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Dizziness With Headache And Nausea. History Of Migraine. MRI, CT Scan, EKG Normal. Why Is This Happening?
Question: I am a 56y old female that has had dizzy spells with fainting 3 times in the past month. I was Hospitalized 2 days ago for the worst episode. I felt like I could not breath and was sweating before I passed out briefly. I developed a headache with nausea. The first thing they checked was my heart with EKG that was ok. I have a history of migraine/seizure from 2 head injuries in the past year. They did lab work, ct without contrast, mri, mra and kept me over night and said everything was within normal limits but to see my neurologist asap. I did see the neuro and he is doing 3 day eeg test and having me tested at seizure lab, plus evaluated by a cardiologist. Now it is Friday and I just had 2 more dizzy spells that are scary. I feel less concerned after all the testing at the Hospital this week and hate to go back to ER. I checked my blood pressure while I was dizzy and was surprised that it dropped to 109/56 then jumped to 156/98 after the dizziness stopped a few minutes later. BP is all over the place and i feel like i can't breath. So i took an aspirin.
Hi XXXXXXX
Thanks for writing in.
Undoubtedly with your history some symptoms like nausea, difficulty in breathing and headache can be explained with the diagnosis of Migraine. It could be post traumatic seizures, Please provide with a list of all the drugs you are taking.
More so because, the recent episode which you described when you had dizziness with BP of 109/56 and no dizziness 156/98 could be drug related postural hypotension. So, I want to know whether you are being treated with drugs to lower the blood pressure. Once we have answers to these questions various diseases you are suffering from will become clear and a treatment plan can be evolved.
Looking forward to answers to the question of injury, seizure description, migraine description and drugs. Please add anything you feel could be relevant for me to reach a comprehensive diagnosis.
With Best Wishes.
Dr Anil Grover
Thanks for writing in.
Undoubtedly with your history some symptoms like nausea, difficulty in breathing and headache can be explained with the diagnosis of Migraine. It could be post traumatic seizures, Please provide with a list of all the drugs you are taking.
More so because, the recent episode which you described when you had dizziness with BP of 109/56 and no dizziness 156/98 could be drug related postural hypotension. So, I want to know whether you are being treated with drugs to lower the blood pressure. Once we have answers to these questions various diseases you are suffering from will become clear and a treatment plan can be evolved.
Looking forward to answers to the question of injury, seizure description, migraine description and drugs. Please add anything you feel could be relevant for me to reach a comprehensive diagnosis.
With Best Wishes.
Dr Anil Grover
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I am taking Topomax 100 mg for Migraine/seizure and lisinopril for blood pressure. I take the Topomax at night and lisinopril in am. I did not know difficulty in breathing can also be caused by migraines.
I have retinal migraine and nystagmus at times but when I get these new dizzy spells I get double vision as i feel like my head is being squeezed. After my first head injury I had vertigo for several months so I know this is different and more like I am falling to one side.
My neck was injured also and I am scheduled for fusion on 4 disc in my neck next week so I don't think I should take aspirin either.
I feel better knowing the shortness of breath may be from something other than my heart .
Thank You for your time and kindness,
Nancy
I have retinal migraine and nystagmus at times but when I get these new dizzy spells I get double vision as i feel like my head is being squeezed. After my first head injury I had vertigo for several months so I know this is different and more like I am falling to one side.
My neck was injured also and I am scheduled for fusion on 4 disc in my neck next week so I don't think I should take aspirin either.
I feel better knowing the shortness of breath may be from something other than my heart .
Thank You for your time and kindness,
Nancy
Hi XXXXXXX
Thank you for your prompt reply.
Not only breathlessness; slurring of speech to aphasia, weakness to move one part of body (hemiplegic migraine) are symptoms described in medical nature. The breathlessness you had was followed by fainting that is why I counted in the migraine symptoms complex.
However, for someone who is scheduled for surgery in a few days (you are right in discontinuing aspirin) we have to exclude breathlessness is not originating from your lungs or heart.
You never had any rapid breathing, cough, wheeze therefore, lungs are not in picture. A hypertensive patient can have breathlessness when due to stiffness of heart and back flow of blood thus filling pulmonary veins (which drain oxygenated blood to heart) this is called diastolic dysfunction pulmonary venous congestions. You do not have symptoms of uncontrolled hypertension or breathlessness waking you from night (air hunger). Therefore, I consider it unlikely. Again, it may mean that you do not require treatment and feel better about this fact. Nevertheless, in view of planned surgery next week I would feel much better if your doctor sees your EKG and echocardiograph for Left Ventricular Hypertrophy and evidence of ischemic heart disease. Your doctor will have to adjust the time of intake of anti hypertensive drugs or modify the dose so that you do not get postural hypotension. An episode you vividly described in your last mail. I am sorry that you had a fall due to illness and now have to undergo surgery.
If there is any further question I will be most happy to answer.
With Best Wishes
Dr Anil Grover
Cardiologist
Thank you for your prompt reply.
Not only breathlessness; slurring of speech to aphasia, weakness to move one part of body (hemiplegic migraine) are symptoms described in medical nature. The breathlessness you had was followed by fainting that is why I counted in the migraine symptoms complex.
However, for someone who is scheduled for surgery in a few days (you are right in discontinuing aspirin) we have to exclude breathlessness is not originating from your lungs or heart.
You never had any rapid breathing, cough, wheeze therefore, lungs are not in picture. A hypertensive patient can have breathlessness when due to stiffness of heart and back flow of blood thus filling pulmonary veins (which drain oxygenated blood to heart) this is called diastolic dysfunction pulmonary venous congestions. You do not have symptoms of uncontrolled hypertension or breathlessness waking you from night (air hunger). Therefore, I consider it unlikely. Again, it may mean that you do not require treatment and feel better about this fact. Nevertheless, in view of planned surgery next week I would feel much better if your doctor sees your EKG and echocardiograph for Left Ventricular Hypertrophy and evidence of ischemic heart disease. Your doctor will have to adjust the time of intake of anti hypertensive drugs or modify the dose so that you do not get postural hypotension. An episode you vividly described in your last mail. I am sorry that you had a fall due to illness and now have to undergo surgery.
If there is any further question I will be most happy to answer.
With Best Wishes
Dr Anil Grover
Cardiologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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