Dizziness and Head Pain in Elderly Patients: Causes and Solutions

Elderly individuals experiencing dizziness, headaches, and numbness in the head?

Hello Dr.
Tsai,
My mother is 80 years old.
Her medical history includes hypertension for which she takes Lercanidipine 50mg.
She does not have diabetes, her liver function tests are normal, and her glomerular filtration rate is 64.
She had an injury to her left ear in childhood, and her hearing has declined with age; however, she has undergone hearing tests showing thresholds of 64/60 dB HL in the left and right ears, respectively.
She has cervical and lumbar spondylosis and often experiences neck stiffness.

In recent years, she frequently complains of dizziness (not vertigo), a feeling of pressure in her head, headaches, and a sensation of noise in her head, along with neck stiffness.
Recently, she has noticed numbness on the left side of her scalp, and when she presses a specific point at the back of her head, her legs also feel numb.
During these episodes of dizziness, she does not experience any cardiac discomfort.

My mother enjoys going to Yangmingshan with friends, but she has noticed that she often feels dizzy when coming down the mountain.
The doctor prescribed anti-vertigo medication (for Meniere's disease), but it did not help.
She also took medication for peripheral circulation, one tablet in the morning and one in the evening, but it caused headaches, so she reduced it to one tablet.
However, her symptoms keep recurring several times a week, and recently she has also experienced unilateral scalp numbness, which raises our concerns about the underlying cause.

Could you please advise what might be causing these symptoms? What tests should be conducted? Is there a way to improve her condition? Which department should we consult? Thank you for taking the time to respond from a worried daughter.

Worried Daughter, 40~49 year old female. Ask Date: 2019/08/05

Dr. Cai Dongqi reply Family Medicine

Hello, first, check if the blood pressure is stable.
A reading of 140-100/90-60 is considered normal.
Be aware that blood pressure medications may have side effects such as dizziness (it is advisable to consult the prescribing physician).
Secondly, consider the possibility of cerebrovascular issues (neurology), such as a mild stroke or cervical artery stenosis.
It is recommended to visit a neurologist for evaluation.

Reply Date: 2019/08/05

More Info

Understanding dizziness and head pain in elderly patients can be quite complex, especially when multiple symptoms are present. In the case of your mother, who is 80 years old and has a history of hypertension, neck stiffness, and previous ear trauma, there are several potential causes for her symptoms of dizziness, head pain, and numbness.

Possible Causes
1. Cervical Spondylosis: Given her history of neck stiffness and the presence of bone spurs (osteophytes), cervical spondylosis could be a significant factor. This condition can lead to nerve compression, resulting in symptoms such as neck pain, headaches, and even numbness in the extremities.

2. Hypertension: High blood pressure can contribute to headaches and dizziness. If her blood pressure is not well-controlled, it could lead to vascular headaches or even transient ischemic attacks (TIAs), which may present as dizziness and unilateral symptoms.

3. Vestibular Disorders: The mention of dizziness, especially when descending from a hill, could indicate a vestibular issue. Conditions like benign paroxysmal positional vertigo (BPPV) or Meniere's disease could be considered, although you mentioned that medications for Meniere's did not help.

4. Neurological Issues: The unilateral numbness and the specific point of tenderness at the back of the head could suggest a neurological issue, such as a pinched nerve or even more serious conditions like a transient ischemic attack or stroke. Given her age, it is crucial to rule out these possibilities.

5. Medication Side Effects: The medications she is taking for hypertension and peripheral circulation could also contribute to her symptoms. Side effects from these medications can include dizziness and headaches.

Recommended Actions
1. Neurological Evaluation: Given the complexity of her symptoms, it would be prudent to consult a neurologist. They can perform a thorough examination and may recommend imaging studies, such as an MRI or CT scan, to rule out any serious conditions like strokes or tumors.

2. Cervical Spine Imaging: An X-ray or MRI of the cervical spine may help assess the extent of cervical spondylosis and any potential nerve compression.

3. Blood Pressure Monitoring: Regular monitoring of her blood pressure is essential. If it is fluctuating or poorly controlled, adjustments to her medication may be necessary.

4. Vestibular Testing: If dizziness persists, a referral to an ear, nose, and throat (ENT) specialist or a vestibular therapist may be beneficial to evaluate her balance and inner ear function.

5. Physical Therapy: If cervical spondylosis is confirmed, physical therapy may help alleviate neck stiffness and improve mobility, which could, in turn, reduce headaches and dizziness.

Conclusion
In summary, your mother's symptoms warrant a comprehensive evaluation to determine the underlying causes. It is essential to approach this systematically, starting with a visit to a neurologist who can guide further testing and treatment options. Managing her hypertension effectively and addressing any cervical spine issues will be crucial in improving her quality of life and reducing her symptoms. Regular follow-ups and open communication with her healthcare providers will be key in navigating her health concerns.

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