Dizziness with a headache

Lightheaded? Top 5 reasons you might feel woozy

Causes of lightheadedness may be dehydration, medication side effects, sudden blood pressure drops, low blood sugar, and heart disease or stroke.

Updated: December 13, 2019Published: March, 2016


Feeling woozy, lightheaded, or a little faint is a common complaint among older adults. Although it’s not usually caused by anything life-threatening, it could be, so you need to be careful.

“Don’t ignore it. Even if the lightheadedness does not have a serious cause, it could lead to serious injuries from a fall. And at the worst, the cause may itself be life-threatening,” says Dr. Shamai Grossman, an associate professor of emergency medicine at Harvard Medical School.

If you feel lightheaded, Dr. Grossman recommends having a drink of water or orange juice and lying down. If symptoms last more than 15 minutes, he says it’s time to seek medical help in an urgent or emergency care setting. Even if symptoms are brief, and even if you think you know the cause, report the lightheadedness to your doctor.

What causes lightheadedness?

Following are the top causes of lightheadedness and common fixes.

Dehydration

You may become dehydrated if you’re overheated, if you aren’t eating or drinking enough, or if you’re sick. Without enough fluids, the volume of your blood goes down, lowering your blood pressure and keeping your brain from getting enough blood, causing lightheadedness. “A glass of water may be enough to make you feel better, but if you haven’t been eating or drinking much for days, it will take more than that to rehydrate your body,” says Dr. Grossman. You may need an intravenous infusion of fluid. A doctor can check to see if you need electrolytes like potassium or salt.

Drug side effects

Sometimes medications make you feel lightheaded, especially those that lower your blood pressure or make you urinate more. “If they work too well, they’ll lower your blood pressure too much and make you lightheaded. Diuretics are notorious for this,” says Dr. Grossman. The fix may be as simple as adjusting the dose or trying a different drug.

Sudden drop in blood pressure

The autonomic nervous system helps the body regulate the shift in blood pressure when we stand up. As we get older, this system may deteriorate, causing a temporary drop in blood pressure when we stand—known as orthostatic hypotension—resulting in lightheadedness. This may be a long-term problem, but there are medications to treat it, such as midodrine (ProAmatine) and fludrocortisone (Florinef), so this too warrants a trip to your doctor.

Low blood sugar

“When you don’t have enough blood sugar, every system in your body goes on reserve to use as little energy as possible, including your brain, making you feel lightheaded or confused,” says Dr. Grossman. It may only take a drink of juice to relieve your symptoms, but it’s best to get your blood sugar levels checked, especially if you need more glucose (sugar) in intravenous or pill form.

Heart attack and stroke

At its most serious, lightheadedness may be a sign of a heart attack or stroke. Other symptoms of a heart attack often accompanying lightheadedness are chest pain, shortness of breath, nausea, arm pain, back pain, or jaw pain. Symptoms suggesting a stroke are the sudden onset of headache, numbness, weakness, visual changes, trouble walking, or slurred speech. “But in older adults, lightheadedness may be the only symptom of a heart attack or a stroke, especially if it doesn’t go away,” says Dr. Grossman. In that case, every second counts, so get to an emergency room for treatment.

Dizziness: How it’s different from lightheadedness

“Are you feeling lightheaded or dizzy?” your doctor may ask. Although it is often hard to tell the difference, your answer may have a big impact on how the doctor moves forward with diagnosis. Lightheadedness is not the same as dizziness, also known as vertigo, which refers to feeling like your surroundings are spinning.

Common causes of dizziness include medication side effects; infections or other disorders of the inner ear; tumors; a stroke that occurs in the back of the brain; Ménière’s disease, which attacks a nerve important in balance and hearing; benign paroxysmal positional vertigo, when tiny crystals in the inner ear become dislodged and move around inside the ear canals; and Parkinson’s disease.

Treating the underlying condition can relieve dizziness. But don’t ignore bouts of dizziness, warns Dr. Grossman. “Vertigo can lead to falls and injury. It’s a real problem, particularly in the elderly, and in many cases, it can be prevented,” he says.

Image: 9nong/Getty IMages

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Vestibular Migraine

After an initial, thorough subjective history is obtained, including a recitation of ongoing symptoms and disruption of activities of daily living, a battery of tests is typically performed, to determine a plan of care for optimized therapy. There are a large number of methods available for testing patients with MAV, and an optimal testing protocol is yet to be determined for this population. Some combination of computerized audiological and vestibular-function tests is typically employed, including positional testing with video-oculography; oculomotor and VOR (vestibulo-ocular reflex) assessments with gaze stability and/or dynamic visual acuity testing; horizontal canal testing with vENG (video electronystagmography), with calorics or rotational chair testing (preferred); audiogram and ABR (auditory brainstem response test); functional balance and gait assessments with CDP (computerized dynamic posturography); and VEMP.

