[41F] Experiencing severe, patterned headaches with abdominal discomfort

Patient Description

A 41-year-old female presents with a throbbing headache localized to the left side of the face, behind the eye, and associated with ear pain and neck discomfort radiating down to the chest. The headaches, which have been occurring 5-7 times a month and lasting for 2-3 days, are described as different and worse than previous headaches. Relief is found using a warm pad. The patient also reports upper abdominal discomfort with nausea for approximately four days, characterized as dull pain, and a bowel movement earlier in the day with soft stool. No fever or chills are reported. The patient experiences blurriness and lightheadedness, particularly upon standing, and has been having low blood pressure readings with a high pulse rate, most recently at 86/53 mmHg with a pulse of 99 bpm. Ear pain has been present for 2-3 weeks without any findings on a recent doctor's examination. There is no known history of chronic illnesses or allergies to medications. The patient is currently taking Vyvanse 70 mg daily for ADHD.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible conditions that could explain your symptoms:

  • Migraine: This is a type of headache characterized by severe throbbing pain or a pulsing sensation, usually on one side of the head. It's often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days, and the pain can be so severe that it interferes with your daily activities.

    • Treatment typically involves pain relieving medications and preventive medications.
  • Orthostatic Hypotension: This is a form of low blood pressure that happens when you stand up from sitting or lying down. It can make you feel dizzy or lightheaded, and maybe even faint. An unusually rapid heart rate (tachycardia) can also accompany these symptoms.

    • Treatment often starts with simple lifestyle changes, such as avoiding alcohol, drinking plenty of fluids, and standing up slowly.
  • Gastroesophageal Reflux Disease (GERD): This is 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, causing upper abdominal discomfort and nausea.

    • Treatment typically involves lifestyle changes and over-the-counter medications.

Please note that these are potential explanations for your symptoms and not a definitive diagnosis.

What you can do

Here are some general recommendations based on your symptoms:

  1. Keep a headache diary: This can help you identify triggers for your migraines, such as certain foods, smells, stress, and lack of sleep. Avoiding these triggers can help reduce the frequency and severity of your migraines.
  2. Stay hydrated: Dehydration can cause low blood pressure and exacerbate symptoms of migraines and GERD. Aim to drink at least eight 8-ounce glasses of water a day.
  3. Stand up slowly: This can help manage symptoms of orthostatic hypotension.
  4. Avoid foods that trigger acid reflux: These can include fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine.

What you should look out for

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

  • Sudden, severe headache or headache accompanied by confusion, seizures, double vision, weakness, numbness, or difficulty speaking
  • Chest pain, shortness of breath, irregular heartbeat, or unexplained sweating
  • Vomiting blood or black material, or passing black stools

Remember, it's important to consult with a healthcare professional who can evaluate your symptoms and medical history in order to provide a formal diagnosis and appropriate treatment options.

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1 yr ago

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People Also Ask


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

Migraines are characterized by severe throbbing pain or a pulsing sensation, usually on one side of the head, and can be accompanied by nausea, vomiting, and sensitivity to light and sound. Management includes pain-relieving medications, preventive medications, and identifying and avoiding triggers.


What is orthostatic hypotension and what lifestyle changes can help manage it?

Orthostatic hypotension is a form of low blood pressure that occurs when standing up from sitting or lying down, causing dizziness or lightheadedness. Lifestyle changes such as staying hydrated, standing up slowly, and avoiding alcohol can help manage it.


What are the symptoms of GERD and how can it be treated?

GERD symptoms include upper abdominal discomfort, nausea, and acid reflux. Treatment involves lifestyle changes like avoiding trigger foods and over-the-counter medications to reduce stomach acid.


How can low blood pressure and high pulse rate affect overall health?

Low blood pressure can lead to dizziness, lightheadedness, and fainting, while a high pulse rate can indicate the heart is working harder than normal. Both can affect overall health by reducing blood flow to vital organs, and should be monitored and managed with lifestyle changes and medical advice.


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