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What causes occasional nausea, blurred vision, throbbing dizziness behind head and eyes?

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Posted on Fri, 21 Aug 2015
Question: Ive had a throbbing dizziness sensation in behind my head/eyes and sinus but have no sickness otherwise, for 2 weeks straight - but on and off for 3 or more years. some days its combined with weakness and the jitters or shakiness, occasional nasuea or blurry vision/well i can see but feels like my brain isnt processing it well.
i have no pain in my head at all. i do get occasional back and neck pain. im on propanolol 20mg a day for migraines since 2013 which providesno relief. pain killers and nosaids dont either. the dizziness or throbbing can be bought on by reading or moving my body around and sometimes with sleep. i am doing regular pyshio for muscular skeletal issues. which are in my neck and hips. had many tests and never been diagnosed with anything besides migraines which seems to me like a cop out or a guess. nothing helps, its hard to sleep and stand for longer than 5-10mins.
doctor
Answered by Dr. Dariush Saghafi (2 hours later)
Brief Answer:
Depends on how aggressive your workup has been

Detailed Answer:
Good morning. I'm an adult neurologist and a headache specialist and can fully appreciate why people might be taken down the obvious road of trying to call these migraine headaches....and at the end of the day....they very well may be. There are headaches of the migraine type referred to as ACEPHALGIC MIGRAINES. That means that the person has a headache problem but WITHOUT THE PAIN COMPONENT. Usually they respond to migraine medication types of treatment. However, if you've had the problem for 3 years without much relief then, I would say that you'd need to get some fresh spectacles on the situation.

How aggressive were they with the initial headache workup to begin with or was it just on the basis of a 5 min. question and answer period, a few blood results...maybe a CT on the brain that didn't show anything and then, on to the propranolol, Imitrex, and how dose Motrin???

Have you ever seen a HEADACHE SPECIALIST? They can usually tell when something is definitely not a HEADACHE SYNDROME. There is another type of headache called VESTIBULAR MIGRAINE or MIGRAINOUS VERTIGO is another term for it where the patient can have terrible vertigo, dizziness, or imbalance along with symptoms of migraine...or migraine pain itself (not true exactly in your case)....and the 2 sets of symptoms can be completely separated in time. In other words, vertigo and dizziness 1 day and then, a day or 2 later other uncomfortable symptoms without the dizziness necessarily.

Have you had an MRI of the brain, with contrast?....are you having any eye PAIN when moving them about, sudden blurriness or loss of vision...

You could have a vestibular nerve issue but I doubt it since I'm not hearing a real story of IMBALANCE and DYSQUILIBRIUM as the primary and most pervasive feature of what's been going on now or in the past.

Back and neck pain are often sites where migraine headaches strike or depending on the situation if you've got cervical arthritis to any extent such as bony spurs, arthritic changes due to an accident or heavy labor activities which have affected the neck over the years, etc. then, this could be a factor.

I would be concerned as to the AMOUNT OF ANALGESIC MEDICATION you're taking as it is often the case that people get caught up in trying to treat a lot of different symptoms with OTC preparations and even prescription meds but all that happens is that cause what's known as an analgesic rebound phenomenon whereby the OVERUSE of such medication can and does produce symptoms (pain or something else) over and above the usual baseline problem and this is interpreted as a WORSENING of the condition. This then, leads to increased medication usage which leads to increased symptoms which are caused by the TREATMENT not by the disease process...and now starts the vicious cycle.

If you've never kept a strict log or diary of your symptoms on a day to day basis and correlated that to medication usage then, if you were my patient and coming to my clinic...that's where this examination would start. Once there is a good solid baseline of data to work with and once I'd seen the diagnostic and blood tests that have been done we'd start from there to decide whether or not you truly had a headache condition or something else. If it's SOMETHING ELSE....then, I'd figure out whethere it was neurological or not. Could you have dysautonomia? Could you have instead a cardiovascular issue (maybe even a mild congenital cardiac defect or vascular anomaly) that would be causing a drop or change in blood pressures sufficient enough NOW as you're getting older to cause symptoms?

Could there be a hormonal or endocrinological problem with the thyroid, the adrenal glands, the hypothalamus, the pituitary?

Finally, if all else is negative what about stress, anxiety, problems that could be manifesting physically but are based more in a psychological realm...there is one single symptom that we know of caused by a real life disease that cannot be MIMICKED by a psychological abnormality, stressor, or situation where the person suffers from something such as a sleep disorder due to PTSD, insomnia for some other reason with mounting fatigue, changes in behavior and personality due to family, work, diet, exercise, excessive weight gain leading to depression and other mood disorders which cannot also have all the other symptoms you mention.

