You are not my doctor: My doctor says not to worry, but should I?
May 9, 2016 11:41 AM   Subscribe

I've had a few incidents of strange occurrences that all deal with my head and maybe my brain: vertigo, headaches, etc. My primary doctor says the fact that the symptoms are so far apart and aren't getting worse suggests they are isolated benign things. But I'm concerned. I asked for a referral for a neurologist and he said he would give me one if it happened again/got worse. I'm wondering if I should just tell tell him it happened again so I can get that referral? Or should I not worry?

Here's what has happened:

1) The other day, I was sitting at my desk reading my computer and all the sudden the room started spinning. It felt like the spins you get when you've drank too much, but it was faster and more in intense than that, and it just happened out of the blue. It lasted about a minute to 90 seconds and it was gone. It hasn't happened again.

I didn't have any additional symptoms. I didn't have a receive cold/flu or ear infection recently. I didn't have any low blood sugar and I hadn't bumped my head or anything prior. I hadn't been bending over or anything either. I was just sitting and reading. My doctor did NOT do that ear crystal test I've read about. He looked inside my ears, looked at my eyes, and said I seemed fine.

In and of itself apparently vertigo, while scary, isn't serious, except...

2) A month ago, I experienced a sharp, intense stabbing pain around my right temple. It only lasted about a minute and it went away. Throughout that day, I had similar, less severe stabbing pains on the right side of my head that last only a few seconds and went away. It hasn't come back, although sometimes I feel twinges, like another "ice-pick headache" (as I believe they are called) could start, but I haven't had one since. Prior to that, I've never felt a sensation like that before.

3) Several months ago, I experienced what is apparently an "ocular migraine." A crescent-shaped pattern of flashing, undulating zig-zags formed around the right side of my vision and it made it very hard to see. It's sort of like when you see a camera flash lingering after the flash goes away, only scarier and for no reason. When I closed one eye, I still saw it regardless of which eye I closed. It lasted about a minute and went away. It happened again at least one more time I can recall a few weeks later, but it hasn't happened again in months.

Any doctors have any thoughts on this? You are not my doctor; this is not medical counseling, yada yada yada.

All of these things are supposed benign, weird things that can happen to people, especially women -- but taken together, this freaks me out. I was worried sick for a couple days after the vertigo that something was seriously wrong with me and it's hard to let that worry go.

I was off health insurance but I just got the best health insurance I can afford out of my own pocket to make sure I can get any needed scans or whatever. The problem is, neurologists I've called want a referral, even if insurance doesn't require it.
posted by AspirinPill to Health & Fitness (32 answers total)
What's your caffeine intake like?

If you are really worried and have health insurance, though, please see another PCP for a different opinion, before getting a referral.
posted by roomthreeseventeen at 11:43 AM on May 9, 2016 [1 favorite]

Those do seem disconnected to me. The thing with getting a bunch of scans is you can find abnormalities that are not hurting you. And then you waste of bunch of your time in the hospital (and your money) following up on a non-issue. If you're really worried, see another doctor. Those do seem disconnected to me (IMNAD) and I might wait for another event to follow up. I can't imagine one issue causing all three. I always ask what my goals are by getting a specific test (or my child). How will this change my treatment? If you are not trying to stop or avoid a specific thing, going finishing for problems can cause more harm than good.
posted by Kalmya at 11:50 AM on May 9, 2016 [1 favorite]

On the caffeine question: I drink one cup of coffee per day. When I make it at home, it's just a cup and whenever I go out, I get a 12 ounce latte. The day of my vertigo I did have more coffee than usual because I stopped at a coffee shop and got a large iced latte around noon. The vertigo happened around 5pm. I don't consume any other forms of caffeine.

I will add, sometimes when I am reading, sometimes I catch myself feeling disoriented or dizzy for just a moment, like a split second, before I catch myself and snap back. This has gone on for a long time, at least a couple years, and is sporadic and minor enough that I never worried about it. (I suppose it may not be only when I am reading, but I spend a lot of my day staring at my computer screen.) It seems similar to the vertigo I experienced in the feeling of it, but I don't know what to make of that.

>I always ask what my goals are by getting a specific test

Making sure I don't have a brain tumor or something that could kill me would be my goal, to be frank.
posted by AspirinPill at 11:54 AM on May 9, 2016

Are you an anxious person? Have you had other oddball symptoms at random? Are you under a lot of stress? Do you ever look back at a health worry you had and think "all along I kind of knew I didn't have [rare cancer only found in inhabitants of the Arctic Circle, etc]".

