Headache, nausea, dizziness standing or sitting

[tigermila]

Hi my wife, 33 years old, is experiencing very acute headache, nausea and dizziness. All the doctors we have seen seems to not have an answer for us.

The lead up to the onset of the headache is as follows: My wife had been breastfeeding our 11 month daughter exclusively. My wife had a cough for about two weeks prior to the onset of the headache. She started experiencing some back pain near her left scapula one month prior to the headache. She also flew 4 days before the headache began. On the onset of the headache she had cough several times and after the coughing spell she complained that she felt like her head exploded. A few hours later we decided to take her to the ER to be examined. She had an abnormal EKG and a slightly elevated troponin level. Due to this they admitted her to the hospital. They did a CT scan and everything was normal. They did bloodwork several times during her stay in the hospital and her troponin levels came back to normal. There were no other significant EKG readings so the cardiologist cleared her. In the meantime her headache persisted. The headache was all over the place. Sometimes it was in her sinuses, other times it was on the top or back of her head. She also started to experience neck pain and stiffness and upper back pain. They did a lumbar tap and it came out negative for meningitis. Soon after she was admitted she started to get bouts of nausea and dizziness. The doctors thought that it was from the pain meds (dilaudid and morphine). They gave her antivert and zofran.  The only comfort that she could get from the headache was lying down. They did an MRI scan of the head and neck and it came out negative. There was a slight misalignment of her C6-C7 but noting that would explain the pain she was in. While in the hospital she saw a whole slew of specialist (infectious disease - who concluded that she might be postpartum, ENT - conclusion menieres, neurologist - migrane, etc). They couldn't agree since her symptoms where non conclusive.  After 7 days in the hospital they discharged her (since she was stable) but the pain in the head was still there. They gave her a short course of steroids (4 days total), antivert and a script for physical therapy and follow-up with ENT. The first few days after the hospital the pain was not as severe (although it was still there) and the nausea and dizziness was under control. In fact, when she went to PT, there was also an acupuncturist in the office who told us that she might be suffering from some form of arthritis that is aggravating her occipital nerve (occipital neuralgia). After a few pins, my wife felt like she was 90% better. This only lasted for a few hours. The on going physical therapy session seemed to have helped as well. He noted that the there she was very tense in her upper back and neck. Any way, the effects of the PT and the acupuncture only lasted for a few hours. When she woke up the next morning the effects would diminish and her pain would reappear (again mostly when she sat down, a little standing up- and no pain lying down). Anyway a few days later, she started to get extremely nauseated and dizzy (she is no longer on any pain meds at this point except motrin- no more than 800mg a day and the steriods had also stopped). She also started to experience some sinus pressure on both sides of her face (this would come and go and we started her oh sudafed which did not help). The PT and acupuncture only relieved the pain in her head and neck. She also mentioned that there are ringing in her ears, the sounds that she hear have an echo. She also feels like there is water in side the ears. So basically thats were we are now. The nausea is extremely bad (zofran doesn't seem to help), the dizziness is still there and there is ringing and echos in her ear. There is pain in her neck and head when standing up or sitting down.
So far these are the possibilities
menieres
occipital neuralgia
migrane
sinus infection

if its menieres/migraine attack do they last this long (2weeks)???

My wife's symptoms seems to follow another post:



http://www.medhelp.org/posts/Undiagnosed-Symptoms/Headache-only-when-standing-or-sitting-up/show/980567#post_4583783

unfortunately, I was not able to get hold of the original poster and there was not answer from the forum.

thank you so much for the help....

[Lcagee]

My 2 cents. I have a similar story. One day in October 4 years ago I got a headache. It has never gone away. One thing similar to this post. The headache began 1 day after flying. Now maybe it's a coincidence. But here are 2 possibilities. 1. The pressure changes with flying resulted in a spinal fluid leak. 2. There was some neurotoxin exposure on the plane. I have read about an organophosphate used as a lubricant on planes that is toxic. I still have no answer.

[selmaS]

Hi and welcome to the Chiari forum.

Do you have Chiari as well?....For those with Chiari, flying is just one more activity that can trigger our symptoms to flare......headaches are one symptom.

[selmaS]

  Hi and welcome to the Chiari forum.

And thank you for sharing ur experience with chiari.We r always happy to have a new member, but not happy for the reasons that bring u.

I hope u continue to share ur chiari journey with us.

  "selma"

[BriMich]

I have had a surgery to correct Chiari I Malformation and have done a lot of research - before and after surgery...