In our clinic, a review of results obtained from such tests with MAV patients reveals a combination of findings that are attributable to both central processes and peripheral vestibular functions.

An important component of the evaluation is reliable documentation of the degree of limitation of daily functional capacities. A number of questionnaires and inventories have been employed for this purpose, including the Jacobsen Dizziness Inventory, Dynamic Gait Index, Activities-Specific Balance Confidence Scale, Timed Up and Go test, and others.7,13

Treatment

The methodology believed to have the highest efficacy in the management of migraine dizziness is a combination of medications, vestibular rehabilitation, and lifestyle modifications that include limitation of the risk factors associated with migraine (those related to diet, sleep, stress, exercise, and environmental factors).

Medication

Medications may be prescribed to prevent migraines or to stop a migraine that has already started. Drugs used to prevent frequent migraine attacks include beta-blockers, tricyclic antidepressants, calcium channel blockers, and certain anticonvulsant medications (Depakote and Topamax). Over the last several years, venlafaxine (Effexor XR) has become one of the favored preventative drug treatments for patients with migraine related vertigo. Drugs commonly used to stop migraine are aspirin, ibuprofen, isometheptene mucate, and the triptans, such as Imitrex and Relpax. Some of these medications work by blocking the action of serotonin (a neurotransmitter that causes large blood vessels to contract) or prostaglandins (a family of chemicals stimulated by estrogen that cause blood vessels to expand and contract).14 Generally the differentiation of whether to use a daily preventive vs an abortive type (taken to stop the already started migraine event) is the frequency and severity of the events. This is best determined by the patient’s discussion of options with the treating Neurologist.

Vestibular rehabilitation

The benefits of vestibular rehabilitation are well documented to reduce symptoms and restore function for vestibular-related disorders.7,13 With MAV, it is often helpful for the patient to have started the prescribed medications prior to beginning the vestibular rehabilitation course. This may allow for better tolerance to the exercise regimen without exacerbating the symptoms. The intensity of the rehabilitation course in gradually increased to the patient’s abilities, yet still at a low enough level so as to not initiate another migraine event.

For patients who have alterations in oculomotor functions and VOR deficits giving rise to visual perceptual dysfunction, a concentrated rehabilitation program consisting of VOR and gaze-stability exercises that emphasize visual acuity is effective. Various eye tracking devices are commercially available which allow the examiner to monitor not only the ability of the patient to visually track objects, but also allow the “method” of eye tracking employed by the patient to be evaluated. Spatial awareness may be altered, and exercises emphasizing proprioception and visual perception are helpful. Isolating visual fields incrementally during visual tracking exercises may be helpful in stabilizing alterations in positional sense. Vestibulo-visual interaction exercises also improve eye tracking abilities. It has become evident that velocity specific exercises are most effective. The velocity of the exercises needs to be matched to the measured velocity deficits on test results. Performing visual retraining exercises at random speeds rather than at specific velocities may be less effective. In cases where BPPV exists, performing canalith repositioning maneuvers is effective, and followed with home habituation exercises.

Postural instability and gait alterations respond to balance and gait-training tasks and exercises, employing both static and dynamic type balance exercises. Dual tasking and exercises that combine hand-eye coordination, balance maintenance, and gaze stability are effective as well, and can be combined with general conditioning exercises to the extent tolerated by the patient’s general health. Performing exercises on various surface textures and variable stabilities also is recommended.

In patients with cervicalgia and cervical muscle spasms that limit range of motion, treatment may also include modalities and manual mobilization and stretching of the upper cervical segments, in order to diminish the muscle spasms and guarding and restore normal mobility to the neck. As an adjunct to therapy, greater occipital nerve block (GON) injections are often helpful in reducing symptoms and restoring motion. Some treating MD’s now use Botox for these injections for more lasting effect.

Lifestyle modifications

A consistent effort by the patient to adhere to necessary lifestyle modifications (including avoiding the migraine triggers mentioned above), medication usage as prescribed, and specific tasks and exercises performed independently at home are critical to the success of the overall rehabilitation program. Such adherence is essential for effective reduction of the symptoms and limitations of function caused by migraine associated vertigo (MAV).7

Vestibular test results commonly observed in migraine-related dizziness patients

During video-oculography, a prevalent feature is poor gaze stability with ocular “drift,” often accompanied by spontaneous up or downbeating directional nystagmus, which does not suppress with fixation-suppression testing added. Unilateral or bilateral gaze induced lateral nystagmus is commonly observed. There may also be a reduced ability to cancel or inhibit the vestibulo-ocular reflex (VOR) function, used for attaining simultaneous head and eye tracking maneuvers. These results may be due to the fact that the cerebellum, which is responsible for coordinating gaze-fixation functions, is thought to be involved in the vascular and neural changes associated with migraine.

