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What causes llightheadness and headache inspite of having controlled diabetes and BP? - Online Doctor Chats

Date : 26-Mar-2014
User rating for this question
Very Good Posted in: Headache and Migraines
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1626 Questions
User:Hi I have been having feelings of lightheadness for over 12 months now, headaches as well.have had a CT scan and MRI found nothing wrong with brain, seen a nurologist nothing wrong, Diabetes and high blood pressure are fine....

I suffer with hayfever and am now wondering if it could be allergy
Doctor:You mentioned that you have feeling of lightheadness, does it occur throughout the day?
Doctor:Or at specific instances?
User:Yes it does
User:not specific circumstances
Doctor:Since its been for over 12 months, will you be able to name some factors that aggravates it or relieves it?
User:there does not seem to be anything that aggrevates it some times pandol helps but not always
Doctor:Besides this feeling what other symptoms do you experience?
Doctor:Any complaints of headache, visual disturbances, hearing problems, nausea, imbalance?
Doctor:I would like more details as some cases of allergy can manifest as light headedness
User:dizzyness- but its a feeling of feeling unsteady and when walking its like I am on a ship feel like I am walking on an angle, headache, sometimes nausea and yes imbalance no visual disturbance or hearing problems
Doctor:I would need to understand the factors involved in causing lightheadedness to be able to convincingly confirm it.
User:what do you mean?.
Doctor:Let me explain that.
Doctor:Allergy related complaints are short lived. I mean you do get recurring symptoms but they do resolve with time.
Doctor:Since you mention that you have lightheadedness on most occasions of the day
Doctor:I might be wrong if I blame it on Hay fever.
User:I cant think of any other causes.
Doctor:I see that you have history of diabetes and blood pressure. May I know how are you treating it?
User:I was diet controlled diabetic until 2 weeks ago now on metform as GP said readings were to high as my morning fasting one was around 7 but my 17HBC was great for blood pressure I am on coverram
Doctor:Did you check blood pressures recently?
Doctor:How long have you been on coverram?
Doctor:Are you with me?
User:yes, my BP is good 120/75, been on coverram for about 8yrs
Doctor:Ok Let me brief you.
Doctor:There are few conditions that might cause the lightheadedness
Doctor:You may discuss about those factors with your treating doctor.
Doctor:1. Is blood pressure variations. Since you have a long history of diabetes and hypertension
Doctor:both these factors are known to disturb autonomic functions
Doctor:resulting in variations.
User:definatly not 1 already checked this one out
Doctor:Your doctor should check your blood pressures in different position to understand and evaluate it.
User:done that also with nurologist
Doctor:2. Second but less likely possibility is drug induced dizziness. Coverram is listed to caused lightheadedness in small set of people.
Doctor:Perhaps trying a different antihypertensive drug such as telmisartan (angiotension receptor blocker) may be tried.
Doctor:3. Cervical spine pathologies.
User:cant be 2 been on it was longer then the problems
Doctor:Age related cervical spine problems are known to cause lightheadedness / imbalance issue.
User:the MRI CAT scans said no spine problems
Doctor:your doctors should perform X-ray or MRI scan of the spine.
Doctor:3. Hematological, metabolic and nutritional disturbance. I order for blood hemoglobin level, vitamin b12, folic acid, thyroid levels
Doctor:to verify these conditions.
User:done also all blood tests fine
Doctor:4. And the last possibility is from psychological factors which need to be assessed by a psychiatrist.
User:done that to
Doctor:5. If you have done all these,
Doctor:I would urge you to visit a cardiologist to verify your heart functions.
Doctor:ECG and echocardiogram may be needed too.
User:done that to had the ECG and stress test done all good
User:as all this isdone and cleared that is why i thought allergy
Doctor:As I mentioned allergic condition does cause light headedness; but during times of allergy.
Doctor:In my opinion allergy isn't the likely cause.
Doctor:At this point of time, without a clinical examination I am unable to think of other conditions to direct you.
Doctor:I apologize for not being able to help you through.
User:hi again
Doctor:I am sorry
Doctor:Is there anything that I could help you with?
