Pain in top of head and syncope

My husband is 32 years old.  He just quit smoking 2 weeks ago but is on otherwise good health.  For the past week he has been experiencing dizzy spells when coughing and standing up.  He has fallen once but has never lost consciousness.  Along with these symptoms he has been having pains on the top portion of his head that last about 5 seconds and happen with more frequency as time goes on.  He is hard pressed to get to the doctor but I am worried that something more serious may be going on.

[Neuro Forum]

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 your doctor.

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

I am not sure what you mean by the term dizziness. When some people use the term dizziness, they often mean vertigo, or room-spinning. Others mean a light-headed, whoozy feeling. Light-headedness occuring with changes in posture (such as standing from a seated position), could signify what is termed orthostasis, or a drop in blood pressure with changes in posture. Sometimes the problem is just dehydration, due to poor fluids intake, leading to low blood volume, and improves with hydration. However, at other times, the problem could be due to a problem in the autonomic nervous system is the part of the nervous system that controls blood pressure, heart rate, and other functions. It is not located in one specific part of the brain or other body part but is rather made up of several different components: a region in the brainstem, certain receptors located on blood vessels and in the heart, and small nerves in our skin, among other areas. Dysfunction of the autonomic nervous system due to whatever cause can lead to a variety of symptoms including but not limited to orthostasis (which means symptoms or signs resulting from assuming an upright posture), light-headedness with drops in blood pressure when sitting up or standing up (this is an example of orthostasis), light-headedness with coughing or other maneuvers, syncope (passing out), constipation, diarrhea, sweating abnormalities etc. There are many potential causes to autonomic dysfunction, including for example autonomic ganglionopathy which can occur following viral illnesses or other stresses and is often autoimmune, neuropathies (such as due to diabetes) and others.

Other causes of light-headedness include cardiac problems, and several other non-neurologic causes. Anemia can cause light-headedness as well.

Evaluation of your husband by his internist (family physician/primary doctor) is recommended, and after he/she assesses your husband, and measures the blood pressure in various positions (lying down, sitting up etc), the appropriate testing could be ordered, with referral to a specialist as deemed necessary by his internist.

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