Headaches and Dizziness: When to Seek Further Evaluation

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 medications.
Two weeks later, I noticed that my headaches have divided into two categories.
One category is the ongoing migraine issue, accompanied by photophobia and nausea, which has 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.
This condition fluctuates; when there is no pain, I can feel the tender points, and when it hurts, I also experience ear fullness or tinnitus, a sensation of pressure in the forehead and mild dizziness.
Bending my head forward worsens the symptoms, while looking up causes neck and shoulder stiffness, and turning my head sometimes produces sounds.
Occasionally, turning my head exacerbates the feeling of pressure and dizziness.
My sleep is sometimes poor; I wake up at night and occasionally notice the aforementioned pain on the left side.
However, changing positions, 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 wake up with pain in the morning, I typically did not wake up during the night.
What should I do next, Doctor? Do I need to request a CT scan or MRI? Thank you!

Ken, 30~39 year old female. Ask Date: 2021/01/07

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, with a sensation of pressure or tightness, and it is non-pulsating.
There may be tightness and stiffness in the occipital and cervical regions, which is more pronounced when turning the neck, with pain intensity ranging from mild to moderate.
(2) There are tender points in the muscles at the pain site, and sometimes pulling on the scalp can also cause pain.
The muscles may feel stiff, and one or more palpable nodules, referred to as tender nodules, may be present.
(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.
Attention should also be paid to muscle tension issues.
Regarding brain CT and MRI, it is advisable to discuss this with your attending physician.
Common migraines and tension-type headaches typically 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: 2021/01/07

More Info

Understanding headaches and dizziness can be quite complex, especially when symptoms vary in intensity and location. Based on your description, it seems you are experiencing two distinct types of headaches: one that resembles classic migraine symptoms and another that presents with localized pain and associated symptoms like ear fullness and dizziness.

Types of Headaches
1. Migraine: This is characterized by unilateral, pulsating pain, often accompanied by nausea, vomiting, and sensitivity to light and sound. Your experience of having nausea and photophobia aligns with this diagnosis. Migraines can be triggered by various factors, including stress, hormonal changes, certain foods, and lack of sleep.

2. Tension-Type Headache: This type often presents as a dull, aching sensation all over the head and can be associated with tightness in the neck and shoulders. The pain points you mentioned, particularly around the temples and occipital region, could suggest a tension-type headache, especially if they are exacerbated by stress or poor posture.

3. Cervicogenic Headache: Given your symptoms of neck stiffness and pain that worsens with certain head movements, this type of headache may also be a consideration. It originates from issues in the cervical spine and can cause referred pain to the head.

4. Sinus Headache: The pain near the cheekbones and forehead could also indicate sinus involvement, especially if you have a history of allergies or sinus issues.

Associated Symptoms
The presence of ear fullness and tinnitus (ringing in the ears) could suggest a few possibilities:
- Eustachian Tube Dysfunction: This can cause a sensation of fullness in the ear and may be related to sinus issues or allergies.

- Vestibular Issues: Dizziness and ear symptoms could also indicate a vestibular disorder, which affects balance and spatial orientation.

Next Steps
1. Medication Management: Since you have been prescribed medication for migraine, it’s essential to adhere to that regimen. If you find that the medication is not adequately controlling your symptoms, follow up with your neurologist to discuss adjustments or alternative treatments.

2. Lifestyle Modifications: Consider implementing lifestyle changes that may help reduce headache frequency and severity. This includes:
- Maintaining a regular sleep schedule.

- Staying hydrated.

- Managing stress through relaxation techniques or physical activity.

- Avoiding known headache triggers (e.g., certain foods, excessive screen time).

3. Physical Therapy: If you suspect that your headaches are related to neck tension or posture, physical therapy may be beneficial. A physical therapist can provide exercises to improve posture and relieve muscle tension.

4. Further Evaluation: Given the complexity of your symptoms, especially the combination of headache, ear fullness, and dizziness, it may be prudent to seek further evaluation. A CT scan or MRI could help rule out any structural issues or other neurological concerns, particularly if your symptoms persist or worsen. Discuss this with your neurologist, who can provide guidance based on your specific case.

5. Follow-Up: Regular follow-ups with your healthcare provider are crucial. If your symptoms change or new symptoms arise, do not hesitate to seek medical advice.

In summary, while your current symptoms may be manageable with medication and lifestyle changes, further evaluation may be warranted to ensure there are no underlying conditions contributing to your headaches and dizziness. Always communicate openly with your healthcare provider about your symptoms and any changes you experience.

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