Migraine: diagnosis and treatment
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby in Headache in Clinical Practice, 2018
The pain of migraine is invariably accompanied by other features. Anorexia is common, although food cravings can occur. Nausea occurs in almost 90% of patients, while vomiting occurs in about one-third of migraineurs (Figure 6.9).18 Many patients experience marked sensory sensitivity, manifested by photophobia, phonophobia, and osmophobia, and seek a dark, quiet room (Figure 6.10).7,18 Other systemic symptoms, including blurry vision, nasal stuffiness, anorexia, hunger, tenesmus, diarrhea, abdominal cramps, polyuria (followed by decreased urinary output after the attack), pallor (or, less commonly, redness) of the face, sensations of heat or cold, and sweating, may be noted during the headache phase. There may be localized edema of the scalp, the face, or under the eyes, tenderness of the scalp, unusual prominence of a vein or artery in the temple, or stiffness and tenderness of the neck. Impairment of concentration is common; less often there is memory impairment. Depression, fatigue, anxiety, nervousness, and irritability are common. Lightheadedness, rather than true vertigo, and a feeling of faintness may occur. The extremities tend to be cold and moist. As discussed below, the IHS selects particular associated features as cardinal manifestations for diagnosis.
Dizziness
Henry J. Woodford in Essential Geriatrics, 2022
‘Dizziness' is a very vague term that is used to describe the symptoms of a wide range of conditions. For simplicity, here it will be divided into ‘vertigo' and ‘lightheadedness' because these can usually be distinguished by a careful history. Vertigo is a sensation of movement, usually the room spinning. Lightheadedness is a sensation of pre-syncope that is often described as a giddiness, wooziness or drunkenness sensation. Sometimes people report dysequilibrium – a sense of reduced balance and unsteadiness while walking. This is typically due to a combination of gait and balance disorders, sensory loss and sometimes medication effects. It can be viewed as a precursor to falls and should be evaluated in a similar way (see Chapter 14). Vertigo, lightheadedness and dysequilibrium may coexist within individuals. In a study of older people in primary care who reported dizziness for at least two weeks, presyncope was judged to be the commonest type affecting 69% but 44% had more than one subtype.3 Vertigo was present in 41%, dysequilibrium in 40% and a small number of cases were deemed unclassifiable.
Exercise, Nutrition, and Medications
Maria A. Fiatarone Singh, John Sutton Chair in Exercise, Nutrition, and the Older Woman, 2000
Diuretics are a diverse group of drugs that are used for the regulation of fluid balance, primarily in the treatment of hypertension, congestive heart failure, and edema. With any of the agents, chronic usage of moderate or high dosages may pre-dispose someone to dehydration, as the intravascular fluid volume is already reduced. This effect is most likely to occur after prolonged exercise in high temperatures when adequate oral fluid replacement is not taken.6 Because older adults have a decreased ability to sense alterations in blood volume and osmolar content, they may not perceive increased fluid needs as thirst until after clinical dehydration occurs.7 Intravascular salt and water depletion may also increase the risk of heat stroke during prolonged exercise in a hot environment. These problems can usually be avoided by advising extra fluid intake (water or electrolyte replacement drinks) on exercise days, even if there is no sense of thirst at the time. Symptoms of lightheadedness or dizziness, dysequilibrium, giddiness, or a change in mental status may be indicative of present or impending dehydration or heat stroke. Exercise should be stopped and a supine posture assumed while fluid is given and vital signs are monitored.
A cross-sectional survey of symptoms and daily living among patients with polycythemia vera and their treating physicians in Japan
Published in Hematology, 2023
Yoko Edahiro, Keita Kirito, Akihiko Gotoh, Katsuto Takenaka, Yuka Sugimoto, Norio Komatsu, Kazuya Shimoda
Of the 27 symptoms listed in the questionnaires (Q2-5), all symptoms were selected as symptoms perceived to be experienced by the patients (Figure 2 and Supplementary Fig. 3A). The PV symptoms that patients most wanted to resolve were pruritus (including after a hot bath/shower) (13.6%), and fatigue (10.9%) (Figure 2). Dizziness/lightheadedness, double/blurred vision, headache, and muscle weakness also ranked highly as symptoms that patients most wanted to resolve (Figure 2). Pruritus (including after a hot bath/shower) (31.3%) and fatigue (30.9%) were the most selected symptoms among the top five most common symptoms that patients wanted to resolve. Meanwhile, the four most common symptoms that physicians perceived as most important to resolve were fatigue (33.8%), headache (19.9%), dizziness/lightheadedness (9.3%), and pruritus (including after a hot bath/shower) (6.0%) (Supplementary Fig. 3B).
Symptoms upon postural change and orthostatic hypotension in adolescents with concussion
Published in Brain Injury, 2021
M Nadir Haider, Kush S Patel, Barry S Willer, Victoria Videira, Charles G Wilber, Andrew R Mayer, Christina L Master, Brandon L Mariotti, Christopher Wertz, Eileen P Storey, Kristy B Arbogast, Grace Park, Scott J Oglesbee, Itai Bezherano, Kenneth Aguirre, Jesse G Fodero, Blair D Johnson, Rebekah Mannix, Jeffrey C Miecznikowski, John J Leddy
Male and female acutely injured adolescents with concussion experienced symptoms of lightheadedness and dizziness upon postural change significantly more often than healthy adolescents; however, they did not more often meet standard OH criteria. The symptom of dizziness (or vertigo) on postural change could have been from vestibular dysfunction since it was associated with an abnormal vestibular ocular reflex. The symptom of lightheadedness could have been from cardiovascular autonomic dysfunction since acutely injured adolescents with concussion had lower HRs and a smaller increase in HR moving from supine to standing when compared with controls. Upon clinical recovery, adolescents with concussion had more significant differences in HR and BP values versus healthy controls, consistent with cardiovascular deconditioning. The clinical utility of assessing the postural symptom response is that it may make the diagnosis of concussion more specific since resting symptoms do not always reliably distinguish concussion from other injuries (e.g., to the cervical spine). Further research into the causes of a variety of symptoms and their utility in concussion assessment is warranted.
Nose blowing-induced biphasic nystagmus of unknown origin
Published in Acta Oto-Laryngologica Case Reports, 2021
Munetaka Ushio, Manabu Kataoka, Kenji Iyama, Ayami Shimizu, Mitsuya Suzuki
On electronystagmography, no spontaneous nystagmus, including periodic alternating nystagmus, was observed. There were no abnormalities in eye tracking, saccades, and optokinetic nystagmus tests. No head positional or positioning nystagmus was observed. No periodic alternating nystagmus (PAN) were observed in the ENG records. The caloric test results were normal, with no difference between the left and right sides. A right-beating nystagmus was observed approximately 22 s after nose blowing (Figure 2(a)), and the patient became aware of spinning vertigo 25 s after nose blowing. Once the nystagmus disappeared (Figure 2(b)), a left-beating nystagmus appeared approximately 45 s after nose blowing (Figure 2(c)), and the direction of rotation of the spinning vertigo was reversed. The nystagmus disappeared approximately 95 s after nose blowing (Figure 2(d)), and the patient was no longer aware of vertigo. Lightheadedness, however, persisted for approximately 30 s. Spinning vertigo and biphasic nystagmus caused by nose blowing were observed in both the sitting and supine positions, and were reproducible upon re-examination.
Related Knowledge Centers
- Dizziness
- Eye
- Inner Ear
- Nervous System
- Syncope
- Vestibular System
- Vertigo
- Brain
- Chronic Condition
- Visual Field