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What causes dizziness, cold flushes behind the head, cold hands and fatigue?

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Posted on Tue, 10 May 2016
Question: Hello, yesterday I had what felt like anxiety which I do have. I had a dizzy spell when I got out of the truck after a lengthy drive. It passed fairly quickly. I thought it might have been from sitting so long and getting up fast. This morning I had what felt like a cold flush from the back of my head down. Sort of the base of neck area down. My hands felt cold and I felt tired and slowed down. This has happened one other time maybe 3 weeks ago.
when it happens I also feel tired

I take 10 mg of hydrochlorithiazide. I take Paxil 30 mg at night. I feel like this is either low sugar OR blood pressure. My heart didn't seem to race at all when this happened. I don't have tingling in my arms or legs and am able to speak. It sort of seemed that my throat was tight when I swallowed. That has passed. I do have tight shoulders from working and often get a left shoulder sore muscle like a big knot. IT seemed like after I stretched my neck out that the episode happened


i do have dx anxiety/panic disorder. I am in the change with menopause. Hot flashes etc. I feel like I have had more anxiety in the past 6 months. Sometimes I feel I bring this on myself thinking I am going to have a panic attack.
doctor
Answered by Dr. Bonnie Berger-Durnbaugh (3 hours later)
Brief Answer:
Possible causes:

Detailed Answer:
Hello and welcome,

I'm sorry you are having this trouble.

I don't have the advantage of doing an examination, but I'll offer some thoughts on this. It's possible that your symptoms are a variant of a panic attack as you have a history of anxiety disorder. However, we should make sure first that there isn't a medical cause before attributing it to anxiety.

As this happened after a long drive and then stretching your neck, a pinched nerve is possible and can create a cold skin sensation and sometimes light headedness. Low blood pressure or low blood sugar can cause the light headedness and also the fatigue afterwards. Pinched nerve is less likely to create the fatigue.

I would suggest:
1. Go to doctor for an exam and to see if there is the possibility of a pinched nerve.
2. Ask the nurse who checks you in to check orthostatic blood pressure and pulse. This is a BP and pulse check when you are lying down, then seated, then standing. It can show if your blood pressure is not rising adequately when getting up.
3. I recommend the following blood tests:

CBC - to check for anemia and occult infection
TSH - to check for thyroid function
Electrolytes/chemistry panel - to check potassium and sodium levels
Fasting blood sugar.

The doctor may want to do other tests as well after examining you.

I hope this information helps. Please let me know if I can provide further information.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Bonnie Berger-Durnbaugh (30 minutes later)
Thank you so much. I feel totally normal now. I know that this happened twice to me when I stretched my shoulder/neck (left)...that cool sensation down the back of my neck and hands. I think that scared me and triggered a panic episode. I usually just wait it out. However I am going to go see my Dr just to talk about this. I take Paxil and have for about 15 years. I wonder too if I should change to a different anti anxiety. Plus I am going thru Menopause with hot flashes, irritability, some insomnia. UGh! Any other comments are appreciated and I thank you
doctor
Answered by Dr. Bonnie Berger-Durnbaugh (29 minutes later)
Brief Answer:
About the other symptoms:

Detailed Answer:
Regarding the increase in anxiety, if Paxil has worked for you in the past, it's possible you may benefit from just having a slightly higher dose. For panic disorder, dose range is 10 - 60 mg, so you are in an intermediate range.

You can try a different SSRI such as Lexapro (escitalopram) which is a newer SSRI, but your doctor should transition you very slowly.

Regarding the hot flashes and insomnia related to menopause, new studies show that SSRIs (including Paxil) can be helpful for these. But if they aren't doing the job, you may want to consider adding a low dose of hormone replacement therapy for a short time such as conjugated estrogen/bazedoxifene or a combination estrogen-progesterone.

If you are interested in trying alternative therapies, some women get benefit from acupuncture. I'd suggest finding a practitioner who was actually trained in China if possible. I think their training in this is more extensive than the Traditional Chinese Medicine schools in the US. If you can't find that, go for a practitioner who has a lot of experience. Also, women have benefited from black cohosh. You can buy this herb in capsules.

