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Lightheadedness, Headaches and Fatigue

Lightheadedness, Headaches and Fatigue
September 23, 2010 Patrick Nemechek, D.O.

Recurrent or Chronic Headaches and Fatigue

Nemechek Autonomic Medicine Headache

Nemechek Medicine Autonomic Headache

Many patients with symptoms of lightheadedness, recurrent or chronic headaches or chronic fatigue are often suffering from inadequate blood flow to the brain that results in inadequate brain oxygen levels.  Many of these patients have been evaluated by their primary care physician, neurologists or cardiologists without any specific diagnosis being made.

These symptoms can also be accompanied by neck stiffness, heartburn, chronic indigestion, abdominal cramping, and frequent urination.  All of these symptoms represent dysfunction of the autonomic nervous system and are frequently treated as individual symptoms.  In essence, many physicians are not seeing the forest because of the trees.  A good review of the autonomic nervous system and some of the symptoms associated with autonomic dysfunction can be found here.

Take ANS Quiz 00001

Orthostatic Intolerance and Orthostatic Hypotension

Although most medical textbooks discuss orthostatic intolerance (OI) and orthostatic hypotension (OH) in relationship to specific patient populations such as the elderly or patients with Parkinson’s Disease or Diabetes, OI and OH are extremely common among the general population as well.

The medical definition of OH is a decrease of systolic blood pressure of at least 20 mm Hg or diastolic blood pressure of at least 10 mm Hg within 3 minutes of standing up.  This basically means that when you stand up, your body cannot maintain normal levels of blood pressure in the upper half of your body because of the pull of gravity and your blood pressure reading declines.

Some patients have symptoms suggestive of OH but will not have as great of a drop in blood pressure as noted above.  These patients are often referred to as having orthostatic intolerance (OI) and not full blown OH.  The general initial treatment approach I use for patients with OI is the same as patients with OH.


Lightheadedness and Fatigue

Most patients with OH and OI have symptoms such as fatigue, abnormal balance or a feeling of being lightheaded.  These symptoms will often worsen after eating, after standing or sitting still too long, after becoming too hot or a short while after exercising.

Many patients also have difficulty with concentration and thinking clearly. In older patients, this can be the most common symptom.  Other symptoms such as rapid heartbeats, nervousness, anxiety or nausea can also occur.

All of these symptoms are due to low blood perfusion of the brain. When the blood perfusion decreases enough, the symptoms can become rather severe and can even result in passing out.



OH is also a very common cause of mild to severe headaches.  These headaches are the result of inadequate perfusion of blood flow through the brain.  As such, they can seem worse after sitting or standing for long periods of time, after eating or after becoming warm or hot.  Sometimes they are associated with intense pain in the neck muscles known as coat-hanger pain.

OH headaches are more likely to improve when lying down than other forms of headaches.  This because laying flat lessens the pull of gravity that contributes to the low brain blood perfusion.  Laying flat makes it easier for your body to pump adequate amounts of blood to your brain; better blood flow means less headache pain because the muscles of the neck and scalp receive better blood flow.


So the big hints for OI or OH as a cause of headaches are:

  • Occasional lightheaded sensation or ‚Äúwoozy‚ÄĚ spells just after standing up.
  • Fatigue after meals especially bigger meals or high carbohydrate meals.
  • Occasional fatigue, poor mental functioning, poor memory or confusion.
  • The association of intense neck muscle pain or chronic stiffness.


Often times symptoms can improve, albeit temporarily, when exercising.  This is because constriction of muscles during exercises helps pump more blood from the muscles themselves into the circulation thereby increasing the blood flow to the brain

OH can get substantially better after increasing the amount of salt and decreasing the carbohydrate intake in your diet.  Salt increases your blood volume and makes it easier to maintain adequate blood flow o the brain.  The reduced carbohydrate intake allows your autonomic nervous system to recover and more properly control blood flow to the brain.

Think about your headache pain.  Does it occur more in one time of the year over another (Fall vs. Spring)?  Do you seem to get sinus infections more commonly than your friends or family?  Does the pain start in the back of the head or at the temples? Or do you also wrestle with chronic fatigue, have intermittent lightheadedness or intense neck muscle pain?

If you answered yes to any of these, you may need to rethink your diagnosis of ‚Äúmigraine headaches‚ÄĚ.

Why Symptoms Occur

Maintaining normal blood flow to the brain depends on the patient having normal blood volume (no anemia, dehydration or kidney problems) and normally functioning neurological reflexes that help to maintain blood pressure.

Through a complex interaction of signals between the brain, pressure sensors in the carotid artery and aorta, nerve impulses and networks of arteries and veins, the body is able to maintain near-perfect blood flow to the brain in spite of sometimes widely fluctuating blood pressures experienced by the rest of the body.

