Differential Diagnosis
The patient's presentation of neck pain, frequent need to move her neck to make it pop and crack, development of headaches, low blood pressure, history of fainting, dizziness, orthostatic hypotension, daily headaches with light sensitivity, anemia, balance difficulties, and tinnitus ("hearing the ocean") suggests a complex interplay of symptoms that could be attributed to various conditions. Here's a categorized differential diagnosis:
Single Most Likely Diagnosis
- Cervicogenic Headaches with Possible Autonomic Dysfunction: The patient's need to frequently move her neck to alleviate tension, which if not done leads to headaches, strongly suggests cervicogenic headaches. The presence of orthostatic hypotension, dizziness, and a history of fainting could indicate some level of autonomic dysfunction, possibly related to the cervical spine issues affecting autonomic nerves.
Other Likely Diagnoses
- Anxiety or Stress-Related Tension Headaches: The daily occurrence of headaches and the patient's overall symptom profile could be exacerbated by or related to anxiety or stress, contributing to tension headaches.
- Orthostatic Intolerance: Given the patient's history of orthostatic hypotension, dizziness, and a single episode of fainting, orthostatic intolerance could be a contributing factor, potentially exacerbated by dehydration, anemia, or autonomic nervous system dysfunction.
- Meniere's Disease: The symptom of hearing "the ocean" in her ears (tinnitus) could suggest Meniere's disease, especially if accompanied by vertigo and hearing loss, although the latter two are not explicitly mentioned.
Do Not Miss Diagnoses
- Subclavian Steal Syndrome: Although less common, this condition, characterized by the reversal of blood flow in the vertebral artery due to stenosis or occlusion of the subclavian artery, could explain the fainting, dizziness, and possibly the neck pain, especially if there's a significant difference in blood pressure between the two arms.
- Multiple System Atrophy (MSA): This rare neurodegenerative disorder can present with autonomic dysfunction (leading to orthostatic hypotension), balance difficulties, and other neurological symptoms. It's crucial to consider, despite its low likelihood, due to its severe prognosis.
- Chiari Malformation: This condition, where the cerebellum extends into the spinal canal, can cause headaches, dizziness, tinnitus, and other neurological symptoms, especially with certain head or neck movements.
Rare Diagnoses
- Ehlers-Danlos Syndrome (EDS): This group of disorders affects connective tissues supporting the skin, bones, blood vessels, and many other organs and tissues. Some types of EDS can lead to joint hypermobility, orthostatic intolerance, and possibly the patient's other symptoms, including easy bruising and poor wound healing, if present.
- POTS (Postural Orthostatic Tachycardia Syndrome): Characterized by a rapid increase in heart rate upon standing, POTS can also present with orthostatic intolerance symptoms like dizziness and fainting but typically includes tachycardia, which is not mentioned in the patient's profile.