[34F] With severe headache and neurological symptoms

Patient Description

A 34-year-old female has been experiencing a severe headache with extreme pressure that has progressively worsened over the past week. The pain is sharp, intense, and located primarily on the top of the head, exacerbated by movement and relieved by sitting still. Accompanying symptoms include sensitivity to light and sound, issues with depth perception, vomiting twice this morning, and a tingling sensation in the neck with a feeling of severe pressure, though no visible swelling. The patient reports trouble concentrating for the past 2-3 days, neck stiffness, and chills without fever. There is a family history of migraines and a brain aneurysm. The patient was diagnosed with migraines at age 7 but feels this is different. She is allergic to Phenergan, which causes severe muscle spasms, and is currently taking Claritin 10 mg daily, Tylenol, and ibuprofen as needed. No recent infections, illnesses, or new medications have been reported.

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Arora's Assessment

What might be happening

Based on your symptoms, there are a few possibilities to consider:

  1. Migraine with Aura: Although you mentioned this feels different, migraines can sometimes present with new symptoms like sensitivity to light and sound, nausea, and visual disturbances.

  2. Meningitis: The combination of severe headache, neck stiffness, and sensitivity to light could indicate meningitis, an infection of the protective membranes covering the brain and spinal cord. This is a medical emergency.

  3. Intracranial Pressure: The feeling of severe pressure and worsening headache could suggest increased pressure in the brain, possibly due to a condition like a brain aneurysm, especially given your family history.

  4. Cluster Headache: These are severe headaches that occur in cyclical patterns and can cause intense pain.

It's crucial to seek immediate medical attention to determine the exact cause and receive appropriate treatment.

What you can do

  • Seek Immediate Medical Care: Given the severity and progression of your symptoms, it's important to visit an emergency room as soon as possible. If you feel unable to get there safely, please call 911 or have someone drive you.

  • Avoid Triggers: Until you receive medical care, try to stay in a dark, quiet room to minimize discomfort.

  • Stay Hydrated: Drink water to stay hydrated, but avoid caffeine and alcohol.

  • Document Symptoms: Keep a record of your symptoms and any changes, as this information will be helpful for healthcare providers.

Please prioritize getting medical attention immediately. Your symptoms could indicate a serious condition that requires prompt evaluation and treatment.

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3 mo ago

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People Also Ask


What are the common symptoms of a migraine with aura?

Common symptoms of a migraine with aura include visual disturbances such as flashing lights or zigzag patterns, sensitivity to light and sound, nausea, and sometimes tingling or numbness in the face or hands. These symptoms typically precede the headache phase.


How can meningitis be distinguished from other types of headaches?

Meningitis can be distinguished from other headaches by symptoms such as a sudden high fever, severe headache, neck stiffness, sensitivity to light, nausea, vomiting, and sometimes a rash. It is a medical emergency and requires immediate attention.


What are the signs of increased intracranial pressure?

Signs of increased intracranial pressure include severe headache, vomiting, blurred vision, changes in behavior, decreased consciousness, and sometimes seizures. It is important to seek medical evaluation if these symptoms are present.


What should I do if I suspect I have a cluster headache?

If you suspect you have a cluster headache, it is important to seek medical advice for proper diagnosis and treatment. In the meantime, staying in a dark, quiet room and avoiding alcohol and smoking can help manage symptoms. Oxygen therapy and certain medications can also be effective treatments.


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