Testing of other cerebellar functions (involving coordinated movements of the extremities) may give normal results, with no postural instability or ataxia/apraxia evident, but postural instability is often evident as well. Smooth pursuit tests often give abnormal results (although these must be distinguished from expected age-related changes). Thus, it may be that only those neural processes of the cerebellum associated with coordinated eye motions are affected in migraine, and not the neural connections involving postural stability.

Computerized dynamic posturography (CDP) may give positive results for postural instability, especially when used in combination with head motions for dual tasking and otolithic system involvement. Alterations in balance strategies are commonly measured, and need to be addressed with the specific balance exercises in accord with test measures.

Saccadic eye-motion testing is usually normal, but a rebound nystagmus may be present with hyperresponsive neural findings and presence of overshoot phenomenon. Directional gaze testing is usually abnormal, as is the Halmagyi head thrust test. HIT (head impulse test) may be helpful in documenting the objective findings of VOR and gaze stability deficit. With Hallpike-Dix positional testing (unless true BPPV presents), no rotational component nystagmus is usually evident. However in acute migraine event, bilateral torsional nystagmus may present with positional testing and gaze added.

With passive VOR assessment via autorotation methods, or with mechanical rotational chair, an abnormal gain value with accompanying phase shift is usually evident. The visual-vestibular interaction can be markedly abnormal and may provoke symptoms of increased dizziness, often with accompanying nausea. Optokinetic after-nystagmus (OKAN) is commonly symmetrically prolonged. Subjective Visual Vertical assessment often is abnormal with accompanying spatial disorientation altered postural positional sense.

Active autorotation testing, which may be limited by cervicalgia and cervical muscle spasms with limited range of motion (often the patient moves “en bloc” to avoid eliciting dizziness), gives sporadic results. Gaze stability testing and dynamic visual acuity testing—after cervicalgia is resolved with appropriate treatments—are typically abnormal. Vestibular-evoked myogenic potentials (VEMP) testing has proven quite useful in determining differential diagnoses. Regularly, hyperactive VEMP responses are found in patients with MAV.

Audiometric testing in cases of migraine associated vertigo (MAV) typically reveals no changes in function other than occasional hyperacusis or noise sensitivity, which usually is temporary and resolves shortly after the migraine event ends. Tinnitus (most commonly associated with labyrinthitis rather than migraine), if present at all, is temporary. In cases of prolonged problematic tinnitus, tinnitus retraining therapy (TRT) may be helpful. Tinnitus masking devices are also commercially available.

Summary

Migraine associated vertigo (MAV) afflicts a large percent of the population and continues to be a challenge to healthcare professionals. Technologies for measurement continue to expand and new medications continue to be manufactured for this affliction. Effective management of MAV necessitates a comprehensive effort and active participation of the patient, the treating physician, and the rehabilitation professionals. Proper identification, objective diagnostic measurements, and optimized treatment approaches net the best results.

By Jeffrey Kramer, MD, Chief of Neurology, Mercy Hospital & Medical Center, Chicago, Illinois and Jim Buskirk, PT, SCS, PEAK & Balance Centers of America, Chicago, Illinois

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Click here to download the “Migrane Associated Vertigo (MAV)” publication.

Headaches and Dizziness

There are a number of possible links between headaches and dizziness:

  • Migraines. Migraines are a common cause of headache pain and disability. They also can be associated with at least one form of dizziness. “A sense of instability can be found in migraine,” says Goadsby. “There is considerable discussion as to how that is related to migraine. You also can get that symptom from the dysfunction of the balance organs in the ear and from how that information is processed in the brain.” You may also feel lightheaded at times or experience the spinning sensation of vertigo. These sensations may be accompanied by ear or hearing disturbances. Dizziness, especially if accompanied by migraine symptoms such as visual disturbances and nausea — but without the headache pain — can be a sign that you’re experiencing headache-free migraines.
  • Traumatic brain injury. People who have had a traumatic brain injury (TBI) because of a fall, blow to the head, or other event may experience dizziness — often a kind of vertigo that occurs when the head is in a specific position — along with headache. Fatigue may also accompany these types of headaches. The headaches people tend to experience after TBI vary from tension-type headaches to migraines, or a mix of the two.
  • Low blood sugar. Another possible cause of both headaches and dizziness is low blood sugar. This is most likely to occur several hours after your last meal. Eating small, frequent meals should help stave off these symptoms. If you are diabetic, be sure to monitor your blood sugar levels throughout the day. Low blood sugar, also called hypoglycemia, is usually accompanied by other symptoms such as hunger, sweating, and trembling.