If so:

I'm not saying that you couldn't have [concerning condition] but all the things you describe have happened to me for no reason and have gone away again. I am an anxious person who easily somatizes things and I have all kinds of weird random crap from time to time. I have learned mostly to discount it. Also, the things you describe don't seem very related. IANAD and they could be related, but just because they all pertain to your head does not mean they add up to a specific head disorder.

If you have good insurance and you are a mess because of worry, go ahead and press your doctor for the referral. But also take steps to address the anxiety. I look back on the diagnostic care that I basically wasted in my late twenties because I had uncontrolled anxiety during a very stressful time, and I wish I had seen a therapist rather than umpty-billion specialists.
posted by Frowner at 11:56 AM on May 9, 2016 [3 favorites]

I get all of these things (headaches, ocular symptoms, vertigo) as part of my migraines. I'm super hesitant to suggest diagnoses over the internet, but it could all be migraine-related. If you keep getting any or all of that stuff, I would ask about it.
posted by ArbitraryAndCapricious at 11:58 AM on May 9, 2016 [7 favorites]

How has your stress level been lately?
posted by bq at 11:58 AM on May 9, 2016

If this happens when you're reading, or sitting down at the computer, it sounds like low blood pressure to me. IANAD but I've known people who have had this problem, usually in the form of a full faint when standing up after sitting, rather than just dizziness while sitting.
posted by beagle at 11:59 AM on May 9, 2016

Are you drinking enough water?
posted by The corpse in the library at 12:01 PM on May 9, 2016 [5 favorites]

I've had all of these symptoms over the last couple of years and actually did see a neurologist for an unrelated issue. My brain scan was normal. Ocular migraines are legit scary and vertigo is one of the most unpleasant physical sensations I have ever experienced, so I can understand why you'd be concerned, but in this case I'd be inclined to trust your doctor. If you think he's being dismissive, see another GP for a second opinion.
posted by xyzzy at 12:02 PM on May 9, 2016

I should've included this - sorry for the additional follow-ups: Stress-wise, I had just moved a couple days before the vertigo and on that day, I did finalize my old apartment, getting it cleaned up so I can get my security deposit back. I lost my day job, so I don't have much work-related stress, although not having a job and the aimlessness of "what should I do next" is its own sort of stress. I freelance too, which was what I was doing when the vertigo struck. Moving was stressful, but by no means not overwhelming. I've moved many times before and this time I actually hired movers.

Not low blood pressure, because my latest few readings have my blood pressure slightly high. My cholesterol is also slightly high too. Combination of getting older and needing to lose some weight I guess.

In light of these recent problems, I made a recent decision to quit caffeine as much as I can. (I'm drinking swiss-water decaf) and to also drink more water. I did feel like I haven't been drinking enough since I moved.
posted by AspirinPill at 12:06 PM on May 9, 2016

These are all things that happen periodically, particularly to people who menstruate. Hormones are jerks, aging is bullshit. A neurologist is going to have nothing to go on without a pattern, which you do not have at this time. Vertigo that doesn't go away is a problem, migraines (visual or otherwise) that don't go away or are in some way chronic are a problem, a twinge that doesn't stop is a problem, but transient idiopathic pains and wobbles are normal, for an annoying definition of normal.

If you are already using some method to track your periods, start logging similar events in the same place. If you have any other symptoms that might additionally lean toward hypoglycemia or food sensitivities, you might log your food too just in case there's a pattern there.
posted by Lyn Never at 12:08 PM on May 9, 2016 [4 favorites]

Why not wait until it recurs and then go back for that referral that your doctor said he would make if it recurred?

I mean maybe see a different PCP if you're otherwise not sure about this one, or think there's something off about his advice on this matter for specific reasons beyond feeling anxious about it. But chances are this doctor knows what he is talking about where this is concerned. Head injuries and neurological symptoms are a big deal, and only the most incompetent doctor would ignore them when something serious was clearly indicated.

A trained and board certified medical doctor is much more likely to be able to make an effective recommendation about this than strangers on the internet.
posted by Sara C. at 12:10 PM on May 9, 2016

Caffeine withdrawal gives me migraines, for what it's worth.
posted by ArbitraryAndCapricious at 12:11 PM on May 9, 2016

I'm not saying that you couldn't have [concerning condition] but all the things you describe have happened to me for no reason and have gone away again. I am an anxious person who easily somatizes things and I have all kinds of weird random crap from time to time. I have learned mostly to discount it. Also, the things you describe don't seem very related. IANAD and they could be related, but just because they all pertain to your head does not mean they add up to a specific head disorder.

