Dizziness and Head Pain: When to Seek Further Evaluation

Dizziness, headache, and a sense of imbalance?

Hello, doctor.
Last month, one day, I suddenly started feeling dizzy (not the spinning type, but more like a sensation of an earthquake).
Then, I felt unbalanced with any movement (for example, when leaning forward, it felt like there was inertia, and I had to exert more effort to maintain my balance.
Even when I was still, I felt a slight swaying of my body).
This dizziness has persisted until now (sometimes it gets a little better), and recently I also experienced a feeling of pressure and pain in my head (the back of my head feels very swollen).
This combination of dizziness and pressure is significantly affecting my daily life (by the way, lying down helps a bit).
So far, I have undergone some tests, including blood tests (to check my thyroid and other things) and auditory evoked potential tests, both of which were normal.
The doctor suggested monitoring the situation, but I am really worried that it could be a brain tumor since it has been over a month.
P.S.
I had a full-body health check-up 9 months ago, which included a self-paid brain MRI that was normal.
I would like to ask the doctor if you think it is necessary to pay for another MRI, or if the previous one from 9 months ago means that it is unlikely to be a brain tumor.
I am unsure about the time frame for the validity of a brain MRI.
I have been feeling very down every day.
Thank you for your response, and I wish you and your family good health.

yoss, 20~29 year old female. Ask Date: 2021/09/04

Dr. Jiang Junyi reply Neurology

Dear Ms.
Yoss,
I believe you have already consulted a neurologist.
If there are currently no neurological deficits, the likelihood of a brain tumor is low.
The symptoms of a brain tumor typically depend on its location and size, and they usually worsen over time.
Increased intracranial pressure due to mass effect may lead to symptoms such as nausea and vomiting.
If headaches occur, they may be particularly severe during the early morning hours.
Other symptoms may include unsteady gait, impaired coordination or balance, memory decline, speech difficulties, or personality changes.
Weakness or sensory deficits in the arms and legs may also be present.
You mentioned that "lying down feels better," which may suggest the possibility of spontaneous intracranial hypotension (SIH) causing your headaches.

In terms of treatment, in addition to hydration and caffeine intake from coffee or tea, you may also consider using medicinal caffeine and theophylline.
A small number of patients may respond to steroids or non-steroidal anti-inflammatory drugs (NSAIDs).
Furthermore, you could consult an anesthesiologist for an epidural blood patch.
I recommend discussing further evaluation and treatment options with a neurosurgeon.
Please ensure to practice self-protection, maintain cleanliness and sanitation, and adhere to preventive health measures before and after your medical visits.
Thank you for your inquiry, and feel free to reach out for further discussion on related issues!
Wishing you good health and peace,
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2021/09/04

More Info

Dizziness and head pain can be concerning symptoms, especially when they persist over time. Based on your description, it seems you are experiencing a combination of dizziness and a sensation of pressure or pain in the back of your head. This can significantly impact your daily life, and it’s understandable that you are worried about the possibility of a serious condition, such as a brain tumor.

First, it’s important to note that dizziness can arise from various causes, including vestibular disorders, anxiety, migraines, or even tension-type headaches. The sensation of imbalance you describe, particularly when moving or even at rest, could suggest a vestibular issue, which affects the inner ear and balance. The pressure or pain in the back of your head may be related to tension headaches or migraines, which can also present with dizziness.

Given that you have undergone blood tests and auditory evoked potential tests that returned normal results, this is a positive sign. It indicates that some of the more common causes of dizziness, such as thyroid dysfunction or significant auditory issues, have been ruled out. However, your ongoing symptoms warrant further evaluation.

Regarding your concern about a brain tumor, it is essential to understand that while MRI scans are a valuable tool for diagnosing brain conditions, they are not infallible. An MRI performed nine months ago that showed no abnormalities is reassuring, but if your symptoms have changed or worsened since then, it may be prudent to discuss the possibility of a follow-up MRI with your healthcare provider. The effectiveness of an MRI in detecting tumors can depend on various factors, including the tumor's size and location. If you have persistent symptoms that significantly affect your quality of life, it is reasonable to seek further imaging.

In addition to imaging, consider discussing your symptoms in detail with a neurologist. They can provide a comprehensive evaluation and may suggest additional tests, such as a CT scan or more specialized vestibular testing, to assess your balance and dizziness further. It’s also worth exploring lifestyle factors that may contribute to your symptoms, such as stress, sleep quality, and hydration, as these can play a significant role in both dizziness and headaches.

As for your mental health, it’s crucial to address feelings of anxiety or depression that may arise from chronic symptoms. Chronic pain and discomfort can take a toll on mental well-being, so seeking support from a mental health professional may also be beneficial.

In summary, while your previous MRI results are reassuring, the persistence and nature of your symptoms warrant further evaluation. Discussing your concerns with a neurologist and considering a follow-up MRI or other tests may provide clarity and peace of mind. Remember, it’s essential to advocate for your health and seek the necessary evaluations to ensure you receive appropriate care.

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