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Suggest Treatment For Headache And Dizziness In An Elderly Person

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Posted on Sat, 19 Dec 2015
Question: Healthy 68 year old woman - have started having headaches and fainting spells. I used to faint when I was younger but it hasn't been a problem since I was about 7. Head aches are usually on left side.
My mother died from gliobastoma multiforme, so I am a little concerned....
doctor
Answered by Dr. Olsi Taka (57 minutes later)
Brief Answer:
Read below

Detailed Answer:
I read your question carefully and your concern is understandable considering also your family history.

If you have been wondering of there being a possibility of a brain tumor such as glioblastoma being inherited the answer is no, they are not inherited and the fact your mother had glioblastoma doesn't put you to any increased risk. (there are some syndromes such as neurofibromatosis, but they have many other early manifestations, you'd know, not your case).

However you speak of headache which has started only now, and a headache of recent onset at your age should be carefully considered as it is not a typical time to manifest common primary headaches such as migraine, a cause must be sought.

It might be useful though if you provided some more details such as:

-since when have the headaches started (weeks, months)
-character of the headache (throbbing, pressure-like, lancinating etc)
-is it constant or intermitent, if intermitent how long do the episodes last, do they ever switch side or is it always the left.
-any triggering or relieving factors such as time of day, head position, stress, fatigue, light or sounds etc.
-any other symptoms such as nausea and vomiting, vision changes, changes in behavior, weakness of the limbs on one side, nasal discharged or congestion, eye redness, lacrimation, fever, fatigue, weight loss etc.
-any fluctuations of blood pressure, heart beat etc
-any details on fainting episodes like preceding sensations, loss of consciousness, duration, movement of the head, body or limbs (if unconscious perhaps described by witnesses), loss of sphincter control (urination), tongue biting etc

If I were to judge solely based on the present info, of a recent onset headache with fainting spells which could represent seizures, I would say that testing is required. By testing I mean head imaging (possibly contrast MRI) and some routine blood tests like blood count, erythrocyte sedimentation rate, c reactive protein, blood glucose, liver and kidney function tests, electrolytes. The aim is to search on imaging for brain lesions like stroke, malformations, inflammation, infection, tumor (all conditions possibly presenting through headache and seizures) as well as blood inflammation markers or other metabolic changes which may affect the nervous system secondarily.

I remain at your disposal for further questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka (20 hours later)
Thank you for letting me know that there is no increased risk.
In answer to your questions:

Headaches started maybe two years ago and usually are proceeded by vision changes. If I can immediately take an aspirin, they usually go away without turning into a full blown headache. They are usually always behind my left eye.

The fainting has just appeared within the last 3 weeks - I usually just get lightheaded beforehand and collapse where I am standing or sitting. The last time was Thursday - I was getting the turkey ready for the oven and the next thing I knew I woke up on the kitchen floor......
I have had 4 episodes in the last 3-4 weeks and they usually last just a minute or two.

I admit that I do not eat as a person should. Usually only eat 1 time a day and that may be only a sandwich or something. Food does not interest me at all - I am never really hungry anymore. Would low blood sugar or anything like that be one of the problems?


doctor
Answered by Dr. Olsi Taka (4 hours later)
Brief Answer:
Read below

Detailed Answer:
Thank you for the additional info.

If it has been two years since the headaches started then issues like malignant tumors and stroke can be excluded, so you should definitely relax about the glioblastoma hypothesis. Judging by your description they look most probably like migraines preceded by visual aura. Had you been younger further tests might not be needed, but migraine is a little unusual after the age of 60, so I still think head imaging may be scheduled, not on an emergency basis, as I said the evolution in time excludes urgent threatening causes.

On the other hand those fainting episodes are worrying now reading that description. Hypoglycemia (low blood sugar) is a possible cause which is why I mentioned its measurement before among other things.
However the primary suspect should be a cardiac cause followed by seizures.
By cardiac cause I mean issues like heart arrhythmia or heart valve abnormalities which can lead to episodes of transitory insufficient blood supply to the brain, hence the loss of conscioussness.So you should definitely have a cardiac evaluation, including at least an EKG and ultrasound.
If that results normal it should be gone ahead with the other blood tests, an electroencephalogram and imaging I mentioned in my first answer. I understand those may sound like many tests, but not necessarily all have to be done, it is started by most common cause and only if normal is proceeded to rarer ones. Those episodes should not be left uninvestigated.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka (3 hours later)
Thank you so much for the advice. I appreciate your time.....
doctor
Answered by Dr. Olsi Taka (4 hours later)
Brief Answer:
Thank you.

Detailed Answer:
Thank you for your kind words. I hope will work out for the best.
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3673 Questions

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Suggest Treatment For Headache And Dizziness In An Elderly Person

Brief Answer: Read below Detailed Answer: I read your question carefully and your concern is understandable considering also your family history. If you have been wondering of there being a possibility of a brain tumor such as glioblastoma being inherited the answer is no, they are not inherited and the fact your mother had glioblastoma doesn't put you to any increased risk. (there are some syndromes such as neurofibromatosis, but they have many other early manifestations, you'd know, not your case). However you speak of headache which has started only now, and a headache of recent onset at your age should be carefully considered as it is not a typical time to manifest common primary headaches such as migraine, a cause must be sought. It might be useful though if you provided some more details such as: -since when have the headaches started (weeks, months) -character of the headache (throbbing, pressure-like, lancinating etc) -is it constant or intermitent, if intermitent how long do the episodes last, do they ever switch side or is it always the left. -any triggering or relieving factors such as time of day, head position, stress, fatigue, light or sounds etc. -any other symptoms such as nausea and vomiting, vision changes, changes in behavior, weakness of the limbs on one side, nasal discharged or congestion, eye redness, lacrimation, fever, fatigue, weight loss etc. -any fluctuations of blood pressure, heart beat etc -any details on fainting episodes like preceding sensations, loss of consciousness, duration, movement of the head, body or limbs (if unconscious perhaps described by witnesses), loss of sphincter control (urination), tongue biting etc If I were to judge solely based on the present info, of a recent onset headache with fainting spells which could represent seizures, I would say that testing is required. By testing I mean head imaging (possibly contrast MRI) and some routine blood tests like blood count, erythrocyte sedimentation rate, c reactive protein, blood glucose, liver and kidney function tests, electrolytes. The aim is to search on imaging for brain lesions like stroke, malformations, inflammation, infection, tumor (all conditions possibly presenting through headache and seizures) as well as blood inflammation markers or other metabolic changes which may affect the nervous system secondarily. I remain at your disposal for further questions.