Question: I have been waking up with a headache for about five weeks. For the first week and a half, it was a dull headache across my forehead. My 7-year-old son had brought a head cold home from school so I thought I was catching it. Then I suspected possible low blood sugar because I had not been eating well, had no appetite. About 10 days in the headache settled on the right side of my head with throbbing in my right temple. When it gets really bad, I have these foggy/shaky/spacey spells and I've lost some short-term memory. I am also having tremors in my hands and feet, some mild incontinence, which I'm not aware is happening and a burning sensation on the skin of my abdomen and it wraps around the sides to the back sometimes. I am not sensitive to light or sound and I have no nausea. Though it gets better and worse (no patterns that I've been able to distinguish) the headache is with me all day. I was referred to a neurologist, but the wait was about 6 weeks, so went to the ER and agreed to be admitted to the hospital for tests. I had an EKG, a CT, a chest X-ray, head and neck MRIs, and EEG and a 2-D Echo to rule out anything cardiac. They also had me on constant cardiac monitoring for two days. They took dozens of vials of blood. I came out exhausted, sore, weak and frustrated, but after three days had no diagnosis. After I got out of the hospital, while washing my hair to get the EEG adhesive out, I had a shaky spell and discovered that everything comes into total balance and peace when I close my eyes. In complete darkness with my eyes open, however, it does not go away. The imbalance becomes worse because I have no frame of reference and I see red, blue and green floaters.

Dr. XXXXXXX - thanks for your detailed response.

The three possibilities I left the hospital with were:
- Menopause
- Vasovagal reaction to the pain from my headache
- Stress/Depression

Menopause has been ruled out, as all of my hormone levels tested normal, despite the fact that I'm not having my menstrual cycle.

The neurologist I saw in the hospital told me to work on reducing my stress before my follow-up appointment (Nov. 7) to see if my symptoms get correspondingly better as the stress is reduced. This has been a challenge as I recover from the hospital stay and transition back to my work routine and caring for a young boy. My son is great, he does not stress me out, but his dad took him camping for the weekend so I could rest from all the tests and blood draws as I was very sore.

Here are the answers to your questions, in CAPS:

I have few questions for you:
1. Which kind of hand tremors do you have? at rest or while working or with outstretched hands? AT REST, AND WHEN WORKING ON THE COMPUTER, BUT NOT WHEN DOING SOMETHING LIKE WASHING DISHES OR COOKING. IT IS MOSTLY THE THUMB AND INDEX FINGER ON MY RIGHT HAND AND THE PINKY FINGER ON MY LEFT. VARIOUS TOES ON THE RIGHT FOOT, WHEN AT REST. SO FAR MY LEFT FOOT HAS BEEN UNAFFECTED.
Continuous or episodic? EPISODIC
2. Do you have difficulty in walking? NO Can you stand still with eyes closed and both the legs together? YES
3. Does your hand shakes while reaching a target during any activity? NO
4. Do you have difficulty in vision? ONLY WHEN THE HEADACHES GET ESPECIALLY BAD AND THE SHAKY/SPACEY SPELLS COME ON
5. Do you have tingling and numbness in feet and back of leg? YES, I HAVE MUSCLE SPASMS IN MY LEG AS WELL
6. Do you have dizziness and blackening in front of your eyes while rising from sitting position suddenly? NO
7. Do these symptoms occur only after any stressful event or thought? THE ONLY WAY I CAN EXPLAIN IT IS THAT IT ALL COMES IN WAVES. FOR EXAMPLE, MY BOSS WANTED ME BACK ON THE JOB (I'm a newspaper reporter) THE DAY AFTER I WAS DISCHARGED FROM THE HOSPITAL. WHILE TALKING ON THE PHONE WITH HIM, MY HEADACHE GOT WORSE. THEN I STARTED TO GET THE SHAKY/SPACEY SYMPTOMS. BUT, IT ALSO COMES ON WHEN I AM JUST LYING IN BED OR DOING ROUTINE TASKS. I'VE FOUND NO REAL PATTERN EXCEPT THAT IT HAPPENS WHEN MY HEADACHES WORSEN. THE HAND TREMORS DON'T SEEM TO BE RELATED TO THE HEADACHES OR SPELLS, THEY COME AT RANDOM TIMES.
8. Do you have salivation involuntarily from your mouth? NO Do you arm movement while walking is lost? NO Do you feel your body rigid? NO

Note: My hand and foot tremors got really bad during the EEG and the head MRI, but not during the MRI of my neck. My headache got pretty bad during all the tests, but I used my meditation techniques to stay calm and when that was getting old, I "played music" in my head to keep me calm during the MRIs and the EEG.

