[43F] Experiencing constant headache with neck and shoulder pain

Patient Description

A 43-year-old female has been experiencing a constant headache for the past month, particularly over her eyes, neck, and forehead. The headache is described as aching, with an intensity rated at 5/10. It worsens when fasting, but Tylenol provides some relief. This headache is similar to one experienced post-Covid. Alongside, she has neck and shoulder pain, with the neck pain described as muscle pain starting concurrently with the headache and rated at 2/10 in severity. The shoulder pain, affecting both shoulders, has been intermittent over the past 2 years, also rated at 2/10 in severity. The patient has a history of pre-diabetes diagnosed 8-10 years ago and borderline high blood pressure diagnosed 2 years ago. She is currently on 0.25 micrograms of Thyroxin daily for hypothyroidism and takes a Vitamin D supplement (3000 IU) and a multivitamin daily. No allergies or adverse reactions to medications have been reported.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible causes of your symptoms include:

  • Tension Headache: This is the most common type of headache and it often feels like a constant ache or pressure around the head, especially at the temples or back of the head and neck. They can be caused by stress, lack of sleep, missed meals, or dehydration.

    • Treatment typically involves over-the-counter pain relievers, stress management, and lifestyle changes such as regular physical activity and adequate hydration.
  • Migraine: Migraines are often described as a throbbing pain that usually occurs on one side of the head. However, it can sometimes affect both sides. They can last for hours to days, and the pain can be so severe that it interferes with your daily activities.

    • Treatment typically involves medications to help reduce the frequency and severity of migraines, as well as lifestyle changes to avoid known triggers.
  • Hypertension Headache: High blood pressure can cause headaches when it becomes extremely high. These headaches typically occur on both sides of your head and are often accompanied by a pulsating or throbbing sensation.

    • Treatment involves managing your blood pressure through lifestyle changes and medication.
  • Hypothyroidism: Although it's less common, hypothyroidism can cause headaches and muscle aches. You mentioned that you are currently on medication for hypothyroidism, so it's important to ensure that your thyroid levels are well-controlled.

    • Treatment involves taking synthetic thyroid hormone to help regulate your body's metabolism.

What you can do

  1. Try to identify any potential triggers for your headaches, such as stress, certain foods or drinks, lack of sleep, or missed meals. Avoiding these triggers can help prevent headaches.
  2. Maintain a regular sleep schedule and ensure you are getting enough sleep each night.
  3. Stay hydrated and eat regular, balanced meals.
  4. Regular physical activity can help reduce the frequency and severity of headaches. Try to incorporate some form of exercise into your daily routine.
  5. Over-the-counter pain relievers, such as Tylenol, can help relieve headache pain. However, they should be used sparingly, as overuse can lead to rebound headaches.
  6. Consider relaxation techniques, such as deep breathing, yoga, or meditation, to help manage stress and prevent headaches.

What you should look out for

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

  • A sudden, severe headache that is different from past headaches.
  • A headache accompanied by a fever, stiff neck, confusion, seizure, double vision, weakness, numbness, or difficulty speaking.
  • A headache after a head injury, especially if the headache gets worse.
  • A chronic headache that is worse after coughing, exertion, straining, or a sudden movement.
  • New headache pain if you're over 50.

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for appropriate examination, testing, and care recommendations.

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9 mo ago


People Also Ask


What are the common triggers for tension headaches and how can they be avoided?

Common triggers for tension headaches include stress, lack of sleep, missed meals, and dehydration. To avoid them, try to manage stress through relaxation techniques, maintain a regular sleep schedule, eat balanced meals at regular intervals, and stay well-hydrated.


How can I differentiate between a tension headache and a migraine?

Tension headaches typically feel like a constant ache or pressure around the head, often at the temples or back of the head and neck, while migraines are usually a throbbing pain on one side of the head and can be accompanied by nausea and sensitivity to light or sound. Keeping a headache diary can help identify patterns and differentiate between the two.


Can hypothyroidism cause headaches and muscle pain, and how should it be managed?

Yes, hypothyroidism can cause headaches and muscle pain. It is managed by taking synthetic thyroid hormone to regulate metabolism. It's important to have regular check-ups to ensure thyroid levels are well-controlled.


What lifestyle changes can help manage pre-diabetes and borderline high blood pressure?

To manage pre-diabetes and borderline high blood pressure, focus on a healthy diet rich in fruits, vegetables, and whole grains, regular physical activity, maintaining a healthy weight, reducing salt intake, and avoiding smoking and excessive alcohol consumption.


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1 Comments


Leo#3962

8 mo ago

This sounds like occipital neuralgia. Does tapping on the areas of your neck that hurt (especially toward the back of the head) also reproduce the headache syndromes? If so muscle relaxants can be prescribed and heating pads might help

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