Intermittent Headaches and Dizziness: When to Seek Help

Intermittent headaches and dizziness?

Hello Dr.
Jiang,
In the past week, I have been experiencing recurrent headaches that are different from my usual migraines caused by staying up late until 2 or 3 AM.
Sometimes the pain is unilateral, while other times it affects my entire head.
For the past three days, the pain has mainly concentrated from the back of my head to the nape of my neck.
The headache is not very severe, but it is accompanied by dizziness and nausea, making it difficult for me to eat.
I need to rest a bit before I can eat again.

The night before last, I suddenly experienced blurred vision, dizziness, and a sensation of darkness closing in, almost feeling like I was going to faint.
This lasted for about five minutes before gradually subsiding.
The headaches primarily occur in the afternoon to evening.
My sleep is relatively okay, although I often wake up around 2 or 4 AM and then go back to sleep.

I am 177 cm tall and weigh 59 kg.
I have mild thalassemia and my blood pressure tends to be low (systolic 90-100 / diastolic 57-63).
A few months ago, I was diagnosed with panic disorder at a psychiatric clinic, but I am still worried that I might be having a stroke or some other brain pathology.

Could you please advise me if I need to go to the hospital for a CT scan, or if I can just rest more? Thank you for taking the time to respond, Dr.
Jiang.

Mr. You, 20~29 year old female. Ask Date: 2021/11/08

Dr. Jiang Junyi reply Neurology

Dear Mr.
You,
You mentioned that "the night before last, I suddenly experienced blurred vision, dizziness, and a feeling of impending fainting, with my vision becoming increasingly dark.
This lasted for about 5 minutes before gradually returning to normal, primarily occurring in the afternoon to evening." This may indicate a potential issue with syncope.
The most common cause is reflex syncope, which can occur due to excessive stimulation of the vagus nerve, leading to bradycardia and decreased cardiac output.
This can happen when changing positions from lying down to standing, suddenly standing up after squatting, certain medications causing hypotension, significant blood volume reduction, peripheral vasodilation in a hot environment, or peripheral neuropathy.

Psychogenic syncope should also be considered, such as arrhythmias, valvular heart disease, cardiac myxoma, acute myocardial infarction, or coronary artery spasm causing arrhythmia and hypotension.
Metabolic causes of syncope, such as hypoglycemia or hyperventilation, should also be distinguished from seizures and vertigo.
If your symptoms persist, I recommend undergoing brain imaging studies, such as a CT scan.

I suggest discussing further examination and treatment with a neurologist.
Thank you for your inquiry, and feel free to reach out with any related questions!
Wishing you good health and peace,
Dr.
Jiang, Department of Neurology, Taoyuan Hospital

Reply Date: 2021/11/08

More Info

When experiencing intermittent headaches accompanied by dizziness and visual disturbances, it is crucial to understand the potential underlying causes and when to seek medical help. Based on your description, it seems you are dealing with a complex set of symptoms that could be indicative of several conditions, ranging from tension-type headaches to more serious neurological issues.

Firstly, the nature of your headaches—varying in location and intensity, with episodes of dizziness and nausea—suggests that they could be tension-type headaches or migraines. Tension-type headaches are often characterized by a dull, aching sensation all over the head, while migraines can present with unilateral pain, nausea, and sensitivity to light or sound. The fact that your headaches are accompanied by dizziness and visual disturbances, such as blurred vision, raises some concerns that warrant further investigation.

Given your history of mild thalassemia and low blood pressure, these factors could contribute to your symptoms. Low blood pressure can lead to insufficient blood flow to the brain, resulting in dizziness and faintness, especially when standing up quickly or after prolonged periods of inactivity. Additionally, your recent diagnosis of panic disorder may also play a role in your symptoms, as anxiety can manifest physically, leading to tension headaches and dizziness.

The sudden onset of blurred vision and the feeling of nearly fainting are particularly concerning. These symptoms could indicate a transient ischemic attack (TIA) or even a migraine with aura, both of which require prompt medical evaluation. TIAs are often referred to as "mini-strokes" and can present with sudden neurological symptoms that resolve quickly, but they are serious and should not be ignored.

In light of these considerations, it is advisable to seek medical attention, particularly if your symptoms persist or worsen. A CT scan of the brain may be warranted to rule out any structural abnormalities, such as a hemorrhage or mass effect, especially given the acute nature of your visual disturbances. Additionally, a thorough neurological examination can help determine if there are any signs of more serious conditions.

In the meantime, there are several strategies you can employ to manage your symptoms. Ensuring you are well-hydrated and maintaining a balanced diet can help mitigate some of the dizziness and nausea. Regular, gentle exercise may also alleviate tension and improve overall well-being. Practicing relaxation techniques, such as deep breathing or mindfulness, can help manage anxiety and reduce the frequency of tension-type headaches.

In summary, while your symptoms may be related to tension headaches or migraines, the presence of dizziness, nausea, and visual disturbances necessitates a thorough evaluation by a healthcare professional. Do not hesitate to seek medical attention, especially if you experience any new or worsening symptoms. Early intervention can be crucial in addressing potential underlying issues and ensuring your health and safety.

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