Treating Dizziness and Headache

Generally, the headache treatments that ease headache pain will also help ease dizziness, says Goadsby. Treatments may include:

  • Over-the-counter pain medications
  • Prescription migraine treatment
  • Medication to prevent migraine or headache
  • Antidepressants
  • Relaxation techniques
  • Biofeedback
  • Maintaining a healthy, regular diet

If your dizziness or vertigo is related to an underlying health condition, you may need other treatments. Occasionally, dizziness may be a sign of a more serious medical condition, so you should always have your symptoms evaluated by a doctor.

Dizziness is a puzzling symptom. More disconcerting than painful, it may be just one more element of a headache or migraine, and proper treatment will help bring you the relief you seek.

Vestibular Migraine Symptoms

  • Vestibular migraines can involve combinations of the following symptoms:

    • Migraine headache symptoms, such as

    • Severe, throbbing headache, usually on one side of the head

    • Nausea and vomiting

  • Sensitivity to light, smell and noiseVestibular symptoms may include:

    • Vertigo (dizziness), usually lasting minutes to hours, but sometimes days

    • Unsteadiness and loss of balance

    • Sensitivity to motion

Although subjective hearing symptoms (ringing, fullness, pressure in one or both ears) are common, significant hearing loss should raise suspicion for an inner ear disorder such as Méniére’s disease.

With vestibular migraine, the person may experience a combination of vestibular attacks, visual aura, or sensitivity to visual stimulation and motion at different times, and they can occur with or without an actual headache.

What causes vestibular migraine?

Vestibular migraines, like other migraine syndromes, tend to run in families. Although science has not completely clarified the complex mechanisms of migraine, it is known that women tend to suffer with the condition than men, and symptoms may get worse around menstruation.

In addition, people vulnerable to vestibular migraines can experience episodes after migraine triggers including altered sleep patterns, MSG, menstrual cycle and food such as chocolate, ripened or aged cheese and red wine.

Vestibular Migraine Diagnosis

Because a majority of people who have vestibular migraine do not have vestibular symptoms and headaches occurring at the same time, the onset of dizziness by itself may make it challenging to arrive at a diagnosis. Other diagnostic considerations that can present similarly to vestibular migraine include:

  • Benign paroxysmal positional vertigo (BPPV)

  • Méniére’s disease

  • Transient ischemic attack (TIA) or “mini-stroke”

It is common for vestibular migraine, Méniére’s disease and BPPV to coexist, which can make diagnosis and treatment even more challenging.

Vestibular Migraine Treatment

Treatment for vestibular migraine is similar to that for other migraine headaches. Use of meclizine or other abortive medications that suppress the vestibular system should be minimized, and only used occasionally as needed, during an episode for instance.

If the person is getting frequent attacks, the doctor may recommend one or more of these medications, as well as others:

  • Beta blockers

  • Calcium channel blockers

  • Tricyclic antidepressants

  • Serotonin or serotonin/norepinephrine reuptake inhibitors (SSRIs or SNRIs)

  • Topiramate

People with vestibular migraine can reduce the number and intensity of episodes by maintaining a regular sleep and meal schedule, avoiding of triggers, exercising regularly and managing stress.

Migraine Associated Vertigo

Between 30 and 50% of migraineurs will sometimes experience dizziness, a sense of spinning, or feeling like their balance is off in the midst of their headaches. This is now termed vestibular migraine, but is also called migraine associated vertigo. Sometimes migraineurs experience these symptoms before the headache, but they can occur during the headache, or even without any head pain. In children, vertigo may be a precursor to migraines developing in the teens or adulthood. Migraine associated vertigo may be more common in those with motion sickness.

For some patients this vertiginous sensation resembles migraine aura, which is a reversible, relatively shortlived neurologic symptom associated with their migraines. Most often an aura is visual, but it can also come in the form of altered sensation or problems with speech or language. Aura typically lasts 5-60 minutes, is followed by migraine pain, and is usually only diagnosed in someone with a known migraine history.

The vertigo associated with migraine can be shorter than a typical aura or last longer, from a few minutes to 3 days. With vertiginous migraine, the symptoms can occur before, during, or after the onset of head pain. The vertigo symptoms vary widely in those with migraine. The sensation can occur without any outside trigger, and can be experienced either as a feeling of the self-moving, or as if the surroundings are moving. Other times, vertigo symptoms may be triggered by a change in head position or ongoing movement of the head. Sometimes just looking at an object that is actually moving will trigger an attack.