Of course, you notice that I put that paragraph of my differential thoughts as the last one because I don't know that you've been entirely ruled out for everything else to this point.

These, I believe are the issues that should be raised to your primary doctor and you should either ask for a specialist consultation or you may want to simply seek a second opinion yourself if your primary doesn't wish to follow up with this sort of discussion. But the long and short of it is that current medication regimens are not and have not been working so the diagnosis must be re-evaluated.

I hope these answers satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?

Also, if there are no other questions or comments, may I ask you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?

Please direct more comments or inquiries to me in the future at:

bit.ly/drdariushsaghafi

I would be honored to answer you quickly and comprehensively.

Please keep me informed as to the outcome of your situation.

The query has required a total of 42 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi (18 hours later)
had all of these tested and all negative. the inital neuro specialist was a 5min + mri of my neck and all clear. was given propanolol. i guess next step is to get brain, neck and back scans?
doctor
Answered by Dr. Dariush Saghafi (1 hour later)
Brief Answer:
Not really- Need good History and examination first

Detailed Answer:
Well, if you've seen a Headache specialist but it was literally only 5 minutes then, I think you are still in need of a specialist with more time to spend getting the details of when the problem started and the exact chronology of how everything evolved. In other words, there must've been a time prior to 3 years ago that none of these symptoms were present...(i.e. you were perfectly normal going about your business)....then, either ONE DAY the whole thing just came up out of the blue....OR...little by little minor symptoms began to happen that you may not have paid attention to until you were suddenly aware of a bigger problem. For example, that kind of detailed detective work. Lots of information can be obtained from just doing that sort of investigation. But it takes longer than 5 min....and it takes a patient who also is willing and able to cooperate with going back that far to put things together.

That's why a HEADACHE DIARY or LOG is the centerpiece of my practice and I recruit patients into believing the same thing. In your case, there seems to be a doubt as to whether this really is a headache problem at all. So that's one point that has to be resolved but if you say you've been tested for all the medical alternatives and nothing is panning out then, it sounds like it is some type of headache syndrome...but it needs a bit more woodshedding to get to the right diagnosis and then, the right treatment. Do you know that the neurologist is actually a headache specialist? If you're not sure then, you need to make that adjustment. If they were a specialist then, you may need another doctor's opinion who can EXAMINE YOU physically.

If after you find someone who is willing to take the detailed history and piece together things as I've suggested then, it will be up to them whether or not you need all the other diagnostic tests like scans of the brain, neck, or back.

You can find a variety of headache diaries on line through many Headache Resources available to patients.

Good luck.

I hope these answers satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?

Also, if there are no other questions or comments, may I ask you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?

Please direct more comments or inquiries to me in the future at:

bit.ly/drdariushsaghafi

I would be honored to answer you quickly and comprehensively.

Please keep me informed as to the outcome of your situation.

The query has required a total of 53 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi (13 minutes later)
oh yeah sorry, had a car crash with soft tissue damage in the c2 area. this started a few months after pyshio was complete. scan from the specialist attached.
doctor
Answered by Dr. Dariush Saghafi (17 hours later)
Brief Answer:
Cervicogenic Headaches?

Detailed Answer:
If you suffered an injury to the neck because of an MVA then, that is also a very good reason (and I would say may actually best explain) to have back, neck, and shoulder pain as you've described. Headaches which are born from this sort of injury are referred to as CERVICOGENIC HEADACHES (CGH) and they can be particularly challenging to treat since treatment is not directed at the headache so much as it needs to be directed to the underlying cause which would be the cervical area of injury.

In my patients with CGH I've found a device called the SOOTHEAWAY helps a good number of them. There is a pad that is called the UNIVERSAL PAD and can be placed upon the neck for relief of pain. If proper therapy, medication, and other methods don't seem to be working then, the sootheaway device just might. You can see the device at www.sootheaway.com

I did look at your scan. If you happen to have the report or are able to get the report then, uploading it would be very helpful. You say that damage to soft tissue occurred in the "C2 area," however, we don't really refer to the C2 area as a separate entity of the cervical spine because normally C1 and C2 are fused and it is one complex. Typically, injury to one of those vertebral bodies is considered an injury to the entire complex and is referred to as the C1/C2 complex.

If you are suffering from CGH then, it is perfectly understandable why the medications being used aren't really working very well since they are geared toward treating headaches as the PRIMARY/MAJOR problem whereas in CGH the primary underlying problem is the injury to the cervical spine and all the soft tissues involved in that whole region.

I hope these answers satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?

Also, if there are no other questions or comments, may I ask you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?

Please direct more comments or inquiries to me in the future at:

bit.ly/drdariushsaghafi

I would be honored to answer you quickly and comprehensively.

