[59F] Experiencing head pressure, feverish feeling, and gastrointestinal discomfort

Patient Description

A 59-year-old female presents with a 20-year history of constant head pressure rated 7/10 in intensity, localized around the eye, not alleviated by specific activities but somewhat relieved by yoga. She reports a 'feverish' feeling without elevated temperature persisting for two weeks, alongside vision changes post-cataract surgery and difficulty chewing. The patient has experienced panic attacks over the past year, with 8 episodes characterized by a rush, tachycardia, and near syncope, leading to a state of fearfulness. She has a medical history of Schogrens and ANA positivity diagnosed 20 years ago and an allergy to penicillin. For the past 6 months, she has had upper stomach bloating and burning, rated 3/10 in severity, after consuming gluten, sugar, and dairy, with associated severe abdominal pain rated 7/10. She also reports fatigue. No current medications are reported.

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Arora's Assessment

What might be happening

Based on the information you have provided, possible diagnoses include:

  • Migraine: This is a type of headache characterized by severe pain on one side of the head, often accompanied by other symptoms such as visual disturbances or nausea. The constant pressure in your head and eye area could be indicative of this condition.

    • Treatment typically involves pain management with over-the-counter or prescription medications, as well as lifestyle modifications to avoid known triggers.
  • Gastroesophageal Reflux Disease (GERD): This is a digestive disorder that occurs when acidic stomach juices, or food and fluids back up from the stomach into the esophagus. It can cause a burning sensation in the stomach and chest, and bloating.

    • Treatment typically involves lifestyle changes and over-the-counter medications. In severe cases, prescription medication or surgery may be required.
  • Irritable Bowel Syndrome (IBS): This is a common disorder that affects the large intestine and can cause bloating, abdominal pain, and changes in bowel habits.

    • Treatment typically involves dietary changes, lifestyle modifications, and managing stress.
  • Panic Disorder: This is an anxiety disorder characterized by recurring unexpected panic attacks. Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a feeling that something terrible is going to happen.

    • Treatment typically involves psychotherapy and medication.
  • Sjogren's Syndrome: This is an autoimmune disease characterized by dryness of the mouth and eyes, fatigue, and joint pain. As you have mentioned being diagnosed with Sjogren's Syndrome, it is possible that some of your symptoms could be related to this condition.

    • Treatment typically involves managing symptoms, which can vary from person to person.

Please note that these are potential explanations for your symptoms based on the information you have provided, but they are not definitive diagnoses. It is important to consult with a healthcare provider for an accurate diagnosis and treatment.

What you can do

  1. For your head pressure, try to identify any triggers such as certain foods, stress, or lack of sleep and avoid them. Over-the-counter pain relievers may also help.

  2. For your stomach symptoms, try dietary changes such as avoiding foods that trigger your symptoms, eating smaller meals, and avoiding lying down after eating. Over-the-counter antacids may also help.

  3. For your panic attacks, try relaxation techniques such as deep breathing, yoga, and meditation. If your panic attacks continue or worsen, consider seeking help from a mental health professional.

  4. For your Sjogren's Syndrome, follow your healthcare provider's treatment plan and manage your symptoms as best you can. This might include using artificial tears for dry eyes and drinking plenty of water to help with dry mouth.

What you should look out for

If you experience any of the following symptoms, seek medical attention immediately:

  • Severe headache or headache that is accompanied by fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness, or speaking difficulties
  • Chest pain, especially if it is accompanied by shortness of breath, jaw or arm pain, or nausea
  • Severe abdominal pain or abdominal pain that is accompanied by blood in your stool, vomiting, or fever
  • A panic attack that is worse than usual or different from what you typically experience

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 accurate information.

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10 mo ago

People Also Ask


What are common triggers for migraines and how can they be managed?

Common triggers for migraines include stress, certain foods (like chocolate, cheese, and alcohol), hormonal changes, and lack of sleep. Managing migraines often involves identifying and avoiding these triggers, using over-the-counter or prescription medications, and implementing lifestyle changes such as regular exercise and stress management techniques.


How can dietary changes help manage symptoms of GERD and IBS?

Dietary changes can significantly help manage GERD and IBS symptoms. For GERD, avoiding spicy, fatty, and acidic foods, eating smaller meals, and not lying down immediately after eating can reduce symptoms. For IBS, identifying and avoiding trigger foods, increasing fiber intake, and staying hydrated can help manage symptoms. Consulting with a dietitian can provide personalized guidance.


What are effective strategies for managing panic attacks?

Effective strategies for managing panic attacks include practicing deep breathing exercises, engaging in regular physical activity, and using relaxation techniques such as yoga and meditation. Cognitive-behavioral therapy (CBT) and medications prescribed by a healthcare provider can also be effective in reducing the frequency and severity of panic attacks.


How does Sjogren's Syndrome affect daily life and what are common treatments?

Sjogren's Syndrome can cause symptoms like dry eyes and mouth, fatigue, and joint pain, affecting daily activities. Common treatments include using artificial tears, staying hydrated, and medications to manage symptoms and prevent complications. Regular follow-ups with a healthcare provider are important to monitor the condition and adjust treatments as needed.


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