Muscle Twitches, Numbness, and Headaches: A Neurology Perspective

Q: Muscle Twitches, Numbness, and Headaches: A Neurology Perspective

Hello： Your symptoms are not easily encompassed by a single disease. <br>However, it is worth considering that patients with anxiety often exhibit symptoms of hyperventilation. <br>Hyperventilation can lead to a decrease in carbon dioxide levels in the blood, resulting in an incr

Muscle twitching, peripheral numbness in the limbs, shoulder and neck pain, headache?

Hello Doctor: In November of this year, I began experiencing widespread muscle twitching and sudden pains throughout my body without a specific location (more frequently in my thighs, calves, and arms).
I have seen many neurologists who only suggested observation and taking medication, as well as eating more fruits (which I have been doing, including drinking sports drinks).
I have a history of migraines, but recently the headaches have become more frequent, sometimes starting from the back of my head and spreading into severe pain.
Even when I don't have a migraine on the right side, I experience intermittent pain on the left side.
Since late November, I have also been experiencing numbness, weakness in my limbs, and increased shoulder pain, especially in my hands.
The doctors have only recommended medication and observation, prescribing anti-anxiety medication and medication to slow my heart rate, advising me to take pain relievers for headaches.
I really want to have an electromyography (EMG) test, but the doctors have no plans to let me do that.
I feel very anxious and worried that I might have a rare disease like cerebellar atrophy or muscular atrophy because one doctor told me that my symptoms do not resemble those of a rare disease and suggested considering tests after further observation.
Later, I was referred to a rehabilitation specialist, who only did an X-ray that showed no issues, but the doctor was concerned about nerve compression and recommended rehabilitation.
However, my condition worsened with rehabilitation, and when I reported this to the doctor, they only changed the rehabilitation plan.
My extremities still feel numb, especially my hands.
Could you help alleviate my anxiety? Could this be related to the severe sinusitis I had about ten days prior, for which I took antibiotics for 15 days? After that severe sinusitis, I often had unexplained low-grade fevers, and I experienced intense skin twitching before going to sleep.
I'm very worried that I might have a serious illness!

Huang Xiao-jia, 20~29 year old female. Ask Date: 2017/11/30

Dr. Jiang Junyi reply Neurology

Hello: Your symptoms are not easily encompassed by a single disease.
However, it is worth considering that patients with anxiety often exhibit symptoms of hyperventilation.
Hyperventilation can lead to a decrease in carbon dioxide levels in the blood, resulting in an increase in pH, which triggers systemic reactions and symptoms.
Common manifestations include vasoconstriction and hypocalcemia.
The reduction in blood flow to the brain due to vasoconstriction can cause dizziness, numbness, and weakness; some patients may even experience agitation, hallucinations, seizures, or fainting.
Hypocalcemia can lead to muscle spasms and cramps in the hands and feet.
Additionally, excessively low carbon dioxide levels often make patients feel short of breath, and excessive breathing can result in chest pain.
Mouth breathing can cause dry mouth, and sometimes air may enter the gastrointestinal tract, leading to bloating and belching.
However, some internal medical conditions such as anemia, metabolic disorders, or cardiovascular issues can also cause hyperventilation symptoms.
It is advisable to consult a neurologist or cardiologist for further evaluation and treatment.
Wishing you good health, peace, and happiness.
Dr.
Tao, Neurology Department, cares about you.

Reply Date: 2017/11/30

More Info

Your symptoms of muscle twitching, numbness, and headaches are understandably concerning, and it's important to approach these issues with a comprehensive understanding of neurology. Based on your description, it seems you are experiencing a combination of neurological symptoms that could be related to various underlying conditions.

Muscle twitching, or fasciculations, can occur for a variety of reasons, including stress, fatigue, electrolyte imbalances, or even benign conditions like benign fasciculation syndrome. However, persistent or widespread twitching, especially when accompanied by other neurological symptoms, warrants further investigation. The fact that you have a history of migraines may also play a role in your current symptoms, as migraines can sometimes be associated with neurological disturbances.

The numbness and weakness in your extremities, particularly in your arms and legs, could suggest a neurological issue that might involve nerve compression or irritation. Conditions such as cervical radiculopathy, where nerve roots in the neck are compressed, can lead to symptoms of pain, numbness, and weakness radiating down the arms. Similarly, lumbar radiculopathy can affect the legs. Given that you have experienced increased pain and discomfort during rehabilitation, it is crucial to ensure that any physical therapy or exercises you are doing are appropriate for your condition and not exacerbating your symptoms.

Your concern about rare diseases, such as cerebellar atrophy or muscular dystrophy, is understandable, especially when experiencing such distressing symptoms. However, your doctor’s initial assessment that your symptoms do not align with those of rare diseases is a positive sign. It is essential to trust the clinical evaluation and consider that many neurological symptoms can stem from more common and treatable conditions.

Regarding your recent sinus infection and the antibiotics you took, it is possible that the infection and subsequent treatment could have contributed to your current symptoms. Infections can sometimes lead to post-viral syndromes, which may include fatigue, muscle pain, and neurological symptoms. The fact that you experienced skin twitching during your illness could suggest a heightened state of nervous system excitability, which might still be affecting you.

To alleviate your anxiety, it is important to maintain open communication with your healthcare providers. If you feel that your concerns are not being adequately addressed, consider seeking a second opinion or requesting specific tests, such as electromyography (EMG) or nerve conduction studies, which can help assess the function of your muscles and nerves. These tests can provide valuable information and help rule out conditions like peripheral neuropathy or myopathy.

In the meantime, focusing on lifestyle modifications such as stress management techniques, regular physical activity (as tolerated), and a balanced diet rich in vitamins and minerals can be beneficial. Additionally, if anxiety is a significant concern, discussing this with your doctor may lead to appropriate interventions, whether through therapy or medication.

In summary, while your symptoms are concerning, many potential causes are treatable or manageable. It is crucial to continue working with your healthcare team to monitor your condition and explore further diagnostic options if necessary. Remember that many neurological symptoms can improve with appropriate care and management.

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