[36F] Experiencing a range of symptoms including migraines and tinnitus

Patient Description

A 36-year-old female presents with a complex symptomatology including migraines with aura, which have been occurring for 9 years, with a frequency of once to twice a week and a duration of 1-4 days. The migraines are described as throbbing with extreme pressure, rated at a severity of 7 out of 10, and are triggered by fluorescent lights, loud sudden noises, and smells. Despite being on preventative medication, the patient still experiences migraines regularly, and abortive medication is effective three-quarters of the time. The patient also reports a mild, intermittent ringing in the ears (tinnitus) that has been present for over 5 years and is exacerbated by migraines. Other symptoms include fatigue, vertigo, sinus pressure, nausea, GERD, a sensation of a lump in the throat (globus sensation), easy bruising, and ridged nail beds. The patient has not mentioned any recent head injuries or exposure to loud noises that could have caused ear damage.

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Arora's Assessment

What might be happening

Based on the information you have provided, possible explanations for your symptoms include:

  • Migraine: A neurological condition that can cause multiple symptoms. It's frequently characterized by intense, debilitating headaches. Symptoms may include nausea, vomiting, difficulty speaking, numbness or tingling, and sensitivity to light and sound. Migraines often run in families and affect all ages. The diagnosis is an important aspect of treatment and prevention.

    • Treatment of migraines often involves medications to help reduce the frequency and severity of migraines. If one medication doesn't work well for you, your doctor may recommend others. In some cases, antidepressants, blood pressure-lowering medicines, and antiseizure medications might help prevent migraines. Lifestyle adjustments that might help reduce the frequency of migraines include regular exercise, drinking plenty of water, reducing stress, and avoiding certain foods.
  • Chronic Sinusitis: This condition causes the cavities around nasal passages (sinuses) to become inflamed and swollen for at least 12 weeks, despite treatment attempts. This can interfere with drainage and cause mucus buildup. Breathing through your nose might be difficult and the area around your eyes might feel swollen or tender.

    • Treatment typically involves medications to reduce inflammation in the nasal passages and sinuses, allowing mucus to drain normally. In some cases, surgery may be necessary.
  • Tinnitus: A common condition characterized by the perception of noise or ringing in the ears. Tinnitus isn't a condition itself — it's a symptom of an underlying condition, such as age-related hearing loss, ear injury or a circulatory system disorder.

    • Treatment of tinnitus focuses on treating the underlying cause of tinnitus.
  • Gastroesophageal reflux disease (GERD): A chronic condition where stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus.

    • Treatment of GERD usually involves lifestyle changes and medications that reduce stomach acid. If these steps don't help or if you have frequent or severe symptoms, your doctor might recommend medications to reduce acid and help the stomach empty faster.

Please note that these are just potential explanations based on the symptoms you've described. It's important to consult a healthcare professional for an accurate diagnosis.

What you can do

  1. Consult a healthcare professional: Given the variety and complexity of your symptoms, it's important to seek medical advice. They can provide a formal assessment and order relevant tests if necessary.

  2. Lifestyle modifications: Regular exercise, a healthy diet, adequate hydration, and good sleep hygiene can help manage many of the symptoms you're experiencing.

  3. Stress management: Techniques such as mindfulness, yoga, and meditation can help manage stress, which can exacerbate many of your symptoms.

  4. Keep a symptom diary: This can help you and your healthcare provider identify triggers or patterns to your symptoms.

What you should look out for

Seek immediate medical attention if you experience:

  • Severe headache or migraine that doesn't improve with medication
  • Sudden or severe abdominal pain
  • Difficulty breathing or shortness of breath
  • Sudden, severe dizziness or vertigo
  • Any new or worsening symptoms

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

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11 mo ago

People Also Ask


What are common triggers for migraines with aura?

Common triggers for migraines with aura include stress, certain foods and drinks (like caffeine and alcohol), hormonal changes, sensory stimuli (such as bright lights or loud noises), changes in sleep patterns, and environmental changes.


How can tinnitus be managed or treated?

Tinnitus management focuses on treating the underlying cause, if identified. This may include addressing hearing loss, managing stress, or using sound therapy. In some cases, hearing aids or tinnitus retraining therapy may be recommended.


What lifestyle changes can help reduce the frequency of GERD symptoms?

Lifestyle changes to reduce GERD symptoms include eating smaller meals, avoiding foods and drinks that trigger reflux (such as spicy foods, caffeine, and alcohol), not lying down immediately after eating, maintaining a healthy weight, and elevating the head of the bed.


What are some potential causes of vertigo and how can it be treated?

Vertigo can be caused by inner ear problems, such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, or Meniere's disease. Treatment depends on the cause and may include medications, physical therapy, or maneuvers to reposition ear crystals. In some cases, lifestyle changes and stress management can also help.


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