If you are looking for an article that will help you understand your headache and dizziness, you have come to the right place. I will try to explain why your head aches or spins, what is the current medical knowledge available out there, and how can you help yourself minimize these attacks. While this is in no way a substitute to a professional medical advice, I hope that this article can help alleviate some fears and pain that is bothering you.
Headache and Dizziness are broad symptoms that have different types and presentations. The key to understanding it is knowing which type do you have.
We will focus on the most common complaints - Migraine Headache, Tension-Type Headache, and Vertigo (most prevalent type of dizziness along with lightheadedness).
The following table shows anecdotes from patients experiencing different forms of headache and dizziness.
Before an attack,
“there are flashes of light”, or “my vision becomes blind”, or “I feel like I will have a stroke”
During an attack,
“Feels like someone is drilling on my skull”, or “I can feel my brain pulsating”
After an attack,
“I am so exhausted”, or “Nauseated”, or “I’m afraid to move because it might happen again”
“My head is wrapped by a tight rubber band”
“Nagging pain on my nape”
“As if someone is squeezing my head”
“That feeling when you just got off a spinning carnival ride”
“I can feel the world rotating”
“I feel woozy when I look down”
“I feel like vomiting”
Migraineurs know that they will have an attack because of what we call, auras. These can be in the form of flashing light, noise out of nowhere, or symptoms similar to a stroke.
During an attack, they experience excruciating pain that pulsates on one side of their head. It is so bad that they want to be in a dark, quiet room.
This may last for hours or even days! After an attack, they feel very tired and nauseated.
Patients with Tension-Type Headache feel the pain around the head and at the nape.
Unlike the migraine headache, they do not have an aura.
Their attacks usually occur when they are stressed but these are not aggravated with physical activity.
Lastly, patients with Vertigo describe their dizziness as rotatory - as if the world around them is moving.
They also get nauseated and may sometimes also feel headache, similar to that of a migraine.
Just like most brain conditions, there is much left to know about headache and dizziness. Its mystery revolves around the limitations in studying the brain, short of cutting your skull open. Nonetheless, we know enough about it to provide relief.
Here are the available medical knowledge on both, headache and dizziness.
There are two classifications of headache - primary and secondary.
Primary headaches are those that occur by themselves, without any external cause. Examples are cluster headache, tension-type headache, and migraine headache.
On the other hand, secondary headaches have external causes. These can be caused by an enlarging brain mass, a brain bleed, or a brain infection.
Thankfully, despite common belief that headache equates to a serious neurologic problem, only 4% of all headaches are considered to be of high-risk origin.
Vertigo can also be classified into two - peripheral and central vertigo.
When the problem arises from the inner ear or from the vestibular nerve, it is classified as peripheral vertigo.
Examples include inflammation of the labyrinth or labyrinthitis, Meinere’s Disease caused by swelling of the inner ear structures, Benign Paroxysmal Positional Vertigo (BPPV)caused by calcium debris in the inner ear and Vestibular neuritis or inflammation of the vestibular nerve.
On the other hand, when the problem arises from the cerebellum or brain stem, it is classified as central vertigo. Examples include a brain mass, brain infection or stroke.
The stark difference in the risk between primary and secondary headache and peripheral and central vertigo explains the need to take these symptoms seriously. That is why it is always prudent to have yourself checked by a medical professional.
Depending on the severity of your symptom, you might be seen by a primary care physician, an emergency room physician, an ENT doctor or a neurologist:
In all these, it is crucial that you remain patient and honest. It may seem taxing, usually lasting for 10-30 mins, and some questions may even sound silly, but these are all necessary to make certain that all you have is just a primary headache or a peripheral vertigo.
The treatment is mostly targeted to provide symptom relief or to prevent future attacks:
When we experience headache, it feels like our brain is being torn, squeezed and even drilled into.
Ironically, our brain, the organ that makes us experience the world, the organ that tells us that needles hurt and cotton feels nice, does not feel pain.
Wait...what then causes our suffering? These are what we call the pain-sensitive structures of our head.
Outside the skull, we have the skin, muscle, sinuses, dental structures and blood vessels that feel pain.
While inside the skull, we have the large arteries, venous sinuses, dura mater (tough outer covering of the brain), and the cranial nerves.
The trigeminal nerve that primarily innervates these structures will send the pain information to the ventroposteromedial thalamus, cerebral cortex and the pain-modulating systems of the hypothalamus and brain stem.