Could have written this myself. Not at all to discount your feelings but I've gotten stress related vertigo and it becomes its own spiraling mess. I think if it were me I'd attack the stress like it was my job (making sure you're getting enough water, sleep, exercise, fluids social time, etc) and see if that makes things better or worse.

If you really feel like going back to the doc I think I would pursue the migraine angle since it's likely the central point with a lot of this stuff (in my very non-medical opinion). I know it's super unnerving to have vertigo and hear a doc say "Eh, let me know if it gets worse, go lie down for three days" but that is a fairly normal response, not that it's not also normal of you to be concerned.
posted by jessamyn at 12:17 PM on May 9, 2016 [1 favorite]

Sorry if this is also relevant, I use birth control to suppress my periods, so I haven't one in months. After the vertigo, I let myself have one just because. My own personal theory was that the ocular migraine was somehow related to my menstruation/birth control. I guess I get migraines during my period, but I didn't really realize until recently -- I realized I get a general malaise and all-day headache about once a month, and it probably was related to my period.

A trained and board certified medical doctor is much more likely to be able to make an effective recommendation about this than strangers on the internet.

Yes, but he didn't actually look at anything. He looked inside my ears, no infection, and he looked at the optic nerves in my eyes and they were fine. Otherwise he just listened to my symptoms, so... if there are any doctors here, I would appreciate their thoughts. I do appreciate the responses I've gotten so far.

I would indeed describe myself as somewhat anxious about things, but I did let the first two instances go. Now I'm at a point where it feels like I brush something aside, and then something new and equally scary pops up.

Anyway, I think maybe I've answered the questions people have had, but still interested in more thoughts from people who have had similar experiences or who are doctors. Thanks all!
posted by AspirinPill at 12:23 PM on May 9, 2016

my latest few readings have my blood pressure slightly high

This can definitely cause dizziness, headaches, and vision issues. I'm not trying to diagnose, but it's certainly not going to hurt you to reduce sodium intake, increase exercise, etc. and see what happens. A home BP monitor will be a heckuva lot cheaper than an MRI.
posted by AFABulous at 12:24 PM on May 9, 2016 [1 favorite]

Before you go all the way to a neurologist, I would also suggest getting your vision checked if you haven't done so in a while.
posted by antimony at 12:38 PM on May 9, 2016 [3 favorites]

I am really vigilant about stuff like brain tumours but all that sounds run of the mill to me. I've probably had much the same stuff happen to me over the same period of time, I'm not worried, and I would suggest you follow your doctor's advice to also not worry.

If you put a pillow underneath the foot end of your mattress, it may help to lower your blood pressure a little. That has certainly helped me.
posted by tel3path at 1:11 PM on May 9, 2016

If you're really concerned you could start a migraine diary. Migraines are very painful and can be scary if you're not used to them. They can cause vertigo and auras and nausea and lots of other weird things. My migraines occasionally cause blindness in one eye, which is not great to deal with, but my brain is fine. They can be triggered by lots of things: odors, certain foods, hormones, medication, skipped medication, hot temperatures, sunlight, stress, body pain, etc.
posted by Stonkle at 1:11 PM on May 9, 2016

>Making sure I don't have a brain tumor or something that could kill me would be my goal, to be frank.

i don't have any specific thoughts on what could be causing your symptoms, but as a person with a malignant brain tumor i wanted to chime in to reassure you that the only symptoms i had prior to a tonic clonic seizure (which was when my tumor was discovered in a CT scan) were increasing fatigue and what felt like sinus headaches-- no vertigo.
posted by hollisimo at 1:22 PM on May 9, 2016 [2 favorites]

I have all of those symptoms and more when I am having a complicated migraine. Medication has helped. If your symptoms continue, you should ask for the referral which will likely lead to MRI and EEG for diagnosis. Migraines don't always include a headache.
posted by tamitang at 1:29 PM on May 9, 2016 [1 favorite]

Last year, I had vertigo three times, had migraines fairly often, and got dizzy when I was stressed (which was often). My doctor was concerned enough to recommend a CT scan. Luckily, I did not have a brain tumor nor was anything out of the ordinary.

