[50F] With severe migraines, nausea, and high blood pressure
Question
I'm just really sick
Patient Description
A 50-year-old female presents with severe migraines for the past 2 days, characterized by pain behind the eyes and across the forehead, described as a squeezing sensation. The patient experiences sensitivity to light and noise, severe nausea, and vomiting. A dark, quiet room provides minimal relief. The patient has a history of frequent migraines, with a similar episode lasting 4 days about a week ago, and another episode last year followed by a stroke. Migraines typically last 1 to 4 days and often start in the early morning with nausea. The patient has a 20-year history of high blood pressure, managed with medication, but readings remain high, leading to complications such as vein occlusion, neovascularization in the retina, and AV nicking. Blurred vision occurs intermittently, sometimes with small blood vessel leaks in the eye. Numbness in fingers and toes, especially in cold weather, started after a stroke a year ago, described as ice-cold burning and loss of feeling, relieved by warm water. The patient also has trouble swallowing, more so with drinks than food, causing throat closure and choking. The patient has a history of a heart attack 7 years ago and an eye aneurysm 3 years ago. Dizziness and loss of balance are reported, but no weakness, paralysis, changes in speech, or recent confusion. There is a family history of stroke or heart disease. The patient does not use tobacco, alcohol, or recreational drugs. An ischemic stroke in the left lower brain was diagnosed, with a questionable hypodense area in the left brain stem and hypoplastic posterior circulation. Diagnosed with hypertension and ADHD since childhood. Allergic to penicillin, lithium, and antidepressants like Prozac. Current medications include lisinopril 10 mg once daily, carvedilol 12.5 mg twice daily, aspirin 81 mg once daily, Vyvanse 60 mg once daily, and atorvastatin 80 mg once daily.
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Arora's Assessment
What might be happening
Based on the symptoms and history you've provided, here are some possible explanations for your condition:
Migraines and Nausea
- Chronic Migraine: Given the frequency and severity of your headaches, along with nausea and sensitivity to light and noise, chronic migraines are a likely diagnosis. Migraines can be triggered by various factors, including stress, certain foods, and physical activities like riding fair rides.
- Medication Overuse Headache: Frequent use of pain relief medications can sometimes lead to medication overuse headaches, which can exacerbate migraine symptoms.
High Blood Pressure and Related Symptoms
- Hypertension: Your long-standing high blood pressure, despite medication, could be contributing to your migraines, blurred vision, and other symptoms. High blood pressure can lead to complications like vein occlusion, neovascularization, and AV nicking in the eyes.
- Stroke History: Your history of ischemic stroke and the presence of a hypodense area in your brain stem could be contributing to your current symptoms, including dizziness, loss of balance, and trouble swallowing.
Numbness and Cold Sensation in Fingers and Toes
- Peripheral Neuropathy: The numbness and cold sensation in your fingers and toes could be due to peripheral neuropathy, which can be a complication of hypertension, stroke, or other underlying conditions.
Blurred Vision and Eye Issues
- Retinal Issues: The blurred vision and small blood vessel leaks in your eyes could be related to your history of vein occlusion, neovascularization, and AV nicking, all of which are complications of high blood pressure.
What you can do
Migraines and Nausea
- Seek Medical Attention: Given the severity and frequency of your migraines, it's important to consult a healthcare provider for a thorough evaluation and appropriate treatment. They may recommend medications to prevent migraines or relieve symptoms.
- Lifestyle Modifications: Try to identify and avoid migraine triggers, such as certain foods, stress, and lack of sleep. Keeping a migraine diary using MDandMe can help track your symptoms and identify patterns.
- Home Remedies: Rest in a dark, quiet room, apply a cold compress to your forehead, and stay hydrated. Over-the-counter pain relievers like ibuprofen or acetaminophen may help, but avoid overuse.
High Blood Pressure and Related Symptoms
- Monitor Blood Pressure: Regularly monitor your blood pressure at home and keep a record of your readings. Share this information with your healthcare provider to adjust your treatment plan if necessary.
- Medication Adherence: Continue taking your prescribed medications as directed. If your blood pressure remains high, consult your healthcare provider to discuss potential adjustments to your medication regimen.
- Healthy Lifestyle: Maintain a healthy diet, exercise regularly, and avoid smoking and excessive alcohol consumption. These lifestyle changes can help manage your blood pressure.
Numbness and Cold Sensation in Fingers and Toes
- Warmth and Circulation: Keep your hands and feet warm, especially in cold weather. Gentle exercises and massages can help improve circulation.
- Consult a Specialist: Consider seeing a neurologist or vascular specialist to evaluate the cause of your symptoms and recommend appropriate treatment.
Blurred Vision and Eye Issues
- Regular Eye Exams: Schedule regular eye exams with an ophthalmologist to monitor and manage any eye-related complications.
- Control Blood Pressure: Managing your blood pressure effectively can help prevent further damage to your eyes.
Trouble Swallowing
- Swallowing Evaluation: Consult a speech therapist or a specialist in swallowing disorders for a thorough evaluation and recommendations on managing your symptoms.
- Dietary Adjustments: Modify your diet to include softer foods and thicker liquids that are easier to swallow. Avoid foods and drinks that trigger your swallowing difficulties.
What you should look out for
Given the complexity and severity of your symptoms, it's important to seek medical care as soon as possible. Reasons to seek care even more urgently include:
- Severe Headache: If your headache is the worst you've ever experienced or is accompanied by other concerning symptoms like confusion, weakness, or vision changes.
- Stroke Symptoms: Sudden numbness or weakness, especially on one side of the body, sudden confusion, trouble speaking, or understanding speech, sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, loss of balance, or coordination.
- Eye Symptoms: Sudden vision loss, severe eye pain, or significant changes in vision.
- Severe Hypertension: Blood pressure readings consistently above 180/120 mmHg, especially if accompanied by symptoms like chest pain, shortness of breath, or severe headache.
Remember, while I can provide information and suggestions, it's crucial to consult with real healthcare professionals for a formal diagnosis and treatment plan. You
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4 mo ago