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Neurology (Expert Forum)
Who should I speak to, to get help?
Answered by
Lama Chahine, MD - Neurology
Cleveland Clinic
Cleveland - OH
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
Who should I speak to, to get help?
by Seagraml, Sep 07, 2009 08:32AM
Pls could you direct me in the right direction. I have been suffering with sever headaches and migraines for the past 7 years. I was put on Topamax, which affected my moods, so I stopped using it. I have been able to manage these headaches, but have recently been also experiencing, chronic fatigue, dizziness and horrible ringing in my ears (and getting worse everyday). I am tired of seeing doctor after doctor, with no results. Who should I be speaking to? A Neurologist?
Doctor's Answer
by Lama Chahine, MD, Sep 12, 2009 02:48PM
, Sep 12, 2009 02:48PM
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 you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.
In treating chronic headaches such as in yourself, the treatment should include two types of medications: preventative therapy and abortive therapy. Preventative therapy is a medication that would be taken every day regardless of whether or not a headache is prevent. This type of medication is used to prevent headaches from occurring, and there are several types including but not limited to beta blockers such as propranolol, calcium channel blockers such as verapamil, and others including topamax, depakote, elavil, etc. A lot of these medications were invented for other uses and are used not only for headache but also epilepsy and depression. They have proven very effective in preventing headaches. The second medication is abortive, meaning it is used when a headache is coming on. The medication used depends on the nature of a headache. If it is a migraine type headache, a group of medications called triptans can be used. And so on. However, with frequent use of abortive medications including triptans, tylenol, advil, and others, medication overuse headache occurs. This requires a specific treatment in which the over-used medications are slowly stopped and replaced with more long-acting medications. Tylenol with caffeine, and similar medications, can cause medication overuse headache if used too frequently. Lyrica, which is used for fibromyalgia, can be used for chronic headaches too. If you frequently experience headaches and are not finding relief, evaluation by a neurologist, and perhaps a headache specialist, might be helpful for you.
Fatigue is usually not specific for a specific diagnosis, but some possibilities include endocrine problems such as thyroid disease, anemia, sleep disorders such as sleep apnea. Sometimes, depression can lead to physical symptoms such as fatigue, and treatment of the depression can help.
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.
If by dizziness you mean vertigo (room-spinning), the causes could be either the inner ear or the brain. Inner ear causes of vertigo most commonly include benign positional vertigo (BPPV), which is due to small particle in the inner ear that moves out of place, and can be repositioned with simple head maneuvers. The symptoms often include vertigo that occurs with turning of the head, often while turning over in bed. Another cause, if your symptoms are associated with tinnitus (ear ringing) and hearing loss is called Meniere’s disease and can be treated with medications and sometimes surgery. And so on, several other causes from inner ear problems exist.
Vertigo can also be due to problems in the brain. The most common is a benign tumor called a schwanoma (also called acoustic neuroma). This is diagnosed by MRI of the brain. Thyroid problems can also lead to vertigo.
If your dizziness is vertigo, and associated with your headaches, your symptoms may be consistent with a variant of migraine called basilar migraine. Basically this is marked by several hours of vertigo associated with nausea, light-sensitivity, and sometimes other symptoms. Headache may or may not be present. The treatment is different from that used to treat other migraine types; the treatment in this case is a type of medication called calcium channel blocker, such as verapamil, which is actually used to treat blood pressure but works in type of basilar migraine as well.
If by dizziness you mean light-headedness, causes could include low blood pressure such as due to dehydration or autonomic dysfunction, cardiac problems, and several other non-neurologic causes. Anemia can cause light-headedness as well.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.
In treating chronic headaches such as in yourself, the treatment should include two types of medications: preventative therapy and abortive therapy. Preventative therapy is a medication that would be taken every day regardless of whether or not a headache is prevent. This type of medication is used to prevent headaches from occurring, and there are several types including but not limited to beta blockers such as propranolol, calcium channel blockers such as verapamil, and others including topamax, depakote, elavil, etc. A lot of these medications were invented for other uses and are used not only for headache but also epilepsy and depression. They have proven very effective in preventing headaches. The second medication is abortive, meaning it is used when a headache is coming on. The medication used depends on the nature of a headache. If it is a migraine type headache, a group of medications called triptans can be used. And so on. However, with frequent use of abortive medications including triptans, tylenol, advil, and others, medication overuse headache occurs. This requires a specific treatment in which the over-used medications are slowly stopped and replaced with more long-acting medications. Tylenol with caffeine, and similar medications, can cause medication overuse headache if used too frequently. Lyrica, which is used for fibromyalgia, can be used for chronic headaches too. If you frequently experience headaches and are not finding relief, evaluation by a neurologist, and perhaps a headache specialist, might be helpful for you.
Fatigue is usually not specific for a specific diagnosis, but some possibilities include endocrine problems such as thyroid disease, anemia, sleep disorders such as sleep apnea. Sometimes, depression can lead to physical symptoms such as fatigue, and treatment of the depression can help.
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.
If by dizziness you mean vertigo (room-spinning), the causes could be either the inner ear or the brain. Inner ear causes of vertigo most commonly include benign positional vertigo (BPPV), which is due to small particle in the inner ear that moves out of place, and can be repositioned with simple head maneuvers. The symptoms often include vertigo that occurs with turning of the head, often while turning over in bed. Another cause, if your symptoms are associated with tinnitus (ear ringing) and hearing loss is called Meniere’s disease and can be treated with medications and sometimes surgery. And so on, several other causes from inner ear problems exist.
Vertigo can also be due to problems in the brain. The most common is a benign tumor called a schwanoma (also called acoustic neuroma). This is diagnosed by MRI of the brain. Thyroid problems can also lead to vertigo.
If your dizziness is vertigo, and associated with your headaches, your symptoms may be consistent with a variant of migraine called basilar migraine. Basically this is marked by several hours of vertigo associated with nausea, light-sensitivity, and sometimes other symptoms. Headache may or may not be present. The treatment is different from that used to treat other migraine types; the treatment in this case is a type of medication called calcium channel blocker, such as verapamil, which is actually used to treat blood pressure but works in type of basilar migraine as well.
If by dizziness you mean light-headedness, causes could include low blood pressure such as due to dehydration or autonomic dysfunction, cardiac problems, and several other non-neurologic causes. Anemia can cause light-headedness as well.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
