[43F] Experiencing migraines, tinnitus, and elevated pulse

Patient Description

A 43-year-old female presents with a history of severe migraines that have been occurring on and off throughout her life, with a recent increase in frequency to every other week, lasting about 4 days. The migraines are characterized by a pain level of 7 out of 10, located on the right side of the head, neck, behind the right eye, and affecting the jaw and ear, accompanied by visual disturbances, nausea, and sensitivity to light and sound. The patient notes that changes in barometric pressure seem to trigger these migraines. She also reports tinnitus that has worsened over the past couple of years, described as a loud ringing, particularly severe in the mornings. Additionally, she experiences vertigo, nausea, and an elevated pulse rate of 130 bpm at rest, which appears to be associated with the migraines. The patient has a family history of migraines and cardiac issues, with her grandpa having had neuropathy and her dad having had heart disease. Her medical history includes anxiety diagnosed in 1998, gastroparesis diagnosed last year, and a childhood condition where her heart would beat excessively fast, causing syncope upon standing. Current medications include Botox injections every three months for migraines, Relpax 40mg as needed for migraine attacks, and Motegrity taken every morning for gastroparesis.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possibilities:

  • Chronic Migraine: This is a type of migraine that lasts for more than 15 days per month for at least three months. The exact cause of migraines isn't known, but they might be related to changes in the brain and to genetics. Since migraines often run in families, genetics may play a role. You've mentioned that your migraines are severe, last for about 4 days, and occur every other week. This fits the description of chronic migraines.

    • Treatment typically involves a combination of medications and lifestyle changes like avoiding known triggers.
  • Tinnitus: This is a non-auditory, internal sound that can be intermittent or continuous, in one or both ears, and either low- or high-pitched. The sound is often described as ringing, buzzing, clicking, hissing, or roaring. You've mentioned experiencing a ringing sound that's worse in the mornings. This could be tinnitus.

    • Treatment can involve medications, noise suppression, or treating an underlying health condition causing the tinnitus.
  • Gastroparesis: This is a condition that affects the normal spontaneous movement of the muscles in your stomach. You've mentioned being diagnosed with this condition last year and are taking Motegrity for it.

    • Treatment typically involves dietary changes, medication, and in severe cases, surgery.
  • Autonomic Dysfunction: This is a condition in which the autonomic nervous system (ANS) doesn't work properly. This could cause a variety of symptoms, including a fast heart rate, which you've mentioned experiencing. It could also potentially explain your history of fainting upon standing up.

    • Treatment typically involves managing the symptoms and any underlying conditions.

Please note that these are possibilities based on the information you've provided, and only a healthcare professional can provide a definitive diagnosis.

What you can do

  1. Continue taking your prescribed medications and follow your doctor's advice.
  2. Try to identify and avoid triggers for your migraines and tinnitus.
  3. Maintain a healthy lifestyle, including regular exercise, a balanced diet, and adequate sleep.
  4. Keep a symptom diary to track your symptoms and identify any patterns or triggers.
  5. Stay hydrated, especially if your migraines are accompanied by vomiting.

What you should look out for

You should seek immediate medical attention if you experience:

  • A sudden, severe headache or a headache that is accompanied by a fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness, or trouble speaking.
  • A significant increase in the frequency or severity of symptoms.
  • New symptoms that you haven't experienced before.

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 some common triggers for migraines and how can they be managed?

Common triggers for migraines include stress, hormonal changes, certain foods and drinks, changes in sleep patterns, and environmental factors like changes in weather or barometric pressure. Managing migraines often involves identifying and avoiding these triggers, using prescribed medications, and making lifestyle changes such as maintaining a regular sleep schedule and staying hydrated.


How is tinnitus typically treated and can it be cured?

Tinnitus treatment focuses on managing symptoms since there is no cure. Options include sound therapy, cognitive behavioral therapy, and medications to reduce the perception of tinnitus. Treating any underlying conditions, such as ear infections or hearing loss, can also help alleviate symptoms.


What lifestyle changes can help manage gastroparesis symptoms?

Lifestyle changes for managing gastroparesis include eating smaller, more frequent meals, avoiding high-fat and high-fiber foods, staying hydrated, and possibly incorporating gentle exercise after meals. Medications like Motegrity can also help improve gastric motility.


What are the symptoms of autonomic dysfunction and how is it treated?

Symptoms of autonomic dysfunction can include a fast heart rate, dizziness, fainting, and digestive issues. Treatment involves managing symptoms and any underlying conditions, which may include medications, lifestyle changes, and in some cases, physical therapy to improve blood flow and reduce symptoms.

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