Headaches then happen when these pain-sensitive structures are stimulated because of injury, stretching or when the pain-modulating pathways of our peripheral and central nervous systems are blocked off inappropriately.
There are multiple theories about the pain mechanism of migraine headache. Some suggests that migraine headaches are caused by spasm of vessels that deprive the brain of blood supply. It is this temporary lack of blood supply that causes the aura before an attack, very similar to how a stroke occurs.
A more biochemical approach looks into the inappropriate release of vasoactive neuropeptides such as nitric oxide (NO), 5-hydroxytryptamine (5-HT)and calcitonin gene-related peptide (CGRP) at the vascular termination of the trigeminal nerve.
Unfortunately, none of these theories have been completely proven.
Tension-type headaches (TTH), on the other hand, originate extracranially at the skin and muscles or the myofascial component of the head and neck.
There is a marked tenderness of these structure that sends signal to the brain. Chronic painful signal from these structures also causes dysfunction in the central pain pathways of the brain.
Here's quick fact sheet about TTH.
In our inner ear, there are parts for hearing (cochlea) and there are parts for balance or the vestibular system (semicircular canals and otolith organs).
Similar to headache, there are just specific culprits in our head that cause vertigo. Specifically, the semicircular canals, oriented in different angles, are hollow bony structure where fluid passes through.
For every change in head direction, there is a corresponding movement of fluid and little brushes in your inner ear sense that, bringing you the information that you have just moved your head.
Now imagine this fluid to be contaminated with crystal debris, or the canals or the nerves that transmit these information are swollen. Your brain will get a false information of your head movement, thereby causing peripheral vertigo.
Your brain may also be a culprit for central vertigo. Specifically, you may have problem with your brain stem where your vestibular nerve enters cerebellum and where all vestibular input is sent and processed.
Together with rotatory dizziness, you may also feel hearing loss, tinnitus (a high-pitched sound), and experience nystagmus (a fast, repetitive movements of the eyes) because of the close association of the systems of balance, hearing and vision.
Headaches and Dizziness may have their own distinct, elaborate neuropathologic mechanisms that differentiate them from each other, but decades of research have shown that they share common physiological and psychological factors.
I would like to focus on 3 key S’s that we can take control of - Sleep, Stress, and Sanity.
Sleep is an active and crucial brain process that maintains our metabolism. Sleep is so important that recent sleep studies have shown that sleep duration less than 7 hours has an increased risk of death.
You can just imagine the damage we do to our brain when we deprive ourselves of good sleep. As much as one-half to two-thirds of patients with migraine and tension-type headache report insomnia, making it the most common sleep complaint.
Patients with obstructive sleep apnea have also shown to have poorer performance in vestibular function tests.
Stress is our body’s response to an internal or environmental obstacle.
The stress response originates in an area of the brain called amygdala, more popularly known as the seat of emotion. The amygdala then sends signal to the command center of the brain, the hypothalamus, that will activate a sympathetic response towards the pituitary and adrenal cortices.
This type of physiologic stress has been known to trigger migraine attacks and is reported to be present in 70% of migraineurs.
On the other hand, dizziness is a common symptom of stress and anxiety.
The relationship of headache and vertigo with mental disorders can be likened to a chicken-and-egg situation.
Headache and vertigo can occur even before the onset of mental disorders. In fact, 11% of participants in a mental disorder study had migraine prior to onset of their psychiatric illness such as Major Depression and Bipolar Disorder.
On the other hand, chronic pain and dizziness can also lead to uncontrollable stress that may lead to anxiety disorders.
It's important to note that brain areas responsible for dizziness is also believed to interact with the brain areas responsible for anxiety.
Doctors use a standard criteria to diagnose patients with a specific headache or dizziness disorder.
Particularly, the International Headache Society lays down the criteria for each and every primary headache here.
Diagnostic criteria: Migraine without aura
Diagnostic criteria: Migraine with aura
Diagnostic criteria: Tension-Type Headache
Diagnostic criteria: Benign Paroxysmal Positional Vertigo
Still unsure what type of condition you have? Sometimes, it is really not as easy as described in paper.
Even the International Headache Society recognizes the difficulty in differentiating one from another.
Tension-Type Headache and Migraine, in the absence of aura, may become confusing for both health professional and patient alike.
What makes it more difficult is the fact that patients who have frequent headaches often have both types of headache.
This is not surprising as they share common physiologic and psychologic factors that predispose a patient to frequent attacks.
