Chronic Head Pressure and Dizziness: Causes and Solutions

Q: Chronic Head Pressure and Dizziness: Causes and Solutions

Hello： The most important thing for your condition is to cultivate the parasympathetic nervous system. <br><br>1. <br>Do I need to have another brain MRI? Under what circumstances should dizziness warrant an MRI? <br>A： Generally, if there are no new neurological symptoms, repeat

Heavy head, pressure in the head, dizziness, and stiffness and soreness in the shoulders and neck?

Hello Dr.
Jiang, my questions are as follows, please help me answer them:
● Medical History
1.
For the past five years, I have almost daily experiences of head heaviness, dizziness, and a feeling of pressure in my head.
In the past year, I have also developed stiffness and soreness in my shoulders and neck.
2.
In 2014, due to head heaviness, dizziness, and a sensation similar to being constricted (like the "tightening spell" on Sun Wukong), a neurologist arranged for a brain MRI, which showed no abnormalities.
The neurologist suggested that I might be experiencing tension-type headaches.
3.
I underwent cervical spine MRIs in 2014 and 2017, which revealed slight degeneration at the C5 and C6 vertebrae.
I have tried neck traction and high-concentration glucose treatments, which I found to be somewhat effective.
4.
I have had inner ear examinations that indicated an imbalance between my left and right inner ears.
I also experience dizziness when on boats or tour buses.
5.
I have experienced severe vertigo in 2010, 2012, and again in April of this year.
6.
An ENT specialist mentioned that my dizziness could be related to structural issues, stress, or sleep problems.
7.
Regarding my sleep issues, for the past year, I have been dreaming every time I sleep, so from August 2017 to March 2018, I took Rivotril daily.
8.
For shoulder and neck soreness, I take muscle relaxants, and for dizziness, I take Meclizine and Ondansetron.
9.
Sometimes when I feel anxious, I take Xanax.
10.
I am gradually tapering off Rivotril due to concerns about withdrawal, and I am also using traditional Chinese medicine.
11.
I only experience dizziness and head heaviness; I do not have tinnitus, confusion, blurred vision, or severe headaches.
● Questions
1.
Do I need to undergo another brain MRI? Under what circumstances should dizziness and head heaviness warrant an MRI?
2.
Are there any other tests I should consider?
3.
Can exercise improve my head heaviness and dizziness?
4.
Do I need to take medication to improve blood circulation?
5.
Why do I feel heavy-headed and dizzy upon waking? How should I address this?
6.
Could the head heaviness, dizziness, and shoulder/neck soreness be caused by stopping Rivotril? What should I do? I do not want to take Rivotril anymore.
7.
I have undergone a sleep study, and there were no significant issues.
8.
The ENT specialist recommended that I take Inderal (Propranolol), stating it could prevent dizziness and head heaviness.
Is this true? However, I took it from April 17 to April 19, and I still felt dizzy and heavy-headed.
9.
How long should I take Inderal? What is the proper dosage? When should I stop? Is it something I need to take for life?
10.
The ENT specialist mentioned that my dizziness may improve with age.
Why is that?
11.
I rarely consume coffee, chocolate, tomatoes, citrus fruits, milk, or cheese, yet I still feel dizzy.
12.
I understand that I experienced dizziness and tension due to high stress while working in a hospital, but I have been out of the workforce for nearly a year and still feel this way.
I believe my current stress levels are much lower than before, yet I still easily experience head heaviness and dizziness.
13.
Doctor, what should I do (medication or other methods) to restore my health?

Nìngmíng, 30~39 year old female. Ask Date: 2018/04/19

Dr. Jiang Junyi reply Neurology

Hello: The most important thing for your condition is to cultivate the parasympathetic nervous system.

1.
Do I need to have another brain MRI? Under what circumstances should dizziness warrant an MRI?
A: Generally, if there are no new neurological symptoms, repeating an MRI is just a waste of money and will not yield significant changes.
2.
Are there any other tests I need to undergo?
A: I am not sure if you have undergone multiple physiological tests (sleep studies) and autonomic nervous system assessments?
3.
Can exercise improve my dizziness and heaviness in the head?
A: Cultivating the parasympathetic nervous system, along with stretching exercises and muscle endurance training, can help relax the neck muscles and improve sleep quality.
4.
Do I need to take medication to improve blood circulation?
A: You can improve circulation by increasing your fluid intake and exercising.
5.
Why do I feel heavy-headed and dizzy after waking up? How should I address this?
A: You may consider scheduling a sleep study to rule out sleep disorders such as sleep apnea.
6.
Is my dizziness and heaviness in the head, along with neck and shoulder pain, caused by stopping Rifampin? What should I do? I don’t want to take Rifampin anymore.

A: The use or discontinuation of medication should be discussed with your treating physician.
7.
I have undergone a sleep study and there were no significant issues...

A: I am not sure what your AHI (Apnea-Hypopnea Index) is.
Do you have any signs of sleep apnea? I am also unsure about your sleep hygiene.
You may consider improving your sleep hygiene.
8.
The ENT doctor said I should take Inderal; he said it can prevent dizziness and heaviness in the head.
Is that true? But I took it from April 17 to April 19, and I still feel dizzy and heavy-headed.