About 1% of the general population has migraine associated vertigo, but the diagnosis can be confusing, as it may resemble, or actually be another disorder happening coincidentally in a migraineur. It has been estimated that migraineurs are more likely to have benign positional vertigo, a common disorder that may be twice as common in migraineurs as the general population, but is not associated with head pain. In benign positional vertigo, the room spins with changes in position, particularly when going from a lying to a sitting or standing position. Even rolling over in bed can cause the sensation. Sometimes a condition similar to benign positional vertigo called vestibular neuronitis (or vestibular neuritis/labyrinthitis) is triggered by a viral infection of the inner ear, resulting in constant vertigo or unsteadiness. Symptoms can last for a few days to a few weeks and then go away as mysteriously as they came on. Vestibular migraine, by definition, should have migraine symptoms in at least 50% of the vertigo episodes, and these include head pain, light and noise sensitivity, and nausea.

There are red flags, which are warning signs that vertigo is not part of a migraine. Sudden hearing loss can be the sign of an infection that needs treatment. Loss of balance alone, or accompanied by weakness can be the sign of a stroke, particularly in those known to have a risk for vascular disease. In Meniere’s disease, there can be a progressive or intermittent hearing loss, sense of ear fullness, and ringing or buzzing in the ear, can also be a cause of vertigo. Vertigo that is worsening or accompanied by nonmigraine symptoms, such as weakness or change in hearing, merits further evaluation as many nonmigraine disorders can also have similar symptoms.

Vestibular migraine frequently responds to standard migraine prevention and attack treatment strategies. Use of magnesium, blood pressure medications, particularly beta blockers, antiseizure medications such as topiramate and in particular, antidepressants (tricyclic or serotonin norepinephrine reuptake inhibitors) may reduce the number of attacks, although good scientific trials for determining effectiveness are not available. There is some evidence that a multidisciplinary approach combining physical exercise, vestibular physical therapy, medications, and lifestyle changes may be effective. Treatment with standard acute, as needed migraine medications such as triptans may reduce the length of attacks if the spells are accompanied by headache. As with nonvertigo migraine, acute medications should be limited to 2 days per week, and if this is not up to the job, preventive medication may be needed.

In summary, vertigo associated migraine is fairly common in migraineurs. Diagnosis is made based on symptoms and history. Any unusual red flags such as hearing loss, ear fullness, new and sudden onset, and 1475 Headache: The Journal of Head and Face Pain VC 2015 American Headache Society Published by JohnWiley & Sons, Inc. doi: 10.1111/head.12704 long length of attacks require consideration for nonmigraine and urgent disorders. Treatment of vertiginous migraine is with migraine preventive medication, vestibular rehabilitation, physical therapy, and exercise, but the best scientific studies are lacking on the effectiveness of these treatments. Acute migraine medications from the triptan family show some evidence of benefit if used correctly for attacks.

Deborah Tepper, MD

Harvard Beth Israel Deaconess,

Department of Medicine,

Forestdale, MA, USA

What’s Causing My Headache and Dizziness?

Bacterial and viral infections

If you have a headache accompanied by dizziness, you may just have a bug that’s going around. These are both common symptoms when your body’s exhausted and trying to fight off an infection. In addition, severe congestion and taking over-the-counter (OTC) cold medicines can also cause a headache and dizziness in some people.

Examples of bacterial and viral infections that can cause a headache and dizziness include:

  • the flu
  • a common cold
  • sinus infections
  • ear infections
  • pneumonia
  • strep throat

If you don’t start to feel better after a few days, make an appointment with your doctor. You may have a bacterial infection, such as strep throat, which requires antibiotics.

Dehydration happens when you lose more fluids than you take in. Hot weather, vomiting, diarrhea, fever, and taking certain medications can all cause dehydration. A headache, especially with dizziness, is one of the main signs of dehydration.

Other symptoms of dehydration include:

  • dark-colored urine
  • decreased urination
  • extreme thirst
  • confusion
  • fatigue

Most cases of mild dehydration are treatable by simply drinking more water. However, more severe cases, including those in which you can’t keep fluids down, might require intravenous fluids.

Low blood sugar happens when your body’s blood glucose level drops below its usual level. Without enough glucose, your body can’t function properly. While low blood sugar is usually associated with diabetes, it can affect anyone who hasn’t eaten in a while.

In addition to a headache and dizziness, low blood sugar can cause:

  • sweating
  • shaking
  • nausea
  • hunger
  • tingling sensations around the mouth
  • irritability
  • fatigue
  • pale or clammy skin

If you have diabetes, low blood sugar may be a sign that you need to adjust your insulin levels. If you don’t have diabetes, try drinking something with a bit of sugar, such as fruit juice, or eating a piece of bread.

