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Sudden onset headaches with giddiness

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Hi. I am a 45 year old female.

About 4 months ago I started to get headaches out of the blue. Severe and lasting all day long. I would label them as pressure headaches. At first they felt very front and sinus to me (but were not sinus related). The onset again was very sudden and alarming. I also had eye symptoms. No visual disturbances but felt that something was tugging behind my eye muscles, moving or straining them- is the best I can describe.

The headaches tapered a bit. Then during a period of flu and work stress a month ago, I started to get this feeling when I lay down to sleep. An "adrenaline" rush that would jolt me awake as if I was about to pass out soon. It felt like a stirring in my chest, like my heart was going to race, but the heart didnt race. This adrenaline feeling happened a few times but once I did awake in the middle of the night with my heart racing.

Then I started to have the headaches back but this time, tons of ear pressure and pain and head rushes like my head was going to explode. Would come on in waves occasionally with dizziness. Sometimes when I would sleep I would have "attacks" of irregular heartbeat getting fast for 10 seconds, the adrenaline feeling and head rush, and nausea. Then it would go away and come back 20 min later all night long. No sleep at all.

Brain, neck MRA/MRI all clear. All blood work fine. At first dr's said migraines, but then said no, it wouldnt act like this.

So I started to take my blood pressure during these events. What I noticed is when I have these "passing out" events at night, my blood pressure is SUPER low (80/40 range). Then I started to get them waking a bit. There was a period of time on a Sunday I had them every few minutes with chest pain and pallor, dizziness, nausea - all heralded by the balloon head rush and pressure. Unfortunately I did not have the monitor yet that day to see what my bp was.

Ever since then my heartbeat has been "off." For background, I am had a mitral valve repair 5 years ago with no problems and am very fit. I "know" palpitations well since I had them my whole life- this doesntt feel like that. My heart rate is normal (monitor says rate around 65) and then it will "pause" and a palpitation comes along and then it beats very slow for another 5 seconds, and then back to normal. Its almost like I have a regular heartbeat with a string of slow beats every minute one or too that make me dizzy.

Yes, I am going to see my cardiologist next week for blood pressure and heart monitoring. I am just very scared I feel like all of a sudden something has hijacked my autonomic nervous system. I will say that I do not perceive fatigue or shortness of breath, in fact just the opposite, I cant sleep/anxious and keep getting jolted away and must sleep upright. I am concerned that maybe it has a terrible neuro cause like Multiple System atrophy? Does it present like this? One of my dr's did check my bp on lying, sitting and standing and it does not seem to drop in orthostatic hypertension. He did not think that was it. He said if there was a failure of my nervous system we would see it on that test and I maintain my bp. However, I do have the neck/muscle ischmia pain. Can you have a failure of the nervous system but maintain BP standing up? I don't have the racing heartrate like POTS syndrome when standing .

I am just concerned how someone's system goes haywire like this without a terrible cause? I can't walk around anymore with this terrible headpressure/ear pressure and head rushes. I also cannot sleep because of the low blood pressure laying down. I have also monitored my bp during the day since this started an the pressures are strange - some like 115/62 or all over the place. I used to be a very standard (albeit low) blood pressure of 95-65.

I realize this sounds very hypo/anxious and yes, I am worried now. But I do not believe, based on my heart rhythm or bp, that I am perceiving this incorrectly.

Category: Cardiologist

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Category: Cardiologist
 18 Doctors Online

Thank you for your query at

It doesn't sound like orthostatic hypotension. So I wouldn't stress too much on a possibility of POTS or multi system atrophy.

You have sudden onset headaches with giddiness. I don't know if you have records of BP during these episodes, but if they are normal then it rules out a variety of hypertensive causes of your headache like renovascular hypertension or pheochromocytoma.

Cluster headaches are another possibility. They too are associated with retroorbital pain and redness of eye.

Another possibility that comes to mind is perimenopausal syndrome. Are your menses regular? Are you nearing a menopause?
Hot flashes with adrenaline rush and feeling of giddiness and doom may occur when the menopause is about to occur.
You seem to have some heart rhythm abnormality associated with an old mitral valve problem which is repaired.

So I would suggest you undergo a 24 hour Holter monitoring to rule out any cardiac rhythm disturbance that may be causing these neurological symptoms. Along with that maintain a diary during the 24 hours as to when you have the symptoms, so that we may correlate retrospectively with the heart rate. It would also help if you could record the bp every time you have that headache sensation or you could alternatively have a ambulatory bp monitor during those 24 hours. If we don't find a correlation between an episode of headache and bp and pulse rate and your holter ecg records then cardiac cause can be effectively ruled out.

Hope this helps, please feel free to get back with follow-up queries.
Dr Vivek Mahajan
DM Cardiology

Dr. Vivek Mahajan
Category: Cardiologist
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
Dr. Vivek Mahajan and 4 other Medical Specialists are ready to help you

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