Dizzy, headache, neck pain/ache

I'm a 33 yr old female and about a year ago I started feeling extremely dizzy. I wouldn't describe it as room spinning dizzy, more like I feel like my head is in a snow globe and someone is shaking it, very spacey. The first "episode" lasted about 5-6 weeks. My doc gave me all the meds for Vertigo, they just made me extremely sleepy & groggy. I don't really take them. Blood work and a CT scan were negative. Doc called it Vertigo and that was that. The extreme dizzy sensations let up, but I never really felt normal again. I'm always in this dizzy haze, when I walk I feel like there is an amplified movement in my head, bouncing up and down. When I drive and look over my shoulder I have a slow motion sensation, like everything is slow to catch up. I do not feel nausea or like I am going to fall down. I sometimes get a feeling of passing out when I'm inside a large building but never have. In August, I woke with a bad migraine headache and the extreme dizzy was back. It lasted intensely for a week or so and then back to my daily dizzy feeling. Six weeks ago I started having bad neck pain. I do not recall a specific injury but I have been seeing a chiropractor. We reviewed the dizzy feeling that I constantly have and so far the treatments have not helped the dizzy. The sharp neck pain has let up, but I do feel an ache inside my neck that goes up to the base of my head. And 2 days ago woke with the bad migraine headache and the severe dizzy is back! Have had a headache for 4 days straight, back & sides of head mostly where it is.  Any suggestions of who/ where I should go next.

[CCF-Neuro-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.      
   The symptoms and story that you describe are not specific for any single disorder, but are most consistent with Migraine headaches with associated dizziness.  Migraine headaches are classically described as pounding/throbbing headaches with sensitivity to lights, sensitivity to sound, exacerbation with movement and nausea/vomiting.  However, there are many different expressions, auras and prodromes that can be associated with migraine.  A common aura includes squiggly lines in the peripheral vision and/or color dots in the vision that happens 30minutes-1 hour prior to the onset of the 'pain' portion of the headache.  In a similar fashion, some people have dizziness as an aura to their migraine headaches, which can happen prior to, during or even after the pain part of the headache.  In addition, migraine auras such as dizziness can occur without the having the pain portion at all.  Treatment for this would include taking a daily medication to prevent headaches.  There are many numerous medications used for this purpose, some of which include elavil (amitripyline), Topamax (topirimate), Nadolol, verapamil.  That being said, I would also suggest an MRI of your brain and cervical spine with contrast to evaluate for additional pathologies (such as tumors, vascular malformations, multiple sclerosis).  Multiple sclerosis in particular can present with episodic dizziness (which should show up on the MRI of that is the case). A CT is not good enough to evaluate for the lesions that I mentioned.  
I hope this has been helpful.

[Kathi49]

Trixmouse,

I had this about 4 years ago.  I was diagnosed with Occipital Neuralgia first and then Cervicogenic Headaches which basically means headaches coming from the neck.  I also suffered DAILY dizzy spells during those 3 years.  In my opinion, you really need to have an MRI done of your cervical spine.  In particular because you mention sharp neck pain WITH the headaches and dizziness.  DO NOT let a Chiropractor do any more manipulations of your neck at all until you can get an MRI.  In my case the headaches and dizziness were coming from the C3/C4 level of the cervical spine. I eventually had a fusion that stopped the headaches and dizziness.  I am not saying this is your problem or advocating a fusion.  But I believe an MRI is a must.  Hang in there.

[Kathi49]

Oops, I forgot to add that osteoarthritis was totally compressing the nerve roots at that level.

[trixmouse]

Thank you for responding.  I should probably clarify that the sharp neck pain I was had was not at the same time as the headaches.  I do a lot of lifting and driving for work and think that I may have pulling or twisted to injure my neck, although I don't recall how it did that.  That's why I went to the Chiropractor plus I head that some timed they can help w/ vertigo.  If that is really what  this dizzy is.  I am not convinced.  The ache-like feeling in my neck has been present for weeks.  Maybe from having manipulation done?  Last years CT scan of my head was negative.  Is there much difference w/ an MRI?  It's very sad that I have to think about this but I'm responsible for the first $2500 and I don't have the money. So coming to a decision of what to do next has been very difficult.  I have read over and over people that have had various tests done and Dr's still can't figure it out.  I feel that my GP was a waste of money.  I need a good recommendation for who to see next in NE Ohio.  Should it be a Neurologist or ENT or any other specialist?

