Intermittent headaches
I have a history of hypertension and experience intermittent headaches.
I also had a head injury five years ago when I fainted after a long drive and was taken to the hospital for stitches.
I have had an EEG that showed no abnormalities.
Recently, the frequency of my headaches has increased.
What additional tests can I undergo, or which specialist should I see? Thank you!
Lin Xiansheng, 30~39 year old female. Ask Date: 2015/09/07
Dr. Jiang Junyi reply Neurology
Based on your description: The symptoms you mentioned are more likely caused by syncope.
Loss of consciousness can occur when cerebral blood flow drops below 30 ml per minute, typically due to rapid drops in blood pressure or vasoconstriction leading to reduced cerebral blood flow and subsequent hypoxia in the brain.
Syncope is more likely to occur when a person is standing, as cerebral blood flow is at its lowest in this position and cardiac output is higher.
However, when there is a decrease in cerebral blood flow, the body may not be able to respond quickly enough, resulting in syncope.
The likelihood of syncope is lower when sitting and almost nonexistent when lying down.
Prior to losing consciousness, there may be prodromal symptoms such as nausea, yawning, dizziness, a feeling of warmth, sweating, and cold extremities.
After losing consciousness, the individual may appear pale, have cold skin, relaxed muscles, a weak pulse, and remain motionless when lying down.
If you frequently experience these symptoms, do not force yourself to stand; instead, quickly sit down or squat to avoid the risk of falling and sustaining a head injury, which could be fatal.
Regarding your headache, it may require evaluation and examination by a physician to determine the underlying cause.
I recommend discussing your symptoms with a neurologist for further assessment and treatment.
Wishing you good health, safety, and happiness.
Reply Date: 2015/09/07
More Info
Managing intermittent headaches, especially in the context of pre-existing conditions like hypertension and a history of head trauma, requires careful consideration and often a multidisciplinary approach. Given your symptoms and medical history, it is crucial to understand when to seek help from a neurologist and what further evaluations may be necessary.
Understanding Your Symptoms
Headaches can arise from a variety of causes, and their management often depends on identifying the underlying issue. In your case, the combination of hypertension and a history of head trauma raises several important considerations:
1. Hypertension: High blood pressure can lead to headaches, particularly if it is poorly controlled. Hypertensive headaches are typically described as a dull, throbbing pain and are often located bilaterally (on both sides of the head). If your blood pressure is fluctuating or consistently high, it may be contributing to your headache symptoms.
2. History of Head Trauma: The fact that you experienced a head injury five years ago could also be relevant. Post-traumatic headaches can occur and may present differently than typical tension or migraine headaches. Symptoms can include a persistent dull ache, sensitivity to light, or even cognitive changes.
3. Increased Frequency of Headaches: An increase in the frequency of headaches, especially if they are different from your usual pattern, warrants further investigation. This change could indicate a new underlying issue that needs to be addressed.
When to Seek Neurology Help
You should consider consulting a neurologist if:
- Your headaches are becoming more frequent or severe.
- You experience any new neurological symptoms, such as vision changes, weakness, numbness, or difficulty speaking.
- You have a significant change in your headache pattern or if they start to disrupt your daily activities.
- You have a history of head trauma and are concerned about potential long-term effects.
Recommended Evaluations
Given your history and current symptoms, the following evaluations may be beneficial:
1. MRI or CT Scan: Imaging studies can help rule out structural issues in the brain, such as tumors, bleeding, or other abnormalities that could be causing your headaches. An MRI is often preferred for its detailed imaging capabilities, especially in soft tissue evaluation.
2. Blood Pressure Monitoring: Regular monitoring of your blood pressure is essential. If you have not been doing so, consider keeping a log of your blood pressure readings, especially during headache episodes.
3. Neurological Examination: A thorough neurological exam by a specialist can help assess for any signs of neurological deficits that may indicate a more serious condition.
4. Blood Tests: Routine blood tests can help rule out other potential causes of headaches, such as infections or metabolic issues.
5. Lifestyle Assessment: Discussing your lifestyle factors, such as stress levels, sleep patterns, and dietary habits, can provide insights into potential triggers for your headaches.
Conclusion
In summary, managing intermittent headaches, particularly with your medical history, requires a proactive approach. It is advisable to consult a neurologist who can perform a comprehensive evaluation and recommend appropriate imaging studies or treatments. Keeping track of your symptoms and any potential triggers can also aid in your diagnosis and management. Remember, timely intervention can significantly improve your quality of life and help prevent complications associated with uncontrolled hypertension or other underlying conditions.
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