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What causes lightheadedness and headache?

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General & Family Physician
Practicing since : 2005
Answered : 2560 Questions
My husband (52yrs & diabetic) has recently (last couple of days) started suffering from light-headedness at various times of the day and night. He just suffered an episode not that long ago after receiving fellatio, he said that the light-headedness started after he got up (he always sits on the side of the bed before getting up) and when he got back into bed a dull ache started in his forehead and this time he felt a slight throb in his head but felt most of the throbbing in a couple of his toes on one foot. He said the light-headedness has settled now but still has a bit of dull ache in the forehead. When he rolled onto his side the light-headedness started again. He said there is no feeling of the room spinning or moving but his vision is slightly blurry. He is sound asleep now, it's 3:10am here. Sometimes (not this time) at the end of fallatio he will have the feeling of about to have a huge orgasm only to get a very severe sudden headache and says he is unable to move his body for a few minutes, instead of having an orgasm (no fluid released). His blood pressure was checked recently when he was getting tested for sleep apnea and was perfect, he does have untreated gastritis which is giving him alot of problems. I also think he is deficient in iron and B12 as he is sleepy all the time, suffering mood changes, stomach pain, sometimes weakness, loss of appetite, light-headedness, pain in the middle of chest (heart has been checked before and is perfect), has a lot of bleeding from the bowel (had colonoscopy and endoscopy- both were clear the only thing found was gastritis. Both tests were done after having a CT scan say he had a lesion on his upper fundus and what they think are 2 cysts on his liver). His stomach gets swollen and firm and he has a lot of pain in the middle of the bottom of the ribs and across to the right, while having that pain he constantly opens his bowels for 2 days, then starts bleeding from the bowel, any where from 1hr up to 1 1/2 days (all the while his pain and feeling unwell is getting worse). When he stops bleeding he will still feel unwell and have pain for a day or two then it settles and he can feel not to bad (but still has the pain in the same area) from a couple of days to a week before we are back to the bleeding cycle again. He also has restless legs and we are awaiting sleep test results. Is everything related to the gastritis and possible deficiencies or could he be suffering from several things at once. Sorry it is so long but I wanted to give you as much information as I could.
Posted Sun, 24 Aug 2014 in Digestion and Bowels
Answered by Dr. Prasad 9 hours later
Brief Answer:
Yes, these are different issues...

Detailed Answer:

I went through the entire history with diligence. It was fairly long and deep. And in my opinion there are multiple conditions here. Let me name them.

1. The current episode of lightheadedness and headache may be related to postural blood pressure changes or an internal ear disturbance. I would want a doctor to record his blood pressure in different positions / through tilt table tests.
Some individuals who have history of diabetes (long term) develop autonomic neuropathy where body is unable to control minute blood pressure changes that occur during position changes. They have a fairly long drop (postural drop) in pressure while standing resulting in lightheadedness. It can also explain the throbbing headache.
Throbbing pain in the toes is unrelated though.

2. Headache at the end of fellatio during or before orgasm is almost similar to coital cephalgia or sexual headaches. They occur due to neurochemical changes and is treatable.

3. Cysts in the liver doesn't explain the pain unless they are large. You should discuss about the cysts size. If they are not large, most likely they are not the cause of pain. However it still needs to be monitored carefully by his doctor.

4. Since he has been evaluated for abdominal pain and bleeding and nothing besides gastritis was found, the pain and bleeding may be attributed to the same. However he may need to undergo a repeat endoscopy to make sure he doesn't have bleeding ulcers; especially since the pain and bleeding episodes are recurrent.

5. Changes similar to menopause also occur in men. Andropause, where testosterone starts to decline after a period of time can cause mood changes, depression, headaches and so on. I do see some of the features in him now. These are common occurrence that shouldn't worry you.

6. Lastly, you may be true he could have nutritional deficiencies. Blood tests are available to test for specific deficiencies. We should consider performing the tests to document deficiencies. I would tests for iron, vitamin b12 and vitamin D levels first.

In a nutshell, yes most likely we are dealing with several clinical conditions here. Some are natural while some are abnormal. A detailed clinical examination and further evaluation will unearth the abnormalities. As a whole from the history I don't see anything alarming except for those bleeding episodes. He should visit a physician.

Hope I have provided you sufficient information pertaining to your husband. Let me know if you need clarifications. And apologies for the late reply...

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