When functioning normally, blood¬†flow in the brain¬†is nearly unchanged when someone goes from the lying to standing position in spite of the fact that gravity causes approximately 1/3 of the body’s entire blood volume to move from the upper portion of the body to the lower portion.

But when the portion of the autonomic nervous that regulates blood pressure is not working well, the body is unable to keep proper blood flow and oxygen levels to the brain.  This condition is referred to as autonomic (sympathetic) withdrawal.

A Simple Test to See if You Have Orthostatic Hypotension

A simple way to check to see if your lightheadedness, fatigue, mental fogginess or headaches are from low blood pressure to the brain is to increase the blood pressure to the brain.  You can do this simply by increasing the salt in your diet.  Salt has a magical property called osmotic pressure that pulls fluid into the blood vessels.

More fluid in blood vessels makes it easier for your heart and blood vessels to provide the proper amount of pressure and blood flow to the brain.  Proper blood flow to the brain will allow the brain to function better and should result in a decrease or disappearance of your symptoms if they are due to poor blood flow.

With all the talk by the health officials about the necessity of eating a low-salt (sodium) diet, you might be concerned with increasing your salt intake.¬† Don’t worry, it’s not dangerous for a few weeks.¬† Only person’s with uncontrolled high blood pressure, heart failure or kidney disease should talk with their physician before adding salt to their diet.

Follow these instructions to see if your symptoms are from low blood flow to the brain:

  1. Purchase¬†several cans of¬†chicken stock from the market.¬† Chicken stock is full of salt (otherwise known as sodium).¬† Be sure not to buy the “Low Sodium” brands.
  2. Drink a cup of chicken stock (heat it up a little to improve the taste) in the morning and around midday.  This will give you body enough extra blood volume to improve the blood flow to your brain.
  3. If you find you are fatigued or sleepy shortly after dinner, you may want to have an additional cup then too or even with dinner.
  4. Within a few days, you should notice a significant improvement in your symptoms.
  5. If your symptoms improved, then you can be reasonably sure your symptoms are from low blood flow to the brain.¬† I would suggest you see your primary care¬†physician about this if you haven’t already.¬† Sometimes things such as low red¬†blood cell¬†counts (anemia), dehydration or heart rhythm problems can cause similar symptoms.

Hopefully, this simple test helped improve your symptoms.¬† If it did, read the next section about how to help your autonomic nervous system’s blood pressure regulation system to recover and be able to provide your brain with proper blood flow without need the extra salt.

Autonomic Testing Guides Treatment for Improved Autonomic Function

The autonomic nervous system (ANS) can be tested and evaluated through a process known as spectral analysis.  This simple, quick (15 minute) and painless test can provide the critical understanding that helps your physician for their treatment plan.

The ANS can become imbalanced in many different ways.  Some ANS dysfunction requires a short course of medication (3-6 months) alone or in concert with nutritional strategies to reduce systemic inflammation and oxidative stress in order for the brain to regain maximal function.  The safest way to reverse heartburn is with a map of your autonomic nervous systems to guide treatment.

Dr. Nemechek often performs autonomic testing prior to initiating treatment for orthostatic hypotension and other autonomic symptoms (lightheadedness, headaches, fatigue, constipation, frequent or urgent urination).  To learn more about this technique contact  Dr Patrick Nemechek.

How to Repair Your Blood Pressure System

If your symptoms improved after adding the salt to your diet, you’ll now need to repair the neurological blood pressure mechanism to your brain.¬† This is done by reducing the number of carbohydrates you’re consuming on a daily basis.¬† Follow these instructions:

  1. Continue drinking the chicken broth for about 2-3 more weeks after you have reduced the carbohydrates in your diet (see following points).  You can switch to other salty foods instead of drinking only chicken stock over these few weeks.  Tomato juice has a lot of salt (sodium) in it as do pickles, salsa, sardines, greek olives and beef broth.  Some patients will pour about a 1/4 teaspoon of salt in the palm of their hand and swallow it plain along with some water to wash it down.  For convenience, some patients will take a Top Ramen oriental noodle cup (any brand will do) to work and drink only the broth from it.
  2. Reduce your carbohydrate intake to less than 100 grams per day.¬† It seems switching to higher fiber carbs such as whole grain bread, brown rice or fruit doesn’t help your¬†blood pressure mechanism to repair¬†itself¬†if your total carb¬†intake is still above 100 grams per day.¬† You need to get the total carb count down.
  3. Some patients find it easier to view their carbs as an allowance.¬† They will save their “carb allowance of 100 grams”¬†for dinner which they find as the most important psychological meal for them.¬† This way they can still have a little rice, pasta or potatoes with dinner and still be under 100 grams per day.¬† You’ll need to read your package labels to get a general sense of how many carbs are contained in some of the common foods you eat.
  4. Within a few weeks, you will be able to stop the added salt because your blood pressure mechanism will of completely recovered.  Your symptoms of low brain blood pressure should be gone for the most part without the need of the added salt in your diet.

