It can also cause symptoms to worsen with activity and upon waking.
Deep Vein Thrombosis (DVT): The swelling in your right calf, especially since it stays indented when pressed, could be a sign of a blood clot. This is a serious condition that requires immediate medical attention.

Causes of your abdominal ache:

GERD: Given your history of GERD, the abdominal ache could be related to acid reflux or other gastrointestinal issues.
PCOS: Polycystic Ovary Syndrome can sometimes cause abdominal pain due to ovarian cysts or other related issues.

What you can do

Right-side body pain, including head and eye pain:

See a doctor as soon as possible: Given the severity and persistence of your symptoms, it's important to get a professional evaluation. Your doctor may recommend imaging studies or other tests to determine the cause.
Manage migraines: Continue taking Ajovy as prescribed and discuss with your doctor if additional migraine management strategies are needed.
Fibromyalgia management: Ensure you are following your treatment plan for fibromyalgia, which may include medications, physical therapy, and lifestyle changes.

Leg swelling:

Seek immediate medical attention: The swelling in your calf could be a sign of DVT, which is a medical emergency. Go to the emergency department or contact your healthcare provider immediately.
Elevate your legs: When sitting or lying down, try to keep your legs elevated to reduce swelling.
Avoid prolonged sitting: Take breaks to stand and move around if you have to sit for long periods.

Abdominal ache:

GERD management: Continue taking Protonix as prescribed and avoid foods that trigger your symptoms. Eating smaller, more frequent meals may also help.
PCOS management: Follow your treatment plan for PCOS and discuss any new or worsening symptoms with your healthcare provider.

What you should look out for

Given the severity of your symptoms and the possibility of life-threatening causes, you should seek medical care as soon as you can. Reasons to seek care even more urgently include:

Sudden or severe shortness of breath
Chest pain
Fainting or severe dizziness
Severe or worsening leg pain or swelling

Remember, I am not a doctor, and it's important to seek care from real health professionals to receive a formal diagnosis and treatment. You can also use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

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