Anxiety

People with anxiety experience fear or worry that’s often out of proportion with reality. The symptoms of anxiety vary from person to person and can include both psychological and physical symptoms. Headaches and dizziness are two of the more common physical symptoms of anxiety.

Other symptoms include:

  • irritability
  • trouble concentrating
  • extreme fatigue
  • restlessness or feeling wound up
  • muscle tension

There are several ways to manage anxiety, including cognitive behavioral therapy, medications, exercise, and meditation. Work with your doctor to come up with a combination of treatments that work for you. They can also give you a referral to a mental health professional.

Labyrinthitis

Labyrinthitis is an inner ear infection that causes inflammation of a delicate part of your ear called the labyrinth. The most common cause of labyrinthitis is a viral infection, such as a cold or flu.

In addition to a headache and dizziness, labyrinthitis can also cause:

  • vertigo
  • minor hearing loss
  • flu-like symptoms
  • ringing in the ears
  • blurred or double vision
  • ear pain

Labyrinthitis usually goes away on its own within a week or two.

Anemia

Anemia occurs when you don’t have enough red blood cells to effectively transport oxygen throughout the body. Without enough oxygen, your body quickly becomes weak and fatigued. For many people, this results in a headache and in some cases, dizziness.

Other symptoms of anemia include:

  • an irregular heartbeat
  • chest pain
  • shortness of breath
  • cold hands and feet

Treating anemia depends on its underlying cause, but most cases respond well to increasing your intake of iron, vitamin B-12, and folate.

Poor vision

Sometimes, a headache and dizziness may just be a sign that you need glasses or a new prescription for your existing lenses. Headaches are a common sign that your eyes are working extra hard. In addition, dizziness sometimes indicates that your eyes are having trouble adjusting from seeing things far away to those that are closer.

If your headache and dizziness seem worse after you’ve been reading or using the computer, make an appointment with an eye doctor.

Autoimmune conditions

Autoimmune conditions result from your body mistakenly attacking healthy tissue as if it were an infectious invader. There are more than 80 autoimmune conditions, each with their own set of symptoms. However, many of them share a few common symptoms, including frequent headaches and dizziness.

Other general symptoms of an autoimmune condition include:

  • fatigue
  • joint pain, stiffness, or swelling
  • ongoing fever
  • high blood sugar

There are a variety of treatments available for autoimmune conditions, but it’s important to get an accurate diagnosis first. If you think you might have an autoimmune condition, make an appointment with your doctor. They can start by doing a complete blood count test before testing for other things, such as specific antibodies.

Medication side effects

Headaches and dizziness are both common side effects of many medications, especially when you first start taking them.

Medications that often cause dizziness and headaches include:

  • antidepressants
  • sedatives
  • tranquilizers
  • blood pressure medications
  • erectile dysfunction medications
  • antibiotics
  • birth control pills
  • pain medications

Many times, side effects may only occur in the first few weeks. If they continue, ask your doctor about adjusting your dose or putting you on a new medication. Never stop taking a medication without talking to your doctor first.

Woman, 22, With Dizziness and Headache

A 22-year-old student was brought in to a college student health center in a wheelchair by campus safety personnel. She appeared drowsy and was crying softly. She complained of a severe headache and said she was “tired of going through this all the time.” The woman said she had seen spots and become dizzy, then had gotten “the worst headache of my life” while sitting in class. She rated the headache pain at 8 on a 10-point scale and also complained of nausea and photophobia.

The history revealed dizziness that made her “feel as if I’m tipping over” and similar headaches during the previous year. The patient said she had seen “a few doctors” for her symptoms, but that they “could never find anything.” The headaches usually occurred on the left side of her head, lasted hours to days, and were only partially relieved with acetaminophen. The patient could not remember whether she had eaten breakfast and was unsure of what day it was. She described herself as frustrated and began to weep again.

She was currently under the care of a psychologist but seemed uncertain why; she said that she was sexually active and used condoms. She had undergone an appendectomy at age 12. She denied taking any medications besides acetaminophen. She denied smoking or drug use, history of migraine headaches, vision or hearing changes, facial weakness, depression, or anxiety. Her family history included a grandfather with diabetes and hypertension and an uncle with heart disease. The family history was negative for migraine or psychiatric illness.