It’s important to remember, if your carbohydrate intake increases after recovering neurological blood pressure function, your symptoms will often return rather quickly.¬†Your¬†symptoms¬†may also return¬†slightly if your are under a lot of psychological stress, excessively warm or¬†are sitting or standing for prolonged periods of time (such as driving in a car).

You’ll need to change your eating habits permanently if you want to continue to feel this healthy.¬†Unfortunately, once you develop these symptoms, it seems your neurological system may never again be the same.

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  1. andy 1 year ago

    I have been suffering for some time, my symtoms match these very closely, neck ache, headaches, migraine like symptoms, fatigue, heartburn, anxiety, i’m hot all the time, dizzy/lightheaded, but also feel the need to pop my ears often due to a sort of pressure feeling..
    However, i have raised blood pressure so suffer from hyper, not hypo tension.

    I have told doctors often that i feel as if my blood flow to my head is not enough, but other than taking blood pressure meds, (which have made next to no difference) i have been unable to have any diagnosis or other treatmeent

    any thoughts?


    • Author
      Patrick Nemechek, D.O. 1 year ago

      Your elevated arm pressure is how your body is compensating to push blood up to your brain which is suffering from low BP.

  2. Trace Hillierd 1 year ago

    Hi. I have a long complex medical history due to a bad medical implant that stuck out of my uterus towards my bowel. Essure. Docu on Netflix about it called The Bleeding Edge. I am getting better of many health issues since I had a hysterectomy to have it removed. It had nickel and polyester fibers. One of the lasting issues I had was SIBO which I think I cured with a month of rifaximin. Still getting over some gasritis. I have ptsd from what was done to me and years of illness. I have this lightheadness and dizzyness more noticeable when I get up or still. I feel like my brain and body are vibrating internally. I am trying so hard to get my health back. What do you think this is? Do you do consultations? Blessings.

    • Author
      Patrick Nemechek, D.O. 1 year ago

      Yes, more info is under the “consultations” section under About tab

  3. annemarie honey 1 year ago

    I found your YouTube channel yesterday and watched every single video. Yesterday morning I was diagnosed with Orthostatic Hypotension – for 6 years I thought I had anxiety , which then became severe agorophobia- I have not been able to work or leave the house without my husbandfor 3 and half years, as I was scared of feeling dizzy out and about, but I never could understand why I would randomly get surges of adrenalin when I was happy at home in my ‘safe place’ it did not make any sense, it does now!! I read the article above and will get the chicken broth. Have you seen people totally recover from OH from your protocol? I would love to know that. My DHA and inulin are ordered and I am starting your book on my kindle right now. Thank you so much.

    • Author
      Patrick Nemechek, D.O. 1 year ago

      The protocol was designed to reverse the symptoms of orthostatic hypotension.

    • annemarie honey 1 year ago

      Thanks so much!! I am on day 8 now. If I cannot get my GP to prescribe Rifaxmin (quite tricky in the UK) could I stiil heal just with Inulin.

  4. Essa Jama Essa 1 year ago

    Thank you so much for providing this valuable information about my problem which i have feeling for this nowdays

  5. jazz 1 year ago

    Hi doc!
    Wow! This was a very interesting read. I think i may have inadequate bloodflow. I’m a woman, 26. I’ve had most of the symptoms since a week ago. I suddenly had low blood pressure and i felt dizzy. I stopped taking the magnesium powder that i started on a few weeks back, because i think i was taking too much, Ever since i stopped, i feel a bit better.

    However, i still feel unbalanced, I cant sit totally still anymore, i feel like im moving a bit… I have mild headaches across my forehead/temples, feels kinda like sinus congestion. Laying down definitely decreases my head ache/pressure. i also feel so tired and low energy, i just want to nap. im also have trouble concentrating on my work. ive been feling anxious, and having occassional heart palps. Other things ive recently discovered: i have low iron, and i have inflammation in my gut.

    I don‚Äôt know if this is all related… do you think taking too much magnesium has hurt my blood pressure system? i might start eating more salt now.

    • Author
      Patrick Nemechek, D.O. 1 year ago

      No, the magnesium probably did not harm you.

      It’s more likely you have been developing cumulative brain injury (see my book) and have added another injury that has further worsened autonomic dysfunction.

      I would always recommend a general medical examination when symptoms start to also make sure your symptoms are from something more common such as anemia.

