Having a headache or feeling dizzy can be unsettling on its own, and together they’re even more anxiety producing. But identifying the source of your dizziness can help you find relief for your symptoms. Describing the sensation to your doctor or even friends or family members can be challenging because the term “dizzy” can mean different things to different people. In medical terms, what exactly does it mean when say we “feel dizzy”? “Vertigo, on the other hand, is a spinning sensation of your body, or the perception of the environment around you moving when you’re not actually moving,” Dr. Spears says. “Lightheadedness would be associated with low blood pressure, lack of blood flow, or lack of blood flow reaching the brain,” says Spears. When you’re lightheaded, you may feel as though you’re going to pass out; the body wants you to get into a lying-down position so you can get adequate blood flow to the brain, he explains. RELATED: 10 Surprising Facts About Dizziness and Vertigo
Pay Attention to When Your Dizziness and Headaches Occur
If you’ve been experiencing bouts of dizziness, make note of when it occurs or gets worse. For example, does it occur when you get up suddenly from sitting or lying positions? If anything improves your dizziness, keep track of that, too. Be sure to tell your doctor if there are any other symptoms that accompany the dizziness, such as a headache or changes to your hearing or vision, says Spears. You’ll also want to inform your doctor of any other health conditions you may have, such as diabetes or pregnancy, which can trigger these symptoms. Low blood pressure is another possible cause of dizziness or lightheadedness.
Potential Causes of Headache and Dizziness
There can be a range of reasons that headache and dizziness can coexist; some are easily remedied, while in rare cases the symptoms could indicate a medical emergency.
Migraine
Dizziness or vertigo with a headache may be a sign of vestibular migraine and can occur in any of the phases of a migraine, according to the American Migraine Foundation. The word “vestibular” is used to describe the inner ear and a person’s sense of balance. Dizziness is a common symptom of migraine, says Loretta Mueller, DO, a headache specialist at Cooper University Health Care in Cherry Hill, New Jersey. “When people complain of dizziness, it’s migraine related about 50 percent of the time,” she says. If the headache and dizziness have additional symptoms such as nausea, light sensitivity, or sound sensitivity, then it may be migraine, says Spears. “One thing that seems specific for vestibular migraine is brain fog. People will often describe a sensation of cognitive clouding, or brain fog, around the time they have these episodes, and it can persist outside of it as well,” he says. Interestingly, vestibular migraine doesn’t always come with a headache. If it does, often the headache is not very severe, says Spears. “Most of the patients I see with vestibular migraine are more concerned with the dizziness or vertigo than they are with head pain,” he says.
Trauma to the Head
It’s common for people who experience a traumatic brain injury (TBI) to have headache, says Spears. “If you have a genetic predisposition for migraine, there’s a greater chance of that post-traumatic headache presenting as a migraine headache,” he says. These post-trauma headaches can often come with dizziness. It’s estimated that 30 to 65 percent of people with TBI report balance issues that include dizziness and disequilibrium during their recovery, according to the American Congress of Rehabilitation Medicine. In some cases, a head trauma, ear trauma, or sudden change in barometric pressure can cause a perilymph fistula, which is when one of the fluids in the inner ear leaks into the air-filled middle ear. This can cause headaches as well as bouts of unsteadiness, dizziness, nausea, hearing loss, and tinnitus, according to the Vestibular Disorders Association (VeDA). Tinnitus is most often described as a ringing in the ears, but it can also be experienced as roaring, clicking, hissing, or buzzing. Whiplash or trauma to the neck area can cause cervical vertigo, which can happen when receptors in the neck that send signals to the inner ear for balance stop working normally. Sudden neck movements can trigger dizziness; other symptoms of cervical vertigo include headache, neck pain, nausea, vomiting, and hearing issues, according to the American Hearing Research Foundation.
Benign Paroxysmal Positional Vertigo (BPPV)
In this disorder, dizziness may occur, but it’s more likely to feel like vertigo, says Dr. Mueller. It can happen when the little crystals in the semicircles of the ear, called otoconia, become dislodged. “This can bring on the symptoms of vertigo. When people have BPPV, it’s positional vertigo — the spinning feeling happens when you move your head or turn over in bed, she explains. Headache is common in people with BPPV. Research published in the Annals of Otology, Rhinology, and Laryngology found that about one-third of people with BPPV reported headache. RELATED: Causes and Risk Factors for Vertigo
Low Blood Sugar
Another possible cause of both headaches and dizziness is low blood sugar, which is also called hypoglycemia. This is most likely to occur several hours after your last meal or if you do a lot of exercise without eating enough. Eating small, frequent meals should help stave off these symptoms. If you have diabetes, low blood sugar can also be brought on by taking too much insulin or other diabetes medication, drinking alcohol, delaying or skipping meals, and increasing your exercise or physical activity without adjusting your medication or food intake. Low blood sugar is usually accompanied by other symptoms such as hunger, sweating, and trembling, according to the University of Michigan Health Library. RELATED: 10 Warning Signs of Low Blood Sugar
Migrainous Stroke
If dizziness occurs very suddenly with a headache, it could be a migrainous stroke, which is when an ischemic stroke happens at the same time as a migraine attack. An ischemic stroke is when the vessels supplying blood to the brain are obstructed. Although about seven out of eight strokes are ischemic, migrainous strokes are very rare and account for less than 1 percent of all strokes, according to Cedars Sinai Health System in Los Angeles. In a migrainous stroke, the migraine symptoms must include an aura, which can be visual changes or tingling in the face or hands. Stroke symptoms come on very suddenly and may include numbness or weakness of the face (especially on one side of the body), confusion, trouble speaking or seeing, trouble walking, dizziness and loss of balance or coordination, and severe headache with no known cause. If you have any signs of a stroke, you should call 911 — or get someone else to call — and seek urgent medical attention. RELATED: What You Need to Know About Migraine and Stroke
Diagnosing Headache and Dizziness
Because there are so many ways to describe the sensation of dizziness — and so many potential causes — you and your doctor may need to spend some time discussing your health to get to the root of the problem. Diagnosing and treating the headache is typically easier than treating the dizziness, says Spears. “Vestibular migraine is a diagnosis of exclusion,” he says. That means that other conditions that may be causing the dizziness must be ruled out first. If a person is experiencing dizziness, they should speak with their doctor; a medical workup may be necessary, says Spears. “Depending on their age, that may involve a brain MRI to rule out a stroke, or they may be referred to an ear, nose, and throat doctor to make sure it’s not a vestibular disorder,” he says.
Treating Headache and Dizziness
Once those things have been ruled out, it’s reasonable for you to see a neurologist or headache specialist for headache treatment and to investigate the possibility that you may have vestibular migraine, says Spears. Treatments for headache or migraine may include:
Over-the-counter pain medicationPrescription migraine treatmentMedication to prevent migraine or headacheAntidepressantsRelaxation techniquesBiofeedbackMaintaining a healthy, regular diet
For dizziness accompanied by nausea, an over-the-counter antihistamine medication such as dimenhydrinate or Bonine (meclizine) might help, although they may cause drowsiness, according to the Mayo Clinic. If your dizziness or vertigo is related to an underlying health condition, such as low blood pressure, you may need other treatments. Dizziness triggered by movement may be best addressed through vestibular rehabilitation therapy, an exercise-based program designed to reduce dizziness and imbalance. RELATED: Is It Time to See a Neurologist for Your Headaches? Additional reporting by Madeline R. Vann, MPH.
