A 42 yr old female came with complaints of headache since 5-6 years. Retro orbital pain +
Patient was apparently asymptomatic 6 yrs back and then developed headache and retro orbital pain. Pain was present continuously through out the day and aggravates in the evening and subsides after taking medication (pain killers).
She was asymptomatic 6 years back.
8 years back her mother died of cancer
7 years back her father died of drowning in water
6 years back her differently abled brother died of cancer.
She is worried about getting the cancer herself as people tell her that she might get cancer as both her mother and younger brother had died of cancer.
She is traumatized with the thought she might also die since six years due to cancer.
She has two sons aged 25 and 23. Elder son is working in construction industry as labourer in kerala. Younger son is in village completed his BA degree. She says they are having financial challenges and she is worried about her sons too. She is worried that some health issue may affect them too.
Psychological Course of treatment:
Placebo pain medication
Cognitive behaviour therapy
Not a k/c/o DM, HTN, TB, Asthma
No H/o major surgeries in the past
Tubectomised 23 yrs back
ENT opinion -
Headache - insidious, progressive, band type, aggravated in the night, relieved partially on medication associated with photophobia, phonophobia. Nausea +
No H/o trauma to head. No H/o facial heaviness, post nasal drip & smell abnormalities.
No H/o Nasal obstruction, Nasal discharge, paroxysmal sneezing, itching in the nose.
O/E: Grade I tonsillar Hypertrophy +.
Mild tenderness present on B/L ethmoid &frontal sinuses. - No symptoms suggestive of chronic Rhinosinusitis
Ophthal opinion -
Right Eye Left Eye
V/A: 6/12 . NI 6/6
Normal fundus study
Advised regular spectacle use for near vision
Eye drops LUBREX 4times/day in both eyes
Provisional diagnosis :
? Somatoform disorder with depression
Treatment -
TAB DOLO 650 mg SOS
TAB NAPROXEN 250 mg SOS
TAB PAN 40mg PO OD
TAB MVT PO OD
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