In the end, what it was was that I was chronically sleep deprived--as in, I would only get six hours of sleep a night and I fooled myself into thinking that was enough. It wasn't--I need seven to eight. I've now changed my sleeping patterns to get way more sleep and exercise more regularly. I don't get anywhere near the amount of symptoms that I used to last year.

However, I would also go to a doctor for a second opinion if you are concerned enough. As an anxious person, I was pretty convinced that I had a brain tumor and it was a huge relief for me to go get the CT scan. Of course, YMMV.
posted by so much modern time at 1:33 PM on May 9, 2016

If you are concerned keep a symptom journal. Write down what happens & when what you were doing when it happened & just before. Weather can also be a factor. If you suspect migraines also track light, flicker light can be a big trigger. I get ocular migraines from lights flickering & sinus infections actually I get all your symptoms from sinus infections if it makes you feel any better.

Then you have something concrete doctors can work with instead of random symptoms, it will help with diagnosis & help them take you more seriously if you can show a pattern.
posted by wwax at 3:17 PM on May 9, 2016 [1 favorite]

Explaining your concerns to your doctor, getting a second opinion or even switching doctors if you don't feel like you trust this one are all reasonable things.

Deliberately misleading your doctor by falsely reporting symptoms in an effort to trick him into a particular course of treatment seems like a bad idea. I mean, like "hold my beer and watch this" bad. Maybe even Apple Maps bad.
posted by sourcequench at 3:20 PM on May 9, 2016 [2 favorites]

Might be an electrolyte imbalance. Sodium, magnesium and other minerals might be missing from your diet. Changes in the amount of water in your body can upend your electrolytes and can cause dizziness, headache and other symptoms like you are describing.
posted by diode at 7:04 PM on May 9, 2016

I would echo the stress management approach as a starting point. You kind of dismiss the idea that you just moved and lost a job as not that big of a deal, but both things are stressors even if they are positive - in fact, some of the biggest stressors we experience on the Rahe Stress Inventory. Since you don't want to make too much of those events I do wonder if maybe you're suppressing the stress in order to try to feel like things are normalizing. That can definitely express itself in random physical symptoms. So maybe take stock of how things have been for you lately, acknowledge the difficulty of going through those changes, and maybe take up some intentional stress management strategies.

In your shoes, I wouldn't bother with followups unless symptoms became more intense, more frequent, or interfered with my work or relationships. If you feel like maybe just maybe they result from anxiety, though, you could try taking that tack and talking to your doctor about the anxious feelings and some strategies for controlling them, from exercise to meditation to medication. Good luck.
posted by Miko at 7:49 PM on May 9, 2016 [3 favorites]

Yes, but he didn't actually look at anything. He looked inside my ears, no infection, and he looked at the optic nerves in my eyes and they were fine. Otherwise he just listened to my symptoms, so...

This is how medical decision making works. It is primarily deductive rather than inductive. Your doctor starts with a theory and then asks questions or performs tests to confirm or disconfirm his hypothesis.

Presumably he thinks, "suppose Aspirin Pill has a brain tumor. What signs or symptoms would she have?" He might then ask questions like, do you experience numbness or tingling sensations? Has your vision been blurry? And so on, because he knows that a certain set of symptoms would cluster together if the tumor was in one part of your brain as opposed to another. As those questions are answered, he's ruling diagnoses out.

Along with this, he's using knowledge he already has about you and knowledge he has about the base rate of certain conditions, as well as his own experiences. For example, if he already knows that you have a tendency toward anxiety and that you are under stress, that renders those diagnoses as more plausible than a brain tumor, which is a relatively rare event. Of course, it's *possible* but it's generally good medical practice to consider that a rare diagnosis is relatively unlikely, especially in the absence of confirming symptoms.

If you generally like and trust your doctor, don't assume that him telling you to come back if the symptoms reoccur is a sign that he's blowing you off. Don't forget that things slide MRI scans have their own set of risks.
posted by jasper411 at 9:46 PM on May 9, 2016 [3 favorites]

When your doctor looked at your eye, that particular examination tells if you have had raised pressure inside the skull. Like from a tumour. When you say that the doctor didn't do anything, you are grossly underestimating. Not every random symptom needs an MRI.

And "just listening to my symptoms" is about 85% of diagnosis.