User:well I hope so Dr really didnt give me any ideas on the cause of my problems I have had stress test on heart all good, have had blood tests all good, seen pysologist all good, had CT scan and MRI all good, see nurologist all good, BP good, BSL good what else can be casuing these lightheaded eposoides
User:i do suffer with hayfever and have noticed my nose blocks up a bit when I laydown ie at night time I have been experience some breathless as well
Doctor:Well, let me read your query
Doctor:Is this lightheadedness your only symptom apart from the nose blocks?
User:and headaches but the lighteadness is contant where the other two come and go I can go a day without a headache and then have it all day on others
Doctor:so, you already have high blood pressure and on medications for it?
User:yes coverram have been on it for at least 7yrs now
Doctor:hmm, I see
Doctor:since when are you experiencing the light headedness?
Doctor:is it constant throughout?
User:dec 2012
Doctor:is your blood pressure under good control?
Doctor:or it fluctuates?
User:yes constant not a day goes by without it my BP is under good control I check it regar and its good sits around 120/70 highest was 140/80
Doctor:all right
Doctor:have you done a CT scan of your brain or an angiography of your carotids?
User:brain and neck.spine
User:and MRI of same
Doctor:I would think of a block in the carotids in this scenario
Doctor:Why don't you get a CT or MR angiography of both the carotids
User:what is a block in the carotids?. and how does this get testd?.
Doctor:this is to look for plaques
Doctor:A block in the carotids can happen when there is atherosclerosis or increased fat or lipids in the body
User:does the stress test/photos not show this up?.
Doctor:Definitely, a block in the carotids can cause lightheadedness in the background of high blood pressure
Doctor:an angiography can only show this
User:what part of the body is this done on what is an angiography and who can do it?
Doctor:over the neck and head region
Doctor:an interventional radiologist does it
User:we are limited hear as to specilists but we do get a guy that does ultrasound just goggled it is this all i need
Doctor:hmm, i see
Doctor:you can get a carotid doppler or ultrasound done
Doctor:that should suffice as well
Doctor:the sonologist can do it
User:My GP did say that the MRI said in the deeper part of brain I had an area of blood flow problems but not not serious but put me on plavix for it and I had a reaction to it and was very dizzy, sick and stomach pains so went back to see him he took me off it as he said it was not that bad
User:so I am thinking you might be on the right pARTH with is plaque idea.
User:assuming it is what sort of treatment for it?. is it just medication or?.
Doctor:medical and surgical management
Doctor:medical for small plaques
Doctor:surgical intervention for large ones
User:surgery on brain?.
Doctor:on the location of the area of plaque
Doctor:depending on the location either brain or carotid artery
User:oh ok
User:can you think of any other possible medical issues that could cause these symptoms that we have not thought of
Doctor:let me think
Doctor:yes, I was thinking of this too earlier
Doctor:perhaps there is a variation in the way the blood pressure medicine acts in you
Doctor:it either makes your blood pressure too low or inadequate to control it
Doctor:You can record your blood pressure at home,while the lighheadedness worsens
Doctor:A continuous recording can help in assessing the efficacy of drug treatment
Doctor:If need be, your doctor can change over to different drug
User:I have tried this makes no difference and have been on medication for years.
Doctor:In the context of diabetes, lightheadedness occurs in hypoglycemia
Doctor:When the blood sugar levels drop
Doctor:least possible is this being due to inner ear problems
Doctor:get this checked by your ENT Specialist
User:I have tested my BP even at times of really bad lightheadness and its is fine same with my BSL I know there are times when my BSL has been high or low and been dizzy but other times it has been normal and still dizzy am sure this is not problem.. I dont have a ENT specilist none out my way and I was on weightlist for 6 months for nurologist
Doctor:sorry about that
Doctor:this is all I can think of now
Doctor:perhaps, a detailed clinical examination can help me further
Doctor:unfortunately, this cannot happen
Doctor:sorry about it
User:thats in fine, you have helped me with the carotid idea GP has not thought of that i will go see him and run it past him and see what we can do at most its problem at least is another condition we can cross off list than you
Doctor:please go ahead and discuss about it with your GP
Doctor:Wish you good health as well
User:yes i think so thank you for your help
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