Because of the patient’s weakness, she was assisted onto the examination table by a nurse. Physical exam revealed a pale, slightly sweaty, overweight, tearful young woman who was slow to respond. Her blood pressure was measured at 134/104 mm Hg; pulse, 100 beats/min; respirations, 14 breaths/min; and temperature, 97.0ºF. Point-of-care testing of blood glucose was 91 mg/dL, and hemoglobin was measured at 12.3 g/dL. The ophthalmologic exam was positive for photophobia and revealed slightly disconjugate gaze with horizontal nystagmus during testing of cranial nerves (CN) III, IV, and VI. The otoscopic exam revealed a slightly injected right tympanic membrane, and there were no apparent hearing deficits.

The neurologic exam showed patellar and brachial deep tendon reflexes equal, grips weak and equal, and the pupillary response intact. The patient was able to stand without assistance, although her gait was slightly unsteady. Because the patient was of college age, the clinician ruled out meningitis by negative Kernig’s and Brudzinski’s signs and absence of fever. Subarachnoid hemorrhage was also a concern when the patient mentioned the “worst headache of my life,” indicating the need for emergent imaging.

The patient’s presentation, it was felt, warranted a 911 call. The emergency medical team arrived, and its members began to question the patient. Discrepancies in the patient’s history during the paramedics’ reexamination led them to question whether an emergency department (ED) visit was necessary, but at the clinician’s insistence, they agreed to transport the student to the ED.

The following day, the student health center clinician was contacted by a member of the hospital ED staff with an update on the patient’s status. Shortly after her arrival at the hospital, she underwent MRI and was diagnosed with a vestibular schwannoma. She had surgery that same evening, during which the surgeon removed most of the tumor. Although the ED staff was not at liberty to provide more complete information, they did inform the clinician that the patient would require radiation for the remainder of the tumor.

DISCUSSION
Vestibular schwannoma is also known as acoustic schwannoma, acoustic neuroma, acoustic neurinoma, or vestibular neurilemmoma. These tumors arise from perineural elements of Schwann cells, which commonly form and lead to myelination in the vestibular area of CN VIII1 (see figure). They occur with equal frequency on the superior and inferior branches of the vestibular nerve and originate only rarely at the cochlear portion of the eighth cranial nerve. Vestibular schwannomas represent approximately 8% to 10% of brain tumors and 80% to 90% of tumors in the cere­bellopontine angle in adults.2 Tumors are distributed evenly across genders, but the majority of diagnosed patients are white.3

Most likely because of improvements in diagnostic technology, the incidence of vestibular schwannoma has increased over the past 30 years. One British research team predicts that one in 1,000 persons will receive a diagnosis of vestibular schwannoma in their lifetime.4 These tumors are most commonly diagnosed in people ages 30 to 60, with a median age of 55.5

A relationship has been demonstrated between neurofibromatosis type 2 (NF2), an autosomal-dominant disease, and the development of vestibular schwannomas.6,7 NF2 has a birth prevalence of one in about 25,000 persons,4,8 and those who inherit the responsible gene inevitably develop vestibular schwannomas.9 Patients with a confirmed diagnosis of vestibular schwannoma should be screened by a geneticist for the NF2 gene; although the tumors are benign, they can cause compression of the vestibular nerve, leading to deafness and balance disorders.10 Schwannomas of the spinal nerves can also occur in persons with NF2.11 Compression of the spinal nerves in these patients can lead to significant morbidity and a shortened average life span.10

25 Oct Tension-Type Headache

Posted at 18:49h in Headache Fact Sheets by headache

Tension-type headache is a nonspecific headache, which is not vascular or migrainous, and is not related to organic disease. The most common form of headache, it may be related to muscle tightening in the back of the neck and/or scalp. There are two general classifications of tension-type headache: episodic and chronic, differentiated by frequency and severity of symptoms. Both are characterized as dull, aching and non-pulsating pain and affect both sides of the head.

Symptoms for both types are similar and may include:

  • Muscles between head and neck contract
  • A tightening band-like sensation around the neck and/or head which is a “vice-like” ache
  • Pain primarily occurs in the forehead, temples or the back on head and/or neck

Episodic

Episodic tension-type headache occurs randomly and is usually triggered by temporary stress, anxiety, fatigue or anger. They are what most of us consider “stress headaches.” It may disappear with the use of over-the-counter analgesics, withdrawal from the source of stress or a relatively brief period of relaxation.

For this type of headache, over-the-counter drugs of choice are aspirin, acetaminophen, ibuprofen or naproxen sodium. Combination products with caffeine can enhance the action of the analgesics.

Chronic

Chronic tension-type headache is a daily or continuous headache, which may have some variability in the intensity of the pain during a 24-hour cycle. It is always present. If a sufferer is taking medication daily or almost daily and is receiving little or no relief from the pain, then a physician should be seen for diagnosis and treatment.