Thanks for taking the time to give me your insight. As you can tell, this is all quite a mystery to me and I'm concerned that it may be something serious that may keep me from my work or daily activities.
XXXXXXX

Dr. XXXXXXX -- A couple more things. I think this will cross with your answer to me as I just got an email from the system.

This may or may not be related, but I'm also being sent to see a rheumatologist. Right after my son was born 7 years ago, I began having joint pain in my hands and feet, I was having a lot of trouble dressing my baby. My OB/GYN on the suspicion of RA sent me to a family doctor who spent three months having me map my pain on paper pictures of the body and prescribing expensive medications that made me sick (high doses of NSAID which I did not want to take for fear of kidney damage, and then Celebrex). I had a newborn at the time and gave up on that process before getting RA diagnosed because I didn't feel like my doctor was really "getting it" about the chronic pain. The symptoms persist and have gradually moved into most of my joints. I deal with it every day without medication by trying to take good care of myself, by getting enough sleep, eating right and walking 2-3 miles a day 3-5 times per week. I have not been sleeping well for several months, and the headaches and shaky/spacey spells have kept me from getting out on the beach and walking. This has all contributed to my depressed emotional state.

I get flares of joint pain 3-4 times a year and they last between three days and a week, depending upon whether I have a cold or something else. I get low-grade fevers and flu-like symptoms. My doctor ordered a rheumatology blood panel but I do not have the results of that yet. They suspect it also might be lupus.

With regard to the B12 deficiency, I had been taking vitamins each day that had 8mcg of B12, but I stopped taking them because they were a gummy vitamin and contained lactic acid, which my acupuncturist thought might not be a good thing for me to ingest as it could aggravate my joint pain. So the fourth possibility for the hand/foot tremors is that my RA has gotten worse, or that it might not be RA, but rather Lupus.

Hope that helps.

Trying this again, apologize if you get dups, the system doesn't seem to be saving my questions. I copy/pasted it into a Word document this time to save it.

Dr. XXXXXXX - I thought I sent a lengthy reply but it seems to not be here, so I'll try to remember what I wrote.

I looked at photos of that Lupus rash, I've never had anything like that. I am a fair-skinned redhead and have some pink in my cheeks, but nothing that's ever concerned me.

Between now and my neurologist appointment on Nov. 7, I'll pay more attention to my hand and foot tremors, as I've only been taking note of the large ones because I try to control them and hide them from other people. I do have a fairly constant tiny movement, almost a twitchy vibration in my hands, legs and feet. It's hard to explain, nothing that could be observed by someone else from the outside, but I notice it because I feel it from the inside.

Stress and anxiety are an unavoidable part of my job as a newspaper reporter. At the company I work for, we feel like we are in battle-stations mode all the time. It's been like that for nearly six years straight with no break. I guess I'm afraid that I will need to somehow make a choice between my career and my health.

Depression could definitely be a significant factor as well, I've suffered from it on and off since my mother died 10 years ago and no amount of talk therapy really helps much - I've basically put two different therapists' kids through college. The relationship that I mentioned that ended this summer was my great escape from a very stressful life and from the monotonous domestic tasks that suck the life out of a very creative person like me. I got involved with a man 17 years my junior. It started out as a friendship, then a casual thing, but we developed an unexpectedly close connection. He made me feel 27 again and I rediscovered aspects of myself that I thought were long gone. My whole outlook on life changed, I was so happy for the first time since before my mom died. I felt great and began living life to the fullest. My son even commented that he had a "new mommy." I even started having my menstrual cycle again after two years of no periods. But after nearly seven months I knew we were at different places in our lives and that I could not make him a part of my "real life" as a 44-year-old single mom. He knew it, too. The decision was mutual. He wants to get married someday soon and have children of his own. He would make a great husband and father - with someone his own age with whom he can build a life. I love my son dearly, but it meant so much to have someone in my life who was just for me, who made me feel beautiful and alive and safe and cared for. I've had a lot of great relationships with wonderful men, but this one was different, an extremely loving person with a kind spirit. I resent not having that escape anymore. I really fell hard for this guy and I feel like something broke inside me and has not yet mended and I don't know how to fix it. Broken heart, maybe, if that's a real thing. Everything is like a huge chore now and I feel like the best part of my life is now behind me, like I'll never feel that way again. That's when many of these health issues started to crop up, and I also stopped having my menstrual cycle. I don't think all of this is a complete coincidence. Maybe my diagnosis is lovesick.

Thanks so much for your time and for giving me your best take on what's going on with my health problems. I will get checked for B12 (my acupuncturist suggested that as well) and will do that research into Parkinson's and Lupus as you suggested.
XXXXXXX

One more thing I forgot to ask when I tried to remember what I wrote, what do you make of the Theta waves in my left temporal lobe that showed up on the EEG? Could that be related to the Lupus or Parkinson's, or to the depression?