Differential Diagnosis

The patient presents with a complex array of symptoms including headaches, migraines, visual disturbances, high blood pressure, gastrointestinal issues, and a history of kidney stones. Organizing these symptoms into a differential diagnosis requires considering various potential causes. Here is a categorized list of potential diagnoses:

• Single Most Likely Diagnosis
  • Migraines with Aura: The patient's description of headaches starting in the occipital region and moving to the frontal area, accompanied by nausea, and relieved by quiet, darkness, and ice application, is classic for migraines. The visual disturbances described as zigzag lines and bars are indicative of an aura, which often precedes a migraine headache.
• Other Likely Diagnoses
  • Irritable Bowel Syndrome (IBS): The patient's symptoms of bloating, sensation of food getting stuck, and discomfort after eating wheat are consistent with IBS, especially given the lack of relief from proton pump inhibitors.
  • Gluten Sensitivity: Similar to IBS, the patient's symptoms after consuming wheat suggest a possible gluten sensitivity, which could be contributing to her gastrointestinal issues.
  • Hypertension: The recent onset of high blood pressure, monitored at home, could be contributing to her headaches, especially if there are fluctuations in blood pressure.
• Do Not Miss Diagnoses
  • Temporal Arteritis: Although less common, temporal arteritis (giant cell arteritis) can cause headaches, visual disturbances, and is associated with an elevated risk of blindness if not promptly treated. The patient's age and symptoms of visual changes warrant consideration of this diagnosis.
  • Kidney Disease: Given the patient's history of kidney stones and an atrophic left kidney, chronic kidney disease or other renal pathologies could be contributing to her symptoms, including hypertension and possibly some of the gastrointestinal issues.
  • Cervicogenic Headaches: The patient's description of headaches worsening with movement could suggest a cervicogenic component, where the headache is referred from the cervical spine.
• Rare Diagnoses
  • Mitochondrial Disorders: Some mitochondrial disorders can present with a combination of migraine headaches, gastrointestinal issues, and other systemic symptoms. However, these are rare and would typically require more specific diagnostic testing.
  • Ehlers-Danlos Syndrome: This genetic disorder can cause a variety of symptoms including gastrointestinal issues, joint hypermobility, and potentially contribute to migraine headaches and other pain syndromes. The patient's history of a hiatal hernia and possibly other gastrointestinal issues might suggest this, although it is less common.

Each of these potential diagnoses should be considered in the context of the patient's full medical history, physical examination, and potentially further diagnostic testing to determine the most likely cause(s) of her symptoms.