Regular exercise is very good for helping anxiety. And, if there are any issues that increase or keep the anxiety going, you may want to talk with a psychologist to help work these out.

Your thought about having the cool/cold sensation followed by panic is very likely. I have had anxiety/panic (and am close to your age) and know that a real physical symptom can then trip the the panic reaction.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Bonnie Berger-Durnbaugh (2 hours later)
Thank you again for writing back. I actually had a very great day and felt good. I do however have a huge knot in my shoulder and again, pretty certain that is what caused the cool flush thingie. I might try the black cohosh. I had also heard that was good. I'm hesitant to do on the replacement therapy with the cancer risks. I just joined the gym so that will certainly help. I was an athlete back in the day but now struggle with weight. Anxiety/panic runs in our family. My niece is on Lexapro and said she likes that better than Paxil. Anyway, I still plan on seeing my Dr just to go over all of this but it is nice to have quick access to a professional online. My how times have changed. I see you are from XXXXXXX I live over my Menomonie WI. I think you all are going to get some snow tonight but we are too from what I hear. Thanks again for your advice Dr XXXXXXX
doctor
Answered by Dr. Bonnie Berger-Durnbaugh (3 hours later)
Brief Answer:
Hasn't started snowing here yet!

Detailed Answer:
I agree about being hesitant regarding hormone replacement therapy. For women that have nearly unbearable symptoms, it is probably worth it for a short duration.

Lexapro has overall fewer side effects compared with the older antidepressants. Lexapro is said to be a pharmacologically "cleaner" serotonergic antidepressant.

Paxil is still a good SSRI antidepressant. One of the main problems with Paxil though is that it is one of the antidepressants with the highest incidence of weight gain. Not all people have this from Paxil, but many do. Lexapro (or generic escitalopram) has a lower incidence of weight gain compared with Paxil.

I hope you all in Menomonie don't have to shovel out too much tonight.




Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Bonnie Berger-Durnbaugh (25 hours later)
I was TOTALLY OFF with the snow thing. However we are suppose to get something friday. Then the warm days start...FINALLY! Have a good week Dr Bonnie! Thanks again for your knowledge and suggestions. :)
doctor
Answered by Dr. Bonnie Berger-Durnbaugh (1 hour later)
Brief Answer:
Your welcome!

Detailed Answer:
If you have no further questions right now, you can go ahead and close the discussion. If you have a subscription with HCM and want to ask a question in the future and have it routed to me, just include my name (or Dr. Bonnie) at the beginning of your question.

Wishing you well (and hoping you have a good Spring)!

Bonnie Berger-Durnbaugh, MD
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 3134 Questions

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What causes dizziness, cold flushes behind the head, cold hands and fatigue?

Brief Answer: Possible causes: Detailed Answer: Hello and welcome, I'm sorry you are having this trouble. I don't have the advantage of doing an examination, but I'll offer some thoughts on this. It's possible that your symptoms are a variant of a panic attack as you have a history of anxiety disorder. However, we should make sure first that there isn't a medical cause before attributing it to anxiety. As this happened after a long drive and then stretching your neck, a pinched nerve is possible and can create a cold skin sensation and sometimes light headedness. Low blood pressure or low blood sugar can cause the light headedness and also the fatigue afterwards. Pinched nerve is less likely to create the fatigue. I would suggest: 1. Go to doctor for an exam and to see if there is the possibility of a pinched nerve. 2. Ask the nurse who checks you in to check orthostatic blood pressure and pulse. This is a BP and pulse check when you are lying down, then seated, then standing. It can show if your blood pressure is not rising adequately when getting up. 3. I recommend the following blood tests: CBC - to check for anemia and occult infection TSH - to check for thyroid function Electrolytes/chemistry panel - to check potassium and sodium levels Fasting blood sugar. The doctor may want to do other tests as well after examining you. I hope this information helps. Please let me know if I can provide further information.