[46F] With severe headache and neck pain

Patient Description

A 46-year-old female presents with severe headache and neck pain for the past four days. The headache is described as throbbing and affects the entire skull, including the temples and behind the eyes. It worsens with movement, talking, and standing, and over-the-counter medications like aspirin, Tylenol, and ibuprofen have not provided relief. The headache started gradually and is accompanied by cloudy vision (described as looking through a dirty window), neck stiffness, a little nausea, and occasional chills. There is a hard, painful lump on the left side of the neck, about the size of a grape. The patient has a history of thyroid cancer 17 years ago and has been diagnosed with schizophrenia for the past six years. She is currently taking 200 mg of Levothyroxine daily and has been on this dose for 15 years. No allergies to medications and no recent changes in medication regimen.

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Arora's Assessment

What might be happening

Based on the information you've provided, several potential conditions could explain your symptoms:

  • Tension Headache: This is a common type of headache that can cause a throbbing sensation and is often associated with neck pain and stiffness. Stress, poor posture, and muscle tension can contribute to this condition.

    • Treatment typically involves over-the-counter pain relievers, stress management techniques, and physical therapy.
  • Migraine: Migraines can cause severe, throbbing headaches that may be accompanied by nausea, vision changes, and sensitivity to light or sound.

    • Treatment may include prescription medications to relieve symptoms, lifestyle changes to avoid triggers, and preventive medications.
  • Cervical Spine Issues: Problems with the cervical spine, such as a herniated disc or cervical spondylosis, can cause neck pain and headaches. The lump you described could be related to muscle tension or a swollen lymph node.

    • Treatment may involve physical therapy, pain management, and, in some cases, surgical intervention.
  • Meningitis: This is a serious infection that causes inflammation of the membranes surrounding the brain and spinal cord. Symptoms can include severe headache, neck stiffness, nausea, and chills.

    • Meningitis requires immediate medical attention and is typically treated with antibiotics or antiviral medications.

Given your history of thyroid cancer, it's also important to consider the possibility of a recurrence or other thyroid-related issues. The lump on your neck should be evaluated by a healthcare professional to rule out any serious conditions.

What you can do

  1. Seek Medical Attention: Given the severity and duration of your symptoms, it's important to consult a healthcare professional as soon as possible. They can perform a thorough evaluation, including physical examination and imaging studies, to determine the cause of your symptoms.
  2. Stay Hydrated and Rest: Ensure you are drinking plenty of fluids and getting adequate rest. This can help alleviate some of your symptoms.
  3. Apply Heat or Cold: Applying a warm compress or ice pack to your neck may help reduce pain and muscle tension.
  4. Maintain Good Posture: Ensure you are maintaining good posture, especially if you spend long periods sitting or working at a computer.

What you should look out for

Seek immediate medical attention if you experience any of the following:

  • Worsening headache or neck pain
  • High fever (temperature over 100.4°F)
  • Persistent nausea or vomiting
  • Confusion or changes in mental status
  • Difficulty breathing or swallowing
  • Sudden vision changes

Remember, while this information can help guide you, it is not a substitute for professional medical advice. Please consult a healthcare provider for a formal diagnosis and appropriate treatment.

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9 mo ago

People Also Ask


What are the common symptoms of a tension headache?

Common symptoms of a tension headache include a dull, aching head pain, a sensation of tightness or pressure across the forehead or on the sides and back of the head, and tenderness in the scalp, neck, and shoulder muscles.


How can migraines be distinguished from other types of headaches?

Migraines are often characterized by severe, throbbing pain on one side of the head, accompanied by nausea, vomiting, and sensitivity to light and sound. They may also include visual disturbances known as auras.


What are the potential causes of a lump on the neck?

A lump on the neck can be caused by swollen lymph nodes due to infection, muscle tension, cysts, or, in rare cases, tumors. It is important to have it evaluated by a healthcare professional to determine the cause.


What are the warning signs of meningitis that require immediate medical attention?

Warning signs of meningitis include a sudden high fever, severe headache, neck stiffness, nausea or vomiting, sensitivity to light, confusion, and a rash. Immediate medical attention is necessary if these symptoms are present.


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