[60F] Experiencing severe fatigue, headaches, and widespread pain

Patient Description

A 60-year-old female presents with a long-standing history of severe fatigue, daily headaches with a severity of 7 out of 10, and generalized muscle and joint pain rated 8 out of 10. The patient experiences constant dull, gnawing pain in the back, shoulders, and head, with the shoulder pain radiating down the right arm and causing numbness in the hand. Visual disturbances include double vision and blurriness, and there is a history of retinal hemorrhage in the right eye. The patient also suffers from chronic nausea, managed with Zofran, and numbness in the fingertips, cheeks, and toes. Medical history includes Crohn’s Disease, hypothyroidism, psoriatic arthritis, and asthma, with a noted allergy to sulfa drugs. Current medications include Singulair, Tirosint, Diclofenac PRN, Loratidine, a vitamin supplement, Ropinrole, methotrexate, Enbrel, Albuterol rescue inhaler, Baclofen, and Fioricet.

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Arora's Assessment

What might be happening

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

  • Fibromyalgia: This is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. It amplifies painful sensations by affecting the way your brain processes pain signals. Your symptoms of generalized muscle and joint pain, severe fatigue, and headaches could be indicative of this condition.

    • Treatment usually involves a combination of medications, exercise, stress management measures, and healthy lifestyle habits.
  • Chronic Fatigue Syndrome (CFS): This is a complicated disorder characterized by extreme fatigue that can't be explained by any underlying medical condition. The fatigue worsens with physical or mental activity, but doesn't improve with rest. This could explain your severe fatigue and headaches.

    • Treatment typically focuses on symptom relief.
  • Migraines: These are a type of headache characterized by severe throbbing pain or a pulsing sensation, usually on one side of the head. It's often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Your symptoms of frequent headaches and migraines, along with visual disturbances and nausea, could be indicative of this condition.

    • Treatment is aimed at preventing a full-blown attack, and alleviating the symptoms if you do get a migraine.
  • Psoriatic Arthritis: This is a form of arthritis that affects some people who have psoriasis — a condition that features red patches of skin topped with silvery scales. Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but the joint problems can sometimes begin before skin patches appear. This could explain your generalized muscle and joint pain.

    • Treatment involves managing symptoms and preventing further joint damage.
  • Hypothyroidism: This is a condition in which your thyroid gland doesn't produce enough of certain crucial hormones. Hypothyroidism may not cause noticeable symptoms in the early stages, but over time, untreated hypothyroidism can cause a number of health problems, such as obesity, joint pain, infertility and heart disease. This could explain your generalized muscle and joint pain and severe fatigue.

    • Treatment involves daily use of the synthetic thyroid hormone levothyroxine.

What you can do

You should definitely consult a doctor about your symptoms so that they can provide a formal assessment and order relevant tests if necessary. In the meantime, here are some things you can do to manage your symptoms:

  1. Try to maintain a regular sleep schedule. This can help manage your fatigue and headaches.
  2. Stay hydrated and eat a balanced diet. This can also help manage your fatigue.
  3. Try gentle exercises like walking or swimming, which can help with joint and muscle pain.
  4. Practice stress management techniques like meditation or deep breathing, which can help with pain and fatigue.

What you should look out for

Reasons to see a doctor more urgently:

  • If your pain becomes severe or unbearable
  • If your fatigue becomes so severe that it interferes with your daily activities
  • If your headaches become more frequent or severe
  • If you notice any new or worsening symptoms

Remember, while I strive to provide accurate and helpful information, I'm not a doctor and this advice should not replace a consultation with a healthcare professional.

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1 yr ago

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People Also Ask


What are the common symptoms of fibromyalgia?

Common symptoms of fibromyalgia include widespread musculoskeletal pain, severe fatigue, sleep disturbances, cognitive difficulties (often referred to as 'fibro fog'), and headaches. Some patients also experience irritable bowel syndrome, anxiety, and depression.


How is chronic fatigue syndrome diagnosed?

Chronic fatigue syndrome is diagnosed primarily based on the patient's symptoms and by ruling out other possible conditions. There is no specific test for CFS, so doctors often rely on a detailed medical history, physical examination, and sometimes laboratory tests to exclude other causes of fatigue.


What are the treatment options for migraines?

Treatment options for migraines include medications to relieve symptoms during an attack, such as triptans and NSAIDs, and preventive medications like beta-blockers, antidepressants, or anticonvulsants. Lifestyle changes, such as stress management, regular sleep, and dietary adjustments, can also help manage migraines.


Can psoriatic arthritis cause numbness in the extremities?

Psoriatic arthritis can cause numbness if it leads to nerve compression or damage, particularly if there is significant joint inflammation or swelling. However, numbness is not a typical symptom of psoriatic arthritis and may require further investigation to determine the underlying cause.


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