There is also another group of patients who suffer from both migraine headache and vertigo and that condition is called Vertiginous Migraine.
In a Chinese study, around 10% of Migraine patients were observed to have vestibular symptoms as well.
The scientific explanation for this is still unclear and the confusion now lies in the overlap of Meniere’s Disease and Migraine Headache, especially if the patient just presents with dizziness.
Indeed, aside from taxes and work, there are a whole lot of reasons why our head hurts and spins and for most, they usually are just that - headaches and vertigo.
You take a pill and they will go away. However, we have talked about the possibility of secondary headaches and central vertigo - the ones that may have underlying, serious conditions. How do you know it’s not a stroke? A brain tumor? A ruptured aneurysm? Do all patients suffering from headache and dizziness need a brain MRI or a CT scan?
There is an easy-to-remember mnemonic to see if you have the red flag signs of headache and it is called SNOOP.
Red flags are alarming signs and symptoms that necessitate further evaluation and testing. Now, it has been upgraded to SNNOOP 10 which is less catchy and can be a bit confusing to the ordinary people, so I’ll just summarize it here (for a more comprehensive list, visit this study).
While these are made for headache sufferers, vertigo sufferers may also find these red flags useful. After all, they are both neurologic symptoms.
If you or your loved ones have any of these, please go to the emergency room immediately.
There is another overlapping disease that does not get much recognition probably because of how it is portrayed in movies and television. However, its recognition could spell the difference between an early life-saving treatment and a debilitating neurologic condition. It is called seizure.
“Really? But I don’t spasm”, you might ask.
You may be more familiar with a generalized tonic-clonic seizure that presents with sudden jerking of extremities and upward rolling of eyes.
However, there are other presentations of seizures. Blinking of eyes? Could be a seizure. Lipsmacking? Could be a seizure. Seeing flashing of light or hearing noises? Could be a seizure.
Seizures have a lot of surprisingly overlapping features with headaches, specifically, Migraine Headache.
Just like Migraine Headache, seizures have a strong genetic predisposition and is caused by an imbalance with the neural signals in your brain. They also present with aura that may be seen also in the form of flashing lights, stroke-like symptoms or hallucinations. Pretty much we can say that Migraine and Seizure are buddies that one is usually a comorbidity of the other and they even share similar treatment options.
In fact, some anti-epilepsy medications maybe used for migraine.
Although occurring less commonly, seizure can also be confused with vertigo. If the patient has the classic picture of epilepsy and just with concurrent dizziness, it can be a straight forward epileptic vertigo.
However, this study shows that rarely, dizziness may be the only presentation of seizure. This is where the confusion comes in because it becomes difficult to differentiate it from the peripheral causes of vertigo.
At this point, you already have a good grasp of the difference between headaches and dizziness.
But as you can see in each diagnostic criteria, your doctor has to make sure that it is not attributable to another medical condition, or worse to a medical emergency.
And that’s where the diagnostic tests come in. Again, it is your doctor’s discretion whether or not they will request the following tests, depending on your symptoms:
Brain MRI or Cranial CT Scan
These are imaging modalities that look at your brain tissue along with its blood supply. This is particularly helpful if tumors, bleed or infarct are being considered.
CT scan has significant radiation exposure but lasts just a few minutes and the results come out fast. On the other hand, MRI does not have radiation but you have to lie still for 30 minutes with a loud, pounding noise that you’ll hear from the machine. External metals and metallic implants are also not allowed inside the room.
If your doctor is highly suspecting seizure that disguises as headache, you might be requested to undergo an ElectroEncephaloGram to check your brain waves.
You will be asked to lie flat as they attach electrodes to your head. During the procedure, you will be asked to perform simple tasks such as closing your eyes. External stimuli such as flashing light or sounds may also be given to see if the seizure will be triggered.
This is an invasive procedure that involves sticking a needle between your spine to get fluid from your brain.
This fluid contains a lot of information such as if you have an infection, bleeding, or cancer.
This is a test that may be requested if Meniere’s Disease is being suspected.
You will wear a headset and will be asked to identify sound in different frequencies. It may reveal either a sensorineural hearing loss or a bone-conduction hearing loss
Complete Blood Count
A simple extraction of blood will show systemic signs of infection or cancer that can help the doctor see the complete picture.
Of course, again, these are not routine procedures for headache, per se. These are just done to rule out other medical conditions. The doctor will always decide based on your presentation.