(You said you wanted to hear from doctors)
posted by chiquitita at 4:10 AM on May 10, 2016 [3 favorites]

Two things:

Merely reading your question (I think) prompted two little bursts of vertigo in the past fourteen hours. I am highly suggestible and get symptoms easily. Neurological symptoms are, IME, the easiest symptoms for your body to "counterfeit" when nothing is physically wrong but you are under stress or anxious in some way. I have had a long list of paresthesias and stuff that I won't even type out lest it give bad ideas to someone reading, but you can absolutely have an array of neurological symptoms that have no organic cause at all.

In re doctors: consider something that you do all the time. Like, I bake a lot. I can tell a great deal about a recipe or a batter just by looking casually at it because I have seen so many. A novice baker or someone who bakes infrequently can't do that - people often report recipe problems that I never encounter purely because I have lots of baking experience. A doctor has seen many, many normal patients and a reasonable number of patients with serious illnesses. The doctor is going to pick up on little things about gait, speech, pulse, tremor/lack of tremor etc that you would never, ever notice because you don't spend all day looking at those things.

Doctors aren't magic, it's true. They can miss things. But I think it's easy for non-doctors to underestimate the sheer usefulness of the experienced eye.

My rule for myself as an anxious person is that if I have a loose agglomeration of infrequent symptoms that resolve and don't worsen, I do not second guess the doctor. I went through many years of second-guessing over tiny stuff, and it was really bad for me.

Oh, and one more thing that comforts me (and I think would comfort anyone even if they didn't have anxiety): Even ominous symptoms can be caused by very innocuous, treatable things and most often are. Some years ago, someone on here posted about some rather grave arm symptoms that seemed to me to point straight to [incurable, fatal, terrible neurological disease X for which I have been evaluated]. I didn't say anything except "hie thee to a doctor because I figured "why worry this person if it's terrible news", but I had an awful sinking feeling.

And you know what? Those symptoms were caused by an entirely treatable postural problem with nerve complications. They were not caused by a terrible disease. And in fact, I did some reading and found out that many of the symptoms I had regarded as inevitable signs of terrible neurological diseases are also signs of really trivial musculoskeletal things.

You have some trivial symptoms that may be stress-related but even if they are not, they are most likely entirely innocuous - hold onto that. (IANAD, but god knows I've wasted enough time on medical consults.)
posted by Frowner at 6:31 AM on May 10, 2016

I would definitely say lying to your doctor is a bad idea.

I don't know if this will reassure you or not, but several years ago I had an MRI for vertigo and found out I had three small brain tumors (not malignant). The brain tumors were completely unrelated to the vertigo and were causing no symptoms whatsoever. If I had not found out about them in this accidental way, it is quite likely they would have never been detected. My neurosurgeon told me I could wait to see what happened, but I decided to have two of them removed. I now think that was a bad decision. I had a headache for a solid year because of the surgery, ended up with problems at work, and my sense of smell no longer works properly - not to mention the pain and general hassle of the operation. It has been ten years since the tumors were discovered. One is still there and it has not caused me any physical trouble at all - but it's done a number on my psyche, and I have to have an MRI every year just in case. It's impossible to know what would have happened if I'd never found out about them, but my personal take is that I'd be better off. It doesn't sound to me like your disparate symptoms would be caused by a brain tumor (though IANAD), and an unnecessary MRI could definitely be a bad thing.
posted by FencingGal at 9:49 AM on May 10, 2016 [1 favorite]

I'm a doctor, but not your doctor and I can't give you medical advice.

I can tell you though that typically brain tumors cause daily recurrent headaches that worsen over a period of weeks to months. Why? Think physiologically. You have something growing inside your skull, getting larger and larger every week, causing increasing pressure. Not likely to cause a twinge of stabbing pain for 1 minute, because it doesn't suddenly appear and disappear or get smaller in size.

Ocular migraines are generally a benign thing. Brain tumors can cause visual symptoms, like vision loss or blurred vision, but again, not typically symptoms that last for seconds to minutes then go away. Because the brain tumor would still be there.

There are a variety of disclaimers but that's the general principle I wanted to give you as reassurance. Hope it helps. The more you go asking doctors for a CT scan and mentioning your fear of brain tumors, the more likely you are to find someone who will do one whether you need it or not. Radiation is not benign. Get only the testing you need.
posted by treehorn+bunny at 3:37 AM on May 12, 2016 [2 favorites]

I can tell you though that typically brain tumors cause daily recurrent headaches that worsen over a period of weeks to months.

Maybe typically, but not always. I have vicarious experience to the contrary.

However, I still think you can probably take your doctor at their word, OP.
posted by tel3path at 11:27 AM on May 12, 2016

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