From some things I have read in the past, and reading your question, I think it could be possible that your wife could have a slight spinal leak, possibly as a result of the epidural (assuming that she had one with child birth).  Then with the onset of the hard coughing, it's possible that it could have made the leak worse, which can cause intense headaches -- and if she had a spinal leak it is possible that it could also cause an "apparent Chiari Malformation".  If this she did indeed have a spinal leak, it is a pretty simple procedure to fix --- It is called a blood patch.  They take some of her blood from her arm, and then inject it just outside the area of the spinal column (below the area where she had her epidural), and the blood amazingly travels up outside of the spinal column, and if it gets to an area where there is a spinal leak, the blood stops, and clots the leak right then & there.  And she would probably know within hours if this were the cause & solution.

I had this procedure. Fortunately I didn't have a spinal leak, but unfortunately it didn't help to explain my continued headaches after surgery.

It is possible that she does just have Chiari Malformation though, and may need to see a neurologist/neurosurgeon to discuss treatment options.  I am by no means an expert in this area by any means, just saw your post and thought I'd share results of my own personal research, in case it might benefit your wife.  I hope that you get some answers soon.

[selmaS]

U r  right that many times after a natural birth the strain will have an affect on a dormant chiari....

Thanks cozybee for sending him this way : )

"selma"

[cozybee]

Hey Selma,     I saw this post under the Neuro forum and suggested that he might want to repost here.  I saw the host of symptoms that she had that sounds all to familiar for a lot of us. I hope he can draw from our knowledge and learn what questions to ask to rule chiari in or out. Pushing out a baby would cause lots of strain on the neck and head.

[selmaS]

Hi and welcome to the Chiari forum.

For those of us that have chiari, this is not a diff post to reply to, but an all to common one.Too often u r seen by a dr that has no experience with chiari and since u posted in the chiari forum I am going to assume ur wife did get a chiari dx?Many chiarians have been mis dx'd with mineire's, anxiety, migraines....get copies of the MRI'S and the reports and get a second opinion.

Chiari as a dx is often overlooked even when the dx is made the drs refuse to accept it as the reason for the symptoms....

U deff want a dr that is well informed on chiari to review the MRI and let u know if this may indeed be ur wifes issue...plus there r related conditions that will need to be looked for and ruled out.

I understand how frustrating this is and sorry will continue to be, but once u have th eright drs u will see a difference.

Glad to have u join us, sorry for the reasons that brought u.

"selma"

[meniere135]

This is a difficult post to tackle.  Oh my!  I can relate to a lot of these symptoms.  And I can understand why different doctors have different diagnoses.  That head and neck area, with all of the vertebrae, muscles, and blood supply to the brain can wreak havoc and cause all of the above symptoms.  From the progression of symptoms, it almost sounds more mechanical than hormonal, especially since her symptoms are relieved when lying down. But hormones are a big part also. But the mechanical problems (tense muscles, pinching nerves, etc) can reduce blood supply to the brain,and effect (possibly) intracranial pressure? and produce many of her symptoms.  And I assume she's still breastfeeding.  And she has to continuously hold the baby.  Both add strain to the neck muscles.  So if the problem is mechanical to begin with, she's not able to let the area rest due to her mom duties.
I also have neck trouble and muscle tightness in the shoulders and neck and meniere's disease and it seems that hormonal fluctuations make things worse.  I was diagnosed with Meniere's and found that if I stay off of gluten containing foods it stops the attacks.
Go figure.  Cow's milk free and a gluten free diet together took away the head pressure, reduced the ringing to barely there, opened up my eustachian tubes (after 5 days on the diet I felt a trickling down the tubes and my hearing was much clearer - got rid of the echoing).  The nausea also went away when the fluid drained off.  

My recommendation:  A gluten free, milk free (all milk products) diet (make sure she is still taking her prenatal vitamins for the breastfeeding and for nutrients lacking on this diet).  See if things improve.  I know my post is all over the place, because I never quite figured out why these things helped me.  Maybe it staightened out my hormones and relieved fluid retention which took the pressure off the brain, etc.   So the blood supply and csf problem being effected by the neck problem was not as "challenged" with my hormones in better balance.  So maybe all the doctors were right - but just werern't able to pinpoint the starting point.  I hope this "all-over-the-place" post makes some sense.
Maybe your wife can blindly follow this diet, not knowing why it might help, and see if the worst of her symptoms go away.  I know I'm asking a lot here, but the diet helped the strangest of symptoms.  If you need diet recommendations, just leave me a message.  Good luck!