The primary drug of choice for chronic tension-type headache is amitriptyline or some of the other antidepressants. Antidepressant drugs have analgesic actions, which can provide relief for headache sufferers. Although a patient may not be depressed, these drugs may be beneficial. Selecting an antidepressant is based on the presence of a sleep disturbance. For the patient with chronic tension-type headaches, habituating analgesics must be strictly avoided. Biofeedback techniques can also be helpful in treating tension-type headaches.

Chronic tension-type headache can also be the result of either anxiety or depression. Changes in sleep patterns or insomnia, early morning or late day occurrence of headache, feelings of guilt, weight loss, dizziness, poor concentration, ongoing fatigue and nausea commonly occur. One should seek professional diagnosis for proper treatment if these symptoms exist.

Headaches in Children and Adolescents: When Should a More Serious Problem be Suspected?

Many parents worry that their child’s headache is a sign of a brain tumor or other serious medical condition. This is usually not the case. Stress and muscle tension or migraine cause most of the headaches seen in children and adolescents. Headaches can also occur with fever, colds, the flu, and other upper respiratory infections. However, only your doctor can evaluate your child’s headache to determine its cause.

When might a headache be a symptom of a more serious health problem?

A more serious problem may exist when a child’s headaches:

  • Increase in number (three or more a week), keep getting worse, or won’t go away.
  • Don’t respond to simple therapy.
  • Wake the child from sleep.
  • Are triggered by exertion, coughing, bending, or strenuous activity.
  • Occur along with balance problems, loss of muscle strength in the limbs, vision problems, dizziness, or loss of consciousness.
  • Occur along with a stiff neck or fever.
  • Occur along with projectile vomiting, blurred vision, and confusion.
  • Occur and there is no family history of similar headaches.
  • Occur and there is a family history of neurological disease.

Neurologic symptoms that may indicate a brain problem as the cause of the headache include:

  • Seizures — loss of consciousness.
  • Ataxia — loss of muscle coordination, especially of the arms and legs (for example, can’t walk, pick up objects, or maintain balance).
  • Lethargy — sluggish, sleepy, tiredness.
  • Weakness — especially on one side of the body.
  • Nausea and vomiting — especially if it occurs in the early morning or is becoming more frequent or more severe.
  • Visual problems — blurred vision, double vision, decreased vision, eye movement problems, blind spots.
  • Personality change — acting inappropriate or a change from previous behavior, feeling sad or depressed, rapid mood swings from happy to sad or sad to happy.
  • Slurred speech or numbness/tingling.

Other signs of a more serious health problem:

  • Abnormal temperature, breathing, pulse, or blood pressure.
  • Swelling (inflammation) of the optic nerve (this condition is also called papilledema). (The optic nerve is the nerve in the back of the eye.)
  • An enlarged head.
  • A noise, called a bruit, in the head heard through a stethoscope.
  • Coffee-colored spots on the skin.
  • An abnormal neurological exam.

What known serious medical conditions can cause a headache?

Serious medical conditions that may cause a headache include:

  • Brain tumor
  • Abscess (infection of the brain)
  • Intracranial bleeding (bleeding within the brain)
  • Bacterial or viral meningitis (infections)
  • Hydrocephalus (excess cerebrospinal fluid in the brain)
  • Pseudotumor cerebri (increased pressure in the brain)
  • Seizure disorders
  • Trauma (injury) to the head
  • Changes in metabolic functions, such as changes in blood sugar level, sodium level, or dehydration
  • Drinking chemicals or poisons

How do doctors determine if my child’s headaches indicate a serious health problem?

First, your doctor reviews the child’s headache history. Your doctor will ask how often the headaches occur, how long they last, and any signs and symptoms that occur before, during, or after the headaches. Your doctor will also perform physical and neurological exams to look for signs of an illness that may be causing the headache.

Tests your doctor may order include a MRI scan (magnetic resonance imaging) and a MRA scan (magnetic resonance imaging of the arteries). Both imaging tests show the tissues and arteries in the brain. Skull X-rays are not helpful. Unless the child has lost consciousness while having headaches or a seizure is suspected, an EEG (electroencephalogram) is not needed. If a patient arrives at a hospital’s emergency room, a CT scan is often ordered.

When should I call my doctor about my child’s headache symptoms?

Contact your health care provider as soon as possible if your child has experienced ANY of the symptoms or signs mentioned above. In addition, call if your child:

  • Needs to take a pain reliever more than two or three times a week for the headaches.
  • Needs more than the recommended doses of over-the-counter (nonprescription) medications to relieve headache symptoms.
  • Misses school due to the headaches.

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