Treatment strategies for headache and dizziness can be divided into two - Immediate Relief, and Prevention.
The key to managing acute migraine attacks is being prepared and having a good plan - where can you go? What can you do? What can you take?
Standford Healthcare recommends having a quiet, dark room where you can stay to lessen the stress stimuli. Massage, hot or cold compress may provide additional relief.
If you have been properly diagnosed with Migraine, it might be wise to keep a few prescription medications such as tricyclic antidepressants or simple analgesics available in case of emergency.
Transcranial Magnetic Stimulation may also provide some relief to your headache.
Now we know that Migraine Headache has a strong genetic component that makes certain individuals more at risk to have Migraine.
While we cannot change who our parents are, we can do a couple of things in our capacity to prevent it from happening.
NHS UK recommends a use of migraine diary where you note the time, duration, characteristics of previous attacks, and possible associated activity.
This way, you can identify and avoid your triggers. Other patterns may also be observed. Some women have migraine attacks only during their period. This is called “menstrual migraine”. For these you may take either hormonal pills or pain relievers that may prevent menstrual-related migraines.
Other techniques that may be considered to prevent recurrence of attacks in chronic migraineurs who are non-responsive to simple analgesics include Botulinum Toxin Injection, Anti-epileptic medication, and acupuncture.
The goals of immediate relief in attacks are to decrease pain and to relax the tensed myofascial area.
Stanford healthcare recommends use of muscle relaxants, and over-the-counter pain relievers, such as aspirin and ibuprofen.
Since the cause of pain in Tension-Type Headache is the myofascial compartment and the neural signal imbalance, physical therapy may help reduce these problems.
This study shows that a combination of the following physical therapy techniques have been shown to decrease the frequency of attacks among patients with chronic tension-type headache:
In case of an acute vertigo attack, the National Health Service of UK suggests lying still in a dark, quiet room to reduce the feeling of spinning and relaxing since anxiety may make the vertigo worse. Pharmacologic treatment includes anti-histamines.
Note that these techniques may only work if you have benign paroxysmal positional vertigo, or there is a build up of calcium debris in your inner ear. Other causes of vertigo that are associated with hearing loss, tinnitus or infection may require antibiotic treatment that must be monitored by your doctor.
Just like problems in life, there are three ways on how to deal with vertigo - you fix it, you try to overcome it or just learn to live with it.
You fix it by trying to displace the calcium debris in your ear to their correct place. Technically, it is your healthcare provider, an ENT doctor or a physical therapist, who will fix it but its success will depend on your cooperation and ability to follow instructions.
These are called Canalith Repositioning Techniques.
If these techniques fail, and the calcium debris just won’t budge, your healthcare provider can further agitate your inner ear with the hope that you overcome it by habituating your brain to the spinning sensation.
It sounds terrible but your brain is an awesome organ that knows how to adapt. When it gets used to this sensation, it will adjust to that “new normal” and you won’t feel dizzy with your vertigo.
Live with it:
Lastly, for cases that do not respond to the above strategies, there are ways that you can live peacefully with your vertigo.
These are strategies that minimize the movement of the fluids in your inner ear so that you do not get stimulated.
Considering all factors that contribute to these symptoms, headache and vertigo sufferers may benefit from changing the way they do things.
Stress has always been a critical survival tool across all species of animals, and that includes us.
We may not have to fend off predators or stalk our preys, but in our modern world, we get worked up with deadlines to meet, bills to pay and society to impress.
Society may have progressed but it has also took a toll on our mental health that success has become the end-all and be all of our existence.
If we can just pause and enjoy the beautiful things in life maybe we can relieve ourselves of some of these stress.
One study as has shown that relaxation exercise is equally effective with the use of topiramate (popular migraine preventing medication) in reducing migraine attacks.
We have talked about how lack of sleep is closely interconnected with headache and dizziness. For some, it is really difficult to get a good night sleep especially when you have headache and vertigo attacks.
The key is consistency - going to bed at the same time every night, and even more importantly, getting up at the same time. Exercise, or a warm cup of milk may help, while having gadget at bedtime may hurt your chances of getting a good night sleep.
Regular exercise has been scientifically proven to reduce headaches and dizziness. Exercise is known to release endorphins, our internal painkiller. One study demonstrated that regular exercise for 40 minutes three times a week is as good as using of topiramate in reducing migraine attacks.
There are certain food and drinks that are known to trigger migraine in certain people.
