Severe Headaches and Fainting: Possible Neurological Issues

Severe headache followed by fainting?

Hello doctor, my husband is 30 years old.
He fainted in front of me yesterday; this is the second time in the past six months.
Before fainting, he was conscious and mentioned that he experienced a headache that started as a mild pain in his forehead, which suddenly escalated to severe pain radiating to the back of his head, accompanied by nausea.
After that, he lost consciousness.
The first incident occurred earlier this year, where he experienced a sudden severe headache and nausea, fainted for a few seconds, and then began to have convulsions without foaming at the mouth.
He was unconscious for nearly two minutes.
The second incident happened yesterday and was similar to the first (as mentioned by my husband), but I am unsure if he had convulsions this time because I was not present when he fainted; I only heard a loud noise and found him unconscious.
He often experiences headaches that start in the forehead and radiate to the back of the head, but the pain is bearable, so he does not take medication and usually just sleeps it off.
My husband was in a car accident in December 2008, where he likely hit his head, but it was not severe.
He did not experience any seizures, fainting, or facial paralysis issues until 2019.
His grandfather and uncle have had strokes, and his grandmother passed away from a myocardial infarction.
I am wondering if his condition could be acquired epilepsy or some other type of disorder.
I kindly ask for your guidance.
Thank you.

Mai Mai, 30~39 year old female. Ask Date: 2019/09/17

Dr. Jiang Junyi reply Neurology

Hello, based on your description, it is advisable for your husband to seek medical attention promptly after experiencing headaches followed by fainting.
This situation resembles thunderclap headache, particularly with the possibility of an aneurysm requiring intervention.
Common causes of fainting include: 1.
Neurogenic reflex causing decreased peripheral vascular tone, leading to blood pooling in peripheral tissues and insufficient cerebral blood flow.
2.
Hypotension due to postural changes, such as when standing up suddenly or getting out of bed.
Conditions like autonomic dysregulation and cardiovascular medications may contribute to this.
3.
Narrowing, obstruction, or insufficient blood flow in local cerebral vessels.
4.
Blood-related issues such as hypotension or hypoglycemia.
5.
Seizures can sometimes cause sudden falls that resemble fainting, potentially accompanied by limb jerking and prolonged confusion.
It is recommended to consult a neurologist or cardiologist for further evaluation and treatment.
Wishing you good health and peace.
Dr.
Jiang, Department of Neurology, Taoyuan Medical Center.

Reply Date: 2019/09/17

More Info

Based on the symptoms you've described regarding your husband's episodes of fainting and severe headaches, it is crucial to approach this situation with a thorough understanding of potential neurological issues. The combination of severe headaches, loss of consciousness, and the history of head trauma raises several concerns that warrant immediate medical attention.

Firstly, the pattern of your husband's headaches, which escalate from a manageable pain in the forehead to a sudden, severe headache that radiates to the back of the head, is particularly concerning. This could indicate a range of neurological conditions, including but not limited to migraines, tension-type headaches, or more serious issues such as intracranial hypertension or vascular problems. The fact that he experiences nausea alongside these headaches suggests that they may be more than just tension headaches.

The episodes of fainting (syncope) are alarming, especially since they have occurred twice in a relatively short period. Fainting can be caused by various factors, including vasovagal syncope, which is often triggered by stress, pain, or standing for long periods. However, given the severity of the headaches and the loss of consciousness, it is essential to rule out more serious conditions such as seizures or transient ischemic attacks (TIAs), which can present with similar symptoms.

The history of head trauma from the car accident in 2008 is also significant. Even if he did not experience immediate severe symptoms following the accident, it is possible that there could be long-term effects, such as post-concussion syndrome or structural changes in the brain that could lead to the symptoms he is currently experiencing. The fact that there is a family history of cerebrovascular diseases (strokes) adds another layer of concern, as it may indicate a genetic predisposition to vascular issues.

Given these factors, I strongly recommend that your husband undergo a comprehensive neurological evaluation. This should include:
1. Neurological Examination: A thorough assessment by a neurologist to evaluate his symptoms, medical history, and family history.

2. Imaging Studies: An MRI or CT scan of the brain to check for any structural abnormalities, signs of previous trauma, or other neurological conditions.

3. Electroencephalogram (EEG): This test can help determine if there are any abnormal electrical activities in the brain that could indicate seizures.

4. Blood Tests: To check for any underlying metabolic or hematological issues that could contribute to his symptoms.

5. Monitoring: If possible, a referral to a sleep specialist or a neurologist who specializes in headache disorders may be beneficial, especially if he experiences episodes of sleep disturbances or if the headaches are significantly impacting his quality of life.

In conclusion, your husband's symptoms are concerning and should not be taken lightly. It is essential to seek immediate medical attention to rule out any serious underlying conditions. Early diagnosis and intervention can significantly improve outcomes and quality of life. Please ensure that he sees a healthcare professional as soon as possible to address these issues comprehensively.

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