Patient: I’m a 15 year old female. I have been some what tired, lately. And getting headaches. I have gotten three nose bleeds in the past six months and I haven’t had one since I was little. I get really winded when I walk up the stairs and I’m not out of shape I’m a competitive swimmer and train constantly. I got tested for Juvenile Rheumatoid arthritis, and it came back saying I had a little bit of it. Any ideas on what could be wrong with me?
Doctor: Welcome to Ask The Doctor.We are here to help you.Such headaches with fatigue, exhaustion are mostly due to eithe r Migraine or Tension Headache. You back pain might be just an associated but unrelated symptom.The Migraine headaches are usually unilateral, associated with throbbing, vomiting sensations, photophobia and phonophobia while Tension Headaches usually present with heaviness in head, band-like sensation over the head with sleeping difficulties. Drugs like Flunarizine, Propanolol, Amitriptyline are used in treatment of Migraine.Tension Headaches are treated with Amitriptyline, Escitalopram with behavioral modification treatment.If on examination your doctor feels that the headache requires evaluation, he will get you a MRI done.For back pain, you should do hot fomentation of the affected area and apply diclofenac ointment locally.I hope it helps.Stay Healthy.