These food usually contain cheese, caffeine,alcohol, artificial sweetener, MSG, histamine. It does not mean that you cannot take any of these. First, you have to know your trigger and try to take less of it or eliminate it, if possible.
This question on Quora, and especially the first answer, practically sums it all up before we continue.
Because probably you, like myself, experience symptoms on the intersection of several conditions such as ON, CGH, Migraine, Tension headaches, and more.
Since we are dealing with the mix symptoms (research is not yet clear on how it all manifests), targeting one symptom in isolation is a painful (and costly) waste of time.
We need to address underlying processes on a more global scale that sometimes means getting results which are not immediate but sustainable (assuming you are not fainting right at this moment because of unbearable pain; call emergency now if that's the case).
The idea is: Let's deal with the pain and distress so we can have energy, motivation, and mental clarity for a more radical treatment.
‘The time to fix the roof is when the sun is shining.’
We're going to prepare ourselves (help the sun to come out) in order for the true healing process to even begin (fixing the roof).
Physical pain and emotional frustration (resulting from not understanding what's happening and how to deal with it) is what turns our lives into a miserable existence. Generally, we experience a lack of will to do anything until this continuous confusion goes away.
You can learn here why your emotional and mental states can literally generate physical pain.
We need to clear the fog, so to speak, in order to breath freely for a moment so we can gather energy and realize that there's a way out of all this.
Let's do it.
I cannot know if we have similar issues. But over the years of deep research and even deeper experimentation I can say that I understand what is under the hood of manifestations like headaches, tensions, chronic problems, and all the mental companions of those physical symptoms.
There's a reason why I've separated this section: to let you choose your way, your perspective, your comfort if you'd like.
I'm not a doctor. Not a scientist. Just a regular guy. No credentials. No medical education.
But instead of "borrowing" dry information from others, I am living through my physical and mental issues; I'm experimenting with different perspectives on health and on ways to heal myself; I've been failing countless times in my attempts - sometimes because things didn't work, but way more often because I was giving up on my own trajectory; I've been rising up again and again after being emotionally broken from my own weaknesses... for one reason only - to connect things together and understand how "I work" in the deepest sense possible. This journey had brought me to more profound realizations; but that's not the point here.
I needed to connect what I experience with definitions and labels of conventional medicine as well as so-called alternative and holistic approaches. I desired to connect physical domain with mental and emotional worlds.
In my heart, I felt the call to connect my experience with your struggles and perspectives, and hopefully create a bridge of knowledge, love, and hope.
And I've succeeded to a certain extent.
I've been living with symptoms, which may be familiar to you, for years -
Because of all this, especially blurry vision and physical instability, my anxiety (this mental fragility) and psychological overwhelm grew to the extreme heights.
I experience difficulty with communication (lost in processing), troubles following along with my own decisions, and burning desire to escape from this constant overwhelm. I know that I've just described several psychological conditions. That's not the point.
The general idea is that the brain is too overwhelmed to process the input from the outside because of constant noise covering and distracting the signal. Operating in this state of mental and physical confusion is enormously depleting.
If I would distill my experiences down to the core, it would be:
For several years I've been living with this weird stack of symptoms ranging from neuropathic pain and vestibular issues to psychological imbalances and continuous mental overwhelm.
With time I've learned how to get better. Simple steps over time was bringing this delicious relief from pain, mental stability, and increased desire to tackle this beautiful life.
And I've found a way out which turned out to be a way in - I've realized that all these "unhealthy" imbalances are the doors we can enter with discipline and knowledge. What we find on the other side depends only on the:
I haven't just imagined all that. I found through research and self-experimentation - which sometimes have led me to the dark places - that there's a connection between every aspect of my health imbalances. More importantly, I believe that the roots of my own health issues are no different from anybody living at this day and age.
This grand outplay of influences and effects of those influences becomes pretty clear if you sincerely look through the dirt of our rotten system as well as your own inner kingdom of well-behaved madness.
We simply don't usually see all that because we're taught not to cross accepted avenues for living and healing; it's simply uncomfortable and may feel awful.
Probably, my situation seems different from yours. And it is. Odds are that you won't find anyone with exactly the same experience. Why? Because we haven't lived our lives identically. We have our imbalances on every level and we have different level of awareness of them.
However, the "basis" for our life on this planet, as a part of this planet, is the same. We all are human beings. Thus, we share true roots no matter creed, ideology, race, or any other concept our perplexed minds invented (just to be caught in them later on).