[52F] Experiencing severe headaches and recurring nosebleeds

Patient Description

A 52-year-old female presents with severe headaches described as migraine-like, with intense pressure located behind the right eye and top of the head, worsening upon touch. Accompanying symptoms include moderate dry cough with chest congestion and increased fatigue. The headaches and associated symptoms started after a period of being unwell with congestion. The patient has experienced four to five episodes of nosebleeds in the last two days, often triggered by coughing. She has a history of trauma to the left eye resulting in blindness, with long-standing vision changes and neck stiffness, but no recent changes in these symptoms. The patient is not currently on any medications except for daily omeprazole for severe heartburn. There is no history of allergies or adverse reactions to medications, and no other significant past medical history was reported.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible explanations for your symptoms include:

  • Sinusitis: This is an inflammation or swelling of the tissue lining the sinuses. When they become blocked and filled with fluid, germs can grow and cause an infection. Symptoms can include a headache, particularly around the forehead, behind the eyes, and cheekbones, as well as a cough and fatigue. Nosebleeds can also occur if the nasal passages become dry and irritated.

    • Treatment typically involves the use of over-the-counter remedies to relieve symptoms, such as nasal sprays or decongestants. If the sinusitis is caused by a bacterial infection, antibiotics may be prescribed by a doctor.
  • Migraines: These are severe headaches that can cause throbbing pain, usually on one side of the head. They can last for hours to days, and can be accompanied by sensitivity to light and sound, as well as nausea and vomiting. In some people, migraines can be triggered by certain activities or situations, such as stress or changes in sleep patterns.

    • Treatment typically involves medications to relieve symptoms and prevent future migraines. Lifestyle changes, such as regular sleep, exercise, and a healthy diet, can also help manage migraines.
  • High blood pressure (hypertension): This condition can cause headaches and nosebleeds, particularly if the blood pressure is very high. However, most people with high blood pressure do not have any symptoms, so it's important to have your blood pressure checked regularly.

    • Treatment typically involves lifestyle changes, such as eating a healthy diet, getting regular exercise, limiting alcohol, and avoiding tobacco. In some cases, medication may be needed.

Please note that these are only possible explanations for your symptoms. It's important to consult a healthcare professional for an accurate diagnosis and treatment.

What you can do

Here are some steps you can take to manage your symptoms:

  1. Rest and hydrate: Make sure you're getting enough sleep and drinking plenty of fluids. This can help your body recover and can also help manage your symptoms.

  2. Over-the-counter remedies: You can try using over-the-counter pain relievers for your headaches, such as acetaminophen or ibuprofen. For your nosebleeds, you can try using a saline nasal spray to keep your nasal passages moist.

  3. Monitor your symptoms: Keep track of when your symptoms occur, how long they last, and any triggers that seem to make them worse. This can be helpful information to share with your healthcare provider.

What you should look out for

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

  • A severe headache that comes on suddenly
  • A headache accompanied by a fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness, or speaking difficulties
  • A headache after a head injury, especially if the headache gets worse
  • A chronic headache that is worse in the morning
  • Frequent or worsening nosebleeds
  • Chest pain or shortness of breath

Remember, it's important to consult a healthcare professional for an accurate diagnosis and treatment.

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1 yr ago

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People Also Ask


What are the common symptoms of sinusitis and how is it treated?

Common symptoms of sinusitis include headaches, particularly around the forehead, behind the eyes, and cheekbones, as well as a cough, fatigue, and sometimes nosebleeds. Treatment typically involves over-the-counter remedies like nasal sprays or decongestants, and antibiotics if a bacterial infection is present.


How can migraines be managed and what are common triggers?

Migraines can be managed with medications to relieve symptoms and prevent future episodes. Common triggers include stress, changes in sleep patterns, and certain foods. Lifestyle changes such as regular sleep, exercise, and a healthy diet can also help.


Can high blood pressure cause headaches and nosebleeds?

Yes, high blood pressure can cause headaches and nosebleeds, especially if the blood pressure is very high. However, most people with high blood pressure do not have symptoms, so regular monitoring is important.


What should I do if I experience frequent nosebleeds?

If you experience frequent nosebleeds, try using a saline nasal spray to keep your nasal passages moist. If the nosebleeds persist or worsen, it's important to consult a healthcare professional for further evaluation and treatment.


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