Addressing your mom’s symptoms involves several possible factors. Chronic migraine and tension-type headaches often present with persistent unilateral head pain or pressure—and could possibly explain the symptoms. However, the fact that these symptoms are accompanied by dizziness, tinnitus, and fluctuating blood pressure could suggest a more complex interplay of conditions. Cervical disc herniation can indeed cause referred pain, contributing to headaches, especially if there’s nerve impingement. Tension in the neck and shoulder muscles could exacerbate these headaches. The dizziness and tinnitus, however, might not be fully explained by cervical issues alone. The old ischemic brain lesions indicate past vascular events but may not be directly responsible for the symptoms if they’re stable and unchanged — still, these lesions along with fluctuating blood pressure underline the need for a cardiovascular evaluation.
A multifactorial approach is crucial. For immediate symptom relief, considering treatments like triptans or other migraine-specific medications may provide better relief than general analgesics. A preventive medication strategy might include beta-blockers, calcium channel blockers, or even antiepileptic medications. Since anxiety and stress play a notable role, exploring cognitive-behavioral therapy or other stress management techniques may also reduce symptom severity. For dizziness and tinnitus, vestibular rehabilitation therapy or audiological exams could be beneficial. A referral to a neurologist for an in-depth assessment would help clarify the contribution of each factor and ensure that more serious issues are not overlooked. Keeping track of triggers, symptom patterns, and medication responses in a headache diary can also aid both diagnosis and treatment. It may also be prudent to revisit cervical spine imaging to assess changes. In parallel, lifestyle modifications focusing on diet, regular physical activity, and managing stress play an important supportive role. Always consult appropriately before starting or changing treatments to ensure all steps align with her overall health profile.
Hello Chourouk, thank you for sharing your concern. The old small ischemic lesions seen on MRI do NOT usually cause ongoing unilateral headache, dizziness, or tinnitus for months/years. They are incidental small-vessel changes, common after 50, and not progressive. So this is unlikely to be an active stroke problem.
The causes of her might be one of these- Chronic Migraine/ Cervicogenic Headache/ Anxiety Autonomic Dysregulation.
Regarding treatment, for a proper prescription, she needs a good physical examination by a certified Physician or a Neurologist. I’ll give rest of the advice to you-
Cervical physiotherapy. Posture correction. Avoid prolonged neck flexion. Heat therapy. CBT or counseling. Breathing exercises. Avoid excessive BP checking. Regular walking.
Seek urgent care if: New weakness, speech problem. Sudden severe “worst headache of life”. New vision loss. Persistent vomiting.
Feel free to reach out again.
Regards, Dr. Nirav Jain MBBS, DNB D.Fam.Medicine
Hello dear See as per clinical history it seems migrane with minor occlusion. However I suggest you to please get following tests done for confirmation Ct scan skull MRI Esr CBC EMR Cervical spine Eeg Please share the result with neurologist in person for better clarity Regards
Hello,
Your mother’s symptoms most likely suggest chronic/vestibular migraine and possibly cervicogenic headache from cervical disc herniation.
The old ischemic lesions on MRI are likely not responsible for current ongoing symptoms but mean vascular risk factors (BP, cholesterol, sugar) must be controlled.
Recommended approach
ECG/BP monitoring, consider cervical spine evaluation Migraine preventive treatment (not just painkillers) Cervical physiotherapy Anxiety/stress management Lifestyle + vascular risk control
Urgent care if: sudden severe headache, weakness, speech problems, vision loss, or worsening dizziness.
Thank you
Hello Chourouk Thanks for sharing such a detailed history about your mother. I’ll break down the possibilities and address your questions clearly:
1. Chronic Migraine or Tension-Type Headache - Chronic migraine can cause persistent, one-sided headaches, sometimes with pulsating quality, dizziness, and even symptoms like heaviness of the tongue or difficulty opening the eyes. Tinnitus and visible vein pulsation are less typical but can occur due to associated vascular changes or anxiety. - Tension-type headache usually causes a band-like, pressing pain, often on both sides, and is less likely to cause pulsating pain, dizziness, or neurological symptoms like tongue heaviness.
2. Cervical/Occipital Neuralgia - Cervical disc herniation can cause headaches, especially if there’s nerve root irritation (cervicogenic headache). This pain often starts in the neck and radiates to the head, sometimes causing dizziness and even tinnitus if there’s involvement of nerves near the ear. - Occipital neuralgia typically causes sharp, shooting pain at the back of the head, sometimes radiating forward, but less commonly causes tongue heaviness or eye symptoms.
3. Other Factors - Small vessel disease seen on MRI is common with age and high blood pressure, but old lesions are unlikely to cause ongoing symptoms unless there’s new damage. - Anxiety and stress can amplify all these symptoms, including dizziness, tinnitus, and even the sensation of vein pulsation.
4. Cervical Disc Herniation and Symptoms - Cervical disc herniation can explain headache and dizziness, especially if there’s nerve compression. Tinnitus is less common but possible if there’s involvement of nerves near the ear. - However, the combination of all these symptoms (headache, dizziness, tinnitus, tongue heaviness, eye symptoms) suggests there may be more than one contributing factor—possibly a mix of migraine, cervical issues, and anxiety.
Yes, there are several treatment options beyond painkillers that can help manage your mother’s symptoms. Here are a few possibilities: 1. Preventive Medications: - Antidepressants (like amitriptyline) can help with chronic headaches and anxiety. - Anticonvulsants (like topiramate) are often used for migraine prevention. - Beta-blockers (like propranolol) can also be effective for migraine prevention. 2. Physical Therapy: - A physical therapist can help with neck exercises and posture correction, especially for cervical disc issues. This can alleviate headaches and dizziness. 3. Cognitive Behavioral Therapy (CBT): - This can help manage anxiety and stress, which may be contributing to her symptoms. 4. Nerve Blocks or Injections: - Occipital nerve blocks can provide relief for headaches originating from the neck. 5. Lifestyle Modifications: - Regular exercise, hydration, and a balanced diet can help reduce headache frequency. Stress management techniques like yoga or meditation may also be beneficial. 6. Alternative Therapies: - Acupuncture or chiropractic care may provide relief for some individuals. 7. Neuromodulation Techniques: - Devices like transcutaneous electrical nerve stimulation (TENS) or other neuromodulation therapies can be explored.
What to Do Next - Neurology review: A neurologist can help distinguish between migraine, neuralgia, and cervicogenic headache, and may suggest preventive migraine treatment or nerve blocks if needed. - Cervical spine evaluation: If not already done, a cervical spine MRI can help assess the extent of disc herniation. - ENT review: For persistent tinnitus, an ENT opinion may be helpful. - Blood pressure control: Fluctuating BP should be managed, as it can worsen headaches and small vessel disease. - Stress management: Psychological support or therapy can help, as anxiety can worsen all symptoms.
Thank you
