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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31329
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Pulsating sensation in my head. What could it be?

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I have a strange, non-painful pulsating sensation in my head. I can feel it behind my eyeballs, my temples, in the back of my head, and down my neck. In addition I feel borderline dizzy but not actually dizzy. Sometimes it seems like a kinesthesia echo, if that makes any sense. Other times it feels more as if it were the sensation of the blood moving through the vessels in my head. It's very hard to describe and I'm usually pretty good at specifically describing or labeling symptoms. This has been going on for nearly two months now. Initially it was only at night when I was lying down. It was a very strong sensation but seemed kind of fascinating at that time. I continued to feel it at night every few nights. But for the last 3 days I have been feeling it all day as well and it's no longer so fascinating. I feel it when still and I feel it more strongly whenever I move my head or my eyes, or if I'm lying down. I went to my GP and I do not have high blood pressure. I do not have any cold symptoms or any reason to suspect a sinus infection. She really didn't have any answers at all but referred me to a neurologist. The neurologist doesn't have any appointments for 3 weeks and I don't know whether this should be seen more urgently or if it's not acute and nothing to really worry about.

Do you have nausea, vomiting, headache, vision disturbance, imbalance, hearing problem?
Any significant past medical history?
Are you on any medications?
Are you stressed / anxious?

Customer: replied 4 years ago.

No nausea, headache, vision disturbance, hearing problem, etc.

I take singulair, levothroid, buproprion xl, cymbalta, and zyrtec daily for "Hashimoto's Syndrome" (hypothyroid), non-allergic rhinitis and mild asthma, and depression. No more stressed or anxious than usual.

Following are the possibilites to be looked for your symptoms;

1) Vestibular neuronitis
2) Labyrinthitis
3) Cranial neuropathy
4) B 12 deficiency
5) Central vertigo

Following investigations are likely to help in the diagnosis;

1) Electromyography; measures the electrical activity of muscles when working and at rest

2) CT or MRI scan

3) Nerve conduction velocity tests to help identify how and where the nerve is damaged

4) Hearing tests

5) Angiography

6) Blood levels of the B 12.

7) Tilt table test

8) Electronystagmography (ENG); to evaluate dizziness or balance dysfunction.

Stress and anxiety, hypothyroidism, migraine are the other possibilities of the causes, which may be concomitant to the above issues. Often, dizziness or related sensation can be a multisensory disorder due to any combination of peripheral neuropathy, visual impairment, and musculoskeletal disease. Many patients who have thyroid dysfunction can present with dizziness as an initial complaint. In individuals who have migraine, dizziness and vertigo can occur as part of the aura or separately. Spells usually last approximately an hour but can last several hours or days in patients who have severe symptoms. Most patients who have migraines have a long history of recurring symptoms. So that too should be assessed as a cause if you have a history of migraine.

Customer: replied 4 years ago.

I believe I may not have described the primary symptom adequately. I would not consider it to be dizziness. It's more a "wooshing", pulsating sensation throughout the head. It's behind my eyes, my temples, and back down my neck. It worsens when I move my eyes around when they're open. The first time I experienced it I was lying in bed and the sensation felt as if I could completely sense the flow of all the blood vessels within my head. I know that all sounds kind of nuts, but it's really a difficult sensation to put into words as it is not something I have ever experienced before. I have had dizziness and vertigo, and it is definitely not the same as either of those. I have had no pain at all associated with this, and it's on both sides of my head, as well as feeling as if it goes deeper into my head, not just on the outside of my skulls.

I've had the hypothyroid for over 15 years and it is well regulated and was tested recently. My GP did order tests for that and some other blood tests (I'm not sure what she covered) and has given me a referral to a neurologist. But the neurologist doesn't have any appointments available for 3 weeks. I'm trying to assess the severity of this, whether it's ok for me to do things like drive or not, and whether I should find a different neurologist with an earlier availability or not.

As you can understand, providing a specific diagnosis for this symptom and sensation is not easy. A physical examination (neurology examination of reflexes, muscle power, cranial nerve exam etc) give the clue. But this symptoms would specifically need an MRI and other work up to pin point the cause. While this sensation is not the pointer to anything serious (like a tumor or loss of blood supply to the part of brain), but anything which has been going on for two months would need an early evaluation. So if you can find a neurologist earlier than the 3 weeks, it would be good. As further investigations would take some more time. Meanwhile, you may ask your primary care physician to get an MRI, if the neurologist appointment cannot be sought earlier. Again, to re-emphasize, this does not sound to be serious, though no harm in early evaluation.

It is privilege assisting you.

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