Chronic tension, dizziness, brain fog

For the past two months I have been experiencing chronic tension above and around my temples, around and behind my eyes, and at the base of my skull, most prevalently while driving, walking, or talking; and a stiff neck. This is accompanied by dizziness and a feeling like I'm always on a boat. These symptoms are also accompanied by a constant feeling of dissociation or mental disconnection - for example, last week someone tried to teach me to play a simple card game and I couldn't understand it, despite being a master's student in laboratory biology with a 4.0 less than a year ago. Also present are chills, a droopy left eyelid, and occasional little tiny flashes of light, but these are intermittent whereas my other symptoms are constant.  

I have been to see four PAs and one doctor so far, and they diagnosed, in order, the following: sinus infection (without post-nasal drip, fever, scratchy eyes, sore throat, or congestion), inner ear dysfunction, labyrinthitis, and, most recently, "a sinus disorder deep in the bone” for which I was prescribed, if you can believe it, Flonase (again: no post-nasal drip or congestion). Antihistamines - both OTC and prescription - haven't touched it, nor has a course of antibiotics, a trial dose of Trazadone gave me a panic attack, and the expense nose-spray isn't doing anything.

What troubles me is that a lot of my symptoms point toward either nerve damage or Lyme disease (I do spend 90% of my time outdoors), especially considering the mental dysfunction and stiff neck, but so far every doctor has waved away the neurological symptoms and, despite not being able to see any obvious infection or even inflammation in my ears, nose or throat, focused on trying to convince me that it's sinus or inner ear-related and doesn't require a CT, MRI, or even a simple blood test. This despite two solid months of incomparable misery that has so far been totally unresponsive to any treatment.

Any input would be greatly appreciated!  

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Headaches can cause many of the symptoms you describe. The difficulty will then determining which headache type you have, since there are different treatment options for the different types of headaches. Broadly speaking headaches can be primary (e.g., migraine) or secondary (e.g., from underlying brain mass, etc). Primary headache disorders are much more common than secondary ones. There are actualy over 50 different types of primary headache disorders. Migraines are classically described as a pulsating throbbing one-sided pain with nausea and discomfort in bright lights that lasts several hours. Another type of a primary headache is a cluster headache which is a sharp pain that occurs around and behind the eye often at night and are associated with tearing of the eye and running of the nose. (This type is male predominate). In primary stabbing headache, sharp or jabbing pain in the head occur, either as a single stab or a series of brief repeated volleys of pain. Primary stabbing headache often occurs in people with migraine. The pain itself generally lasts a fraction of a second but can last for up to one minute in some people. Another type of stabbing headache is called paroxysmal hemicrania. This is marked by episodes of stabbing or sharp pains that occur on one side of the head and may be associated with eye tearing, droopy eyelid, or runny nose. Episodes may occur several times and last 30 seconds to a minute. Yet another type of stabbing headache is abbreviated SUNCT; 100s of stabbing pains lasting seconds occur and are associated with red eye and tearing. Other types include chronic tension headache.

Headaches can also be a result of neck pain. These headache are cervicogenic headache and occipital neuralgia.

Cervicogenic headache is a headache that is "referred" to the head from bony structures, muscles, and other soft tissue in the neck and shoulders. Symptoms are usually one-sided and include: precipitation of head pain by neck movement or awkward neck positions, head pain when external pressure is applied to the neck or occipital region, restricted range of motion of the neck, and neck, shoulder and arm pain. Treatment for cervicogenic headache includes physical therapy, medications, behavioral therapy, and other modalities.

Occipital neuralgia is caused by irritation or injury to two nerves that run from the upper neck to the back of the head. The irritation could be due to  neck trauma, pinching of the nerves (by muscles or arthritis), and other causes. Symptoms include a piercing sharp pain that travels from the upper neck to the back of the head and behind the ears. It is usually a one sided pain but can be on both sides of the head. Treatment includes physical therapy, medications, and in some cases injections, "nerve blocks", during which a physician injects the irritated nerves with an anesthetic.

Without further information about your headache, it is difficult to provide you with adequate information. However, it is important for you to understand that if you have not experienced headaches in the past and you are now having new head pains, seeing a neurologist is a good idea, just to make sure there is nothing serious causing this pain. Imaging of the brain and sometimes then neck may be indicated depending on your exact symptoms, your physical examination, and other factors.

I would suggest that you continue following up with your primary physician. If it seems that your symptoms may be related to an underlying chronic headache (with fluctuation), you may benefit from being evaluated by a neurologist.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[bigkev414]

I have similar symptoms and have suffered from this for years. It waxes and wains but is becoming more constant as I age. I have also started having sudden extreme sensations of falling forward and it feels like a giant magnet is pulling my head forwards and upwards. These sensations come on without warning and last for a few seconds. I then have an adrelaline rush (assume that's it) and feel 'wobbly' , shaky and a bit 'woozy' for the next few hours.
I have neck problems with disc degeneration and bony spurs which the doctor says may interfere with the arteries to my brain. My ears feel full and I have head and neck aches for days at a time which they have diagnosed as sinus related. Have had brain scan which was OK, balance tests etc, all OK. Do you have these 'falling' sensations ? while it's happening you kind of freeze up and have to wait till it subsides before you can move.

[rburrillo]

I haven't had any forward-pulling magnet sensations (that I know of - sometimes you can't really put your finger on a symptom until someone else frames it for you) but the rest of that all seems very familiar. Your doctor says you have neck problems, huh? I've read elsewhere on this forum that spinal problems can create a host of symptoms that include dizziness, tension, fatigue, panic, and even mental impairment when a disc pinches or otherwise monkeys with nerves. I put it down as chiropractic mumbo-jumbo, but maybe there's something to that. What procedures have you had done to your neck for the problem?

[bigkev414]

Hi
Doctors tell me there is nothing they can do. I have bony spurs (like heel spurs) and the discs in my neck are calcified. They said 'don't look down' - don't look up' - don't turn your head to the left. Rub arthritis cream in and take anti inflammatory tabs. Pay on the way out - next please!
I'm 67, therefor past my use by date. They don't bother much, the sooner we all croak the better because it will reduce the welfare costs for the govt. and the doctors have more patients then they can handle anyway.
good luck