Managing Headaches and Dizziness: Insights from Neurology

Headache + Dizziness

Hello Doctor: I have been experiencing headaches for a long time, but about a month ago, the frequency increased.
I consulted a neurologist who diagnosed me with simple migraines and prescribed pain relief and preventive medication.
Two weeks later, I noticed that my headaches have divided into two categories.
One category is the usual migraine issues, accompanied by photophobia and nausea, which have improved significantly with medication.
However, the other category involves several pain points: near the posterior part of my cheekbones, behind my ears, and on the left side of the occipital region.
The condition fluctuates; when there is no pain, I can feel the tender points, and when it hurts, I also experience ear fullness or tinnitus, pressure in the forehead and between the eyebrows, and mild dizziness.
Bending my head forward worsens the symptoms, while looking up causes neck and shoulder stiffness, and turning my head produces sounds.
Sometimes, turning my head also exacerbates the feeling of pressure and dizziness.
My sleep is occasionally poor; I wake up at night and sometimes notice the pain described above on the left side.
However, changing my position, switching sides, or adjusting my pillow usually alleviates the discomfort within five to ten minutes.
Sometimes I wake up in the morning with pain, but if I adjusted my position during the night, I usually do not have pain in the morning.
If I do have pain in the morning, it is typically after I did not wake up during the night.
What would be the best way to proceed, Doctor? Should I request a CT or MRI? Thank you!

Ken, 30~39 year old female. Ask Date: 2021/01/06

Dr. Jiang Junyi reply Neurology

Based on your description, in addition to migraines, tension-type headaches should also be considered.
The symptoms of tension-type headaches include: (1) Typically bilateral, located in the occipital and parietal regions, sometimes with widespread pain.
The nature of the pain is dull, aching, pressure-like, or tight, without pulsation, with tightness and stiffness in the occipital and cervical areas, which is noticeable when turning the neck, with intensity ranging from mild to moderate.
(2) There are tender points in the muscles at the site of pain, and sometimes pulling the scalp can also cause pain; the muscles may feel stiff, and one or more nodules, referred to as tender nodules, may be palpable.
(3) The pain does not interfere with daily activities; for example, walking or climbing stairs does not exacerbate the headache.
(4) Fatigue, tension, excitement, anxiety, insomnia, or depression can worsen the headache.
Generally, in addition to analgesics, muscle relaxants may be used.
It is also important to address muscle tension issues.
Regarding brain CT and MRI, it is advisable to discuss this with your attending physician.
Common migraines and tension-type headaches usually show no abnormal findings on imaging.
It is recommended to consult a neurologist for examination, follow-up, and discussion.
Wishing you good health, peace, and happiness.
Dr.
Jiang Junyi from Taoyuan Medical Center cares about you.

Reply Date: 2021/01/06

More Info

Managing headaches and dizziness can be quite complex, especially when symptoms evolve or become more frequent. Based on your description, it seems you are experiencing two distinct types of headaches: one that aligns with your history of migraines and another that presents with localized pain and associated symptoms such as ear fullness, tinnitus, and dizziness.

Understanding Your Symptoms
1. Migraine Headaches: The first type of headache you mentioned is consistent with migraine symptoms, which often include unilateral pain, photophobia (sensitivity to light), and nausea. It's encouraging to hear that the medication prescribed has helped reduce the frequency and intensity of these migraines.

2. Tension-Type Headaches or Cervicogenic Headaches: The second type of headache, characterized by pain points around the cheekbone, behind the ear, and at the back of the head, may suggest tension-type headaches or cervicogenic headaches. These headaches can be exacerbated by neck strain, poor posture, or muscle tension, especially if you spend long hours at a computer. The fact that changing positions alleviates some of your discomfort supports this possibility.

3. Dizziness and Ear Symptoms: The dizziness, ear fullness, and tinnitus you are experiencing could be related to several factors, including tension in the neck muscles affecting the vestibular system, or even issues related to the temporomandibular joint (TMJ). TMJ dysfunction can cause referred pain to the head and neck and may also lead to ear symptoms.

Next Steps for Management
1. Follow-Up with Your Neurologist: Since you have already consulted a neurologist, it would be prudent to follow up with them regarding the new symptoms. They may want to reassess your condition and consider whether additional imaging studies, such as a CT scan or MRI, are necessary to rule out any structural issues or other neurological concerns.

2. Physical Therapy: Given the neck and shoulder tension you described, physical therapy could be beneficial. A physical therapist can help you with exercises to improve posture, strengthen neck muscles, and reduce tension, which may alleviate both your headaches and dizziness.

3. Lifestyle Modifications: Consider implementing lifestyle changes that can help manage your symptoms:
- Ergonomic Adjustments: Ensure your workspace is ergonomically friendly to reduce strain on your neck and shoulders.

- Regular Breaks: Take frequent breaks when working at a computer to stretch and relax your muscles.

- Hydration and Nutrition: Stay hydrated and maintain a balanced diet, as dehydration and certain foods can trigger migraines.

- Sleep Hygiene: Establish a regular sleep routine to improve the quality of your sleep, which can significantly impact headache frequency.

4. Stress Management: Since stress can exacerbate headaches, consider incorporating stress-reducing techniques such as mindfulness, yoga, or meditation into your daily routine.

5. Medication Review: If your symptoms persist or worsen, discuss with your doctor the possibility of adjusting your medication regimen. Sometimes, a combination of preventive and abortive treatments is necessary to manage complex headache patterns effectively.

Conclusion
In summary, it’s essential to keep an open line of communication with your healthcare provider about your evolving symptoms. A thorough evaluation, possibly including imaging studies, may be warranted to ensure there are no underlying issues contributing to your headaches and dizziness. Meanwhile, lifestyle modifications and physical therapy can play a significant role in managing your symptoms. Remember, effective headache management often requires a multifaceted approach tailored to your specific needs.

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