Please keep me informed as to the outcome of your situation.

The query has required a total of 64 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Dariush Saghafi

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What causes occasional nausea, blurred vision, throbbing dizziness behind head and eyes?

Brief Answer: Depends on how aggressive your workup has been Detailed Answer: Good morning. I'm an adult neurologist and a headache specialist and can fully appreciate why people might be taken down the obvious road of trying to call these migraine headaches....and at the end of the day....they very well may be. There are headaches of the migraine type referred to as ACEPHALGIC MIGRAINES. That means that the person has a headache problem but WITHOUT THE PAIN COMPONENT. Usually they respond to migraine medication types of treatment. However, if you've had the problem for 3 years without much relief then, I would say that you'd need to get some fresh spectacles on the situation. How aggressive were they with the initial headache workup to begin with or was it just on the basis of a 5 min. question and answer period, a few blood results...maybe a CT on the brain that didn't show anything and then, on to the propranolol, Imitrex, and how dose Motrin??? Have you ever seen a HEADACHE SPECIALIST? They can usually tell when something is definitely not a HEADACHE SYNDROME. There is another type of headache called VESTIBULAR MIGRAINE or MIGRAINOUS VERTIGO is another term for it where the patient can have terrible vertigo, dizziness, or imbalance along with symptoms of migraine...or migraine pain itself (not true exactly in your case)....and the 2 sets of symptoms can be completely separated in time. In other words, vertigo and dizziness 1 day and then, a day or 2 later other uncomfortable symptoms without the dizziness necessarily. Have you had an MRI of the brain, with contrast?....are you having any eye PAIN when moving them about, sudden blurriness or loss of vision... You could have a vestibular nerve issue but I doubt it since I'm not hearing a real story of IMBALANCE and DYSQUILIBRIUM as the primary and most pervasive feature of what's been going on now or in the past. Back and neck pain are often sites where migraine headaches strike or depending on the situation if you've got cervical arthritis to any extent such as bony spurs, arthritic changes due to an accident or heavy labor activities which have affected the neck over the years, etc. then, this could be a factor. I would be concerned as to the AMOUNT OF ANALGESIC MEDICATION you're taking as it is often the case that people get caught up in trying to treat a lot of different symptoms with OTC preparations and even prescription meds but all that happens is that cause what's known as an analgesic rebound phenomenon whereby the OVERUSE of such medication can and does produce symptoms (pain or something else) over and above the usual baseline problem and this is interpreted as a WORSENING of the condition. This then, leads to increased medication usage which leads to increased symptoms which are caused by the TREATMENT not by the disease process...and now starts the vicious cycle. If you've never kept a strict log or diary of your symptoms on a day to day basis and correlated that to medication usage then, if you were my patient and coming to my clinic...that's where this examination would start. Once there is a good solid baseline of data to work with and once I'd seen the diagnostic and blood tests that have been done we'd start from there to decide whether or not you truly had a headache condition or something else. If it's SOMETHING ELSE....then, I'd figure out whethere it was neurological or not. Could you have dysautonomia? Could you have instead a cardiovascular issue (maybe even a mild congenital cardiac defect or vascular anomaly) that would be causing a drop or change in blood pressures sufficient enough NOW as you're getting older to cause symptoms? Could there be a hormonal or endocrinological problem with the thyroid, the adrenal glands, the hypothalamus, the pituitary? Finally, if all else is negative what about stress, anxiety, problems that could be manifesting physically but are based more in a psychological realm...there is one single symptom that we know of caused by a real life disease that cannot be MIMICKED by a psychological abnormality, stressor, or situation where the person suffers from something such as a sleep disorder due to PTSD, insomnia for some other reason with mounting fatigue, changes in behavior and personality due to family, work, diet, exercise, excessive weight gain leading to depression and other mood disorders which cannot also have all the other symptoms you mention. Of course, you notice that I put that paragraph of my differential thoughts as the last one because I don't know that you've been entirely ruled out for everything else to this point. These, I believe are the issues that should be raised to your primary doctor and you should either ask for a specialist consultation or you may want to simply seek a second opinion yourself if your primary doesn't wish to follow up with this sort of discussion. But the long and short of it is that current medication regimens are not and have not been working so the diagnosis must be re-evaluated. I hope these answers satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback? Also, if there are no other questions or comments, may I ask you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary? Please direct more comments or inquiries to me in the future at: bit.ly/drdariushsaghafi I would be honored to answer you quickly and comprehensively. Please keep me informed as to the outcome of your situation. The query has required a total of 42 minutes of physician specific time to read, research, and compile a return envoy to the patient.