A: Inderal can reduce sympathetic nervous system activity and is primarily used for preventing migraines and anxiety.
9.
How long should I take Inderal? How should I take it? When should I stop? Should I take it for life?
A: It is advisable to discuss this with a neurologist and check thyroid function and autonomic nervous system function.
10.
The ENT doctor said my dizziness will gradually improve with age.
Why is that?
A: It is recommended to discuss this with a neurologist and check thyroid function and autonomic nervous system function.
11.
I rarely consume coffee, chocolate, tomatoes, citrus fruits, milk, cheese, etc., but I still feel dizzy.

A: The aforementioned foods are common triggers for migraines; if your headaches are not migraines, the effect should be minimal.
12.
I used to work in a high-stress hospital environment and experienced dizziness and anxiety, which I can understand, but I have been out of the workforce for almost a year and still feel this way.
I believe my stress is much lower now, yet I still easily feel dizzy and heavy-headed.

A: It is advisable to discuss this with a neurologist.
13.
Doctor, what should I do (medication or other methods) to restore my health?
A: To maintain good vitality, you should learn to take care of your body like Ma Ying-jeou, focusing on muscle endurance, muscle mass, and flexibility.
Adequate nutrition and sleep are essential.
I recommend discussing examinations and treatments with a neurologist.
Wishing you good health, peace, and happiness.
Dr.
Tao, Neurology, cares for you.

Reply Date: 2018/04/19

More Info

Chronic head pressure and dizziness can be quite debilitating and frustrating, especially when they persist over several years. Based on your detailed medical history and symptoms, it seems like you are experiencing a combination of tension-type headaches, cervical spine issues, and possibly vestibular dysfunction. Let’s address your questions and provide some insights into potential management strategies.

1. Do you need another MRI of the brain?
Given that you had a normal MRI in 2014 and your symptoms have been consistent, a repeat MRI may not be necessary unless there are new symptoms such as severe headaches, neurological deficits, or changes in your condition. MRI is typically warranted if there are concerns about structural abnormalities, such as tumors or significant changes in brain tissue.

2. What other tests should you consider?
Since you have a history of cervical spine degeneration and inner ear imbalance, it might be beneficial to have a comprehensive evaluation by a neurologist or an ear, nose, and throat (ENT) specialist. Vestibular testing (like a VNG or ENG) could help assess your balance system. Additionally, a cervical spine MRI might provide more insight into your neck issues, especially if you are experiencing pain and stiffness.

3. Can exercise improve your symptoms?
Regular physical activity can significantly improve overall health and may help alleviate symptoms of tension-type headaches and neck stiffness. Gentle exercises, particularly those that focus on neck and shoulder mobility, can be beneficial. Activities like yoga or Pilates may also help reduce tension and improve posture, which can alleviate some of your symptoms.

4. Should you take medications to improve blood circulation?
While medications that improve circulation can be helpful for certain conditions, they may not be necessary for your situation. It’s essential to discuss this with your healthcare provider, as they can assess your specific needs and determine if such medications are appropriate for you.

5. Why do you feel heavy-headed and dizzy upon waking?
Waking up with a heavy head and dizziness can be related to several factors, including sleep quality, sleep apnea, or even dehydration. If you are experiencing poor sleep quality or frequent dreams, it might be worth exploring sleep hygiene practices or consulting a sleep specialist.

6. Are your symptoms related to stopping Ritalin?
Withdrawal from medications like Ritalin can lead to various symptoms, including fatigue and mood changes. If you suspect that your symptoms are related to stopping this medication, it’s crucial to discuss this with your doctor. They may suggest a gradual tapering plan or alternative treatments.

7. What about the medication Inderal (Propranolol)?
Inderal is often prescribed for migraine prevention and can help with anxiety-related symptoms. If your ENT specialist recommended it, it may be worth trying under their supervision. The duration of treatment can vary; some patients may need to take it long-term, while others may only need it for a specific period.

8. Why might your dizziness improve with age?
As people age, their bodies often adapt to various stressors, and some vestibular issues may resolve or become less pronounced. However, this is not guaranteed, and ongoing management may still be necessary.

9. What can you do to manage your symptoms?
- Lifestyle Modifications: Focus on maintaining a healthy lifestyle, including regular exercise, a balanced diet, and adequate hydration.

- Stress Management: Techniques such as mindfulness, meditation, or cognitive-behavioral therapy can help manage stress and anxiety.

- Physical Therapy: A physical therapist can provide exercises tailored to improve neck strength and flexibility, which may alleviate some of your symptoms.

- Regular Follow-ups: Keep in touch with your healthcare providers to monitor your symptoms and adjust treatment as necessary.

Conclusion
Chronic head pressure and dizziness can stem from various underlying issues, including tension headaches, cervical spine problems, and vestibular dysfunction. A multidisciplinary approach involving neurologists, ENT specialists, and physical therapists may provide the best outcomes. It’s essential to communicate openly with your healthcare providers about your symptoms and concerns to develop a comprehensive management plan tailored to your needs.

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