[Kathi49]

Trixmouse,

If you want, see a Neurologist first.  Sometimes they can give the injections; trigger point, facet, etc. as well as the meds.  My own Neurologist refers her patients to the Spine Group I go to.  Which is kind of beside the point because I went to the Spine Group first and they ordered the MRI.  Actually, I see a spinal pain management doctor who specializes in headaches coming from the neck.  He is the one that saw the culprit right off the bat which was the C3/C4.  Anyway, I see my Neurologist now for peripheral neuropathy and not headaches because they are virtually gone from the fusion.  Since I don't really know what is causing your headaches/migraines, I think I would see a Neurologist first and then take it from there.  It is just that I now know the difference between the headaches I had from occipital neuralgia/cervicogenic headaches vs migraines.  I have had migraines off and on throughout my life and the other type, the ON headaches, are far, far worse than any migraine I have ever had. Or, you could try a pain management clinic at your local medical center.  I hope this helps.  My main point was NOT to let a Chiro manipulate your neck until you really know what is going on. Having manipulations done can make things much, much worse.

[jcverive]

[Warning - Long Response]

First of all, thanks to Kathy49 for her excellent response!  As I read your letter, I also thought of Occipital Neuralgia (ON) and/or cervicogenic headache at the C2/C3/C4 level. Furthermore, I agree with Kathy49's suggestions to discontinue chiropractic treatments of the head and neck. I'd recommend asking your GP for a referral to a pain doctor or neurologist. I've been dealing with ON for 28 years (even though occipital neuralgia had not been considered a primary pain condition unto itself until about 10 years ago), and I've had better diagnoses and treatment from pain clinic doctors than from neurologists. In most cases, unless nerve trauma or other causes are severe, imaging studies (MRI, CAT, and x-rays) will be of little use other than to establish "baseline" images. Most cases of occipital neuralgia and cervicogenic headache are determined from history, signs, and symptoms rather than specific testing.

For more information on occipital neuralgia and cervicogenic headache, you can use Google, AltaVista, or other such web pages. If you are interested in support groups on the web, you are welcome to join the Neuralgia group on Yahoo! at the following url/web address:

http://health.groups.yahoo.com/group/neuralgia
Or from tinyurl.com,

http://tinyurl.com/3283gg

Migraine headache or trigeminal neuralgia support groups exist in many large cities, and these groups might be able to help you deal with the pain and other consequences of your condition, even though it is unlikely that your pain is related to either of these conditions.

You might want to consider driving to Cleveland to visit the Cleveland Clinic, the hospital that hosts this web forum.  

No matter what doctor you eventually chose to see, you may want to show him/her this entire discussion "thread".  I have included all prior comments in my reply.  I wish you the best of luck.

Jeff

P.S. Some newer medications (Cymbalta, Lyrica, and Keppra) have shown great promise in treating neuralgia pain, which can be hard to treat, even with powerful narcotics. Your doctor may want to consider one or more of these instead of older medications with more serious side-effect profiles.


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Original Post with Comments


Dizzy, headache, neck pain/ache
Forum: The Neurology and Neurosurgery Forum
Topic: Neurology - General
Subject: Dizzy, headache, neck pain/ache
From
To
Post
trixmouse
01/12/2007
.
I'm a 33 yr old female and about a year ago I started feeling extremely dizzy. I wouldn't describe it as room spinning dizzy, more like I feel like my head is in a snow globe and someone is shaking it, very spacey. The first "episode" lasted about 5-6 weeks. My doc gave me all the meds for Vertigo, they just made me extremely sleepy & groggy. I don't really take them. Blood work and a CT scan were negative. Doc called it Vertigo and that was that. The extreme dizzy sensations let up, but I never really felt normal again. I'm always in this dizzy haze, when I walk I feel like there is an amplified movement in my head, bouncing up and down. When I drive and look over my shoulder I have a slow motion sensation, like everything is slow to catch up. I do not feel nausea or like I am going to fall down. I sometimes get a feeling of passing out when I'm inside a large building but never have. In August, I woke with a bad migraine headache and the extreme dizzy was back. It lasted intensely for a week or so and then back to my daily dizzy feeling. Six weeks ago I started having bad neck pain. I do not recall a specific injury but I have been seeing a chiropractor. We reviewed the dizzy feeling that I constantly have and so far the treatments have not helped the dizzy. The sharp neck pain has let up, but I do feel an ache inside my neck that goes up to the base of my head. And 2 days ago woke with the bad migraine headache and the severe dizzy is back! Have had a headache for 4 days straight, back & sides of head mostly where it is. Any suggestions of who/ where I should go next.
The "Comments" posted below are provided by individuals and reflect their personal opinions only. Under NO circumstances should you act on any advice or opinion posted in this forum.

[mandid8c5]

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