  6. Anonymous 2 years ago

    My sister and I both have progressive MS- it’s been 20 years since diagnosed. My twin recently became bed ridden. She currently has a catheter and we are taking a probiotic to make sure she doesn’t get any bladder infection from the catheter. After reading your book we realized you are against probiotics and unsure of what to do at this point. We have rifraximin, olive oil and the now dha fish oil and wanted to ask you first if it’s okay to use it and if it would help to start your protocol. I understand our case is complicated but we are not physically well enough to come see you. Our hopes is to start your protocol to get well enough to come visit. Will your proctol help us at the stage we are in?

    • Author
      Patrick Nemechek, D.O. 1 year ago

      Yes, it can help a great deal even without the vagus nerve stimulator.

      I caution you not to use the probiotics during of after use of rifaximin.

  7. RJ 2 years ago

    I suffer from terrible sinus infection, need to drain my paranasals. My crisis seem to be recurrent. Lately I feel headaches, trouble with bright lights but what really concerns me is that more than often I feel weakness on my legs, shoulders arms while lightheaded, uncoordinated.

    Thought this was all related to sinus problems but after reading your article it could be a possibility for autonumonic dysfunction.

    So a KETO based diet with low carbs and higher daily sodium intake might help?

    • Author
      Patrick Nemechek, D.O. 2 years ago

      It can be related to autonomic dysfunction of the mucous membranes but might also we a sign of silent reflux of stomach acid.

      It is not unusual for people to have recurrent sinus drainage, congestion and infections because of the irritating effects of refluxing acid. Surprisingly, many patients will not have any symptoms that the have reflux of acid.

      Silent reflux is a well-known entity in medicine.

  8. jamie aranda 2 years ago

    Hi dr. Nem,
    I have been checking and surfing the net to check what can my symptoms be. Until I got to this page. Most of the symptoms are like mine. there were times when my mom has to rush me to the emergency because of nausea and my visions being blurry. but my findings are normal. Doctors have advised me to have my eyes check but glasses doe not resolve anything. Some of my symptoms are lightheadedness, pains on the neck. also , frequent urination and nausea are parts of it i will try the chicken broth to see if it works!

  9. marion 2 years ago

    Dear dr Nem.
    My wife has light headness headache and fatigue, she has been seen by her doctor
    has had blood tests done which are normal. Her dr. has advised having her ears cleared by micro suction, and also her spine x-rayed to check if this is part of her problem also her memory is not good. Going to try the salt and reduce carbs to check if this improves her symptons.
    Hope for a quick reply

    • Author
      Patrick Nemechek, D.O. 2 years ago

      With all the normal testing, it sounds as if she has autonomic dysfunction.

      I apologize for not having the book for non-autistic adults completed yet but the protocol I wuld use for her is the same for adults with autism (it was actually designed for those without autism).

      My book expalins the protocol – copies can be purchased at

  10. darien 2 years ago

    Hello Dr. N,

    I trust that you are well. I have had autonomic dysfunction for around 8 years. I am a 40 year old male. In that time I have had bladder issues, brain fog, tingling hands, anxiety, aches and IBS. Most of those are now under control, but as late I have been battling with feeling hungry, which doesn’t bother me too much. But my main complaint is waking up with a dry mouth every morning. Is this all related or am I dealing with something else.

    Warm regards,

    • Author
      Patrick Nemechek, D.O. 2 years ago

      They are all symptoms of autonomic dysfunction

  11. Jo Hart 2 years ago

    Hi Dr Nemechek,
    My daughter is 18 years old. She has a history of occasional severe headaches . During the past two years she has suffered more and more until she now is almost constantly in pain. She suffers from dizziness when bending or moving her head quickly and fatigue, along with light sensitivity and nasal congestion. She has had to give up her A level studies and her part time job, her life is becoming smaller and smaller, she is so desperate for help. MRI and neurology found nothing, pain relief rarely works. Do you think You could help her? We are in the UK.

    • Author
      Patrick Nemechek, D.O. 2 years ago

      Sounds like she has autonomic dysfunction

  12. Lisa 2 years ago

    I stumbled on this page while searching for my symptoms. I have had rather constant lightheadedness, fatigue, and slight nausea since April 2016 with little relief. I’ve seen a neurologist and cardiologist and results are all coming back normal. I don’t feel like my lightheadeness is related to sitting or standing up, it seems rather constant from the moment I wake up in the morning, until I go to bed at night. Reading this article, it sounds a little bit like my symptoms. I’m happy to have found chicken broth in my pantry and will try this route starting tomorrow am. A couple of months ago, my neurologist suggested I drink Gatorade, diluted with water, about 20 oz. I’m not sure if I’ve been diluting too much to get any effect of the salt, but I have not seen improvements as of yet. Does anything I mention sound like what you are referring to in this article? I appreciate any advice. Thank you.

    • Author
      Patrick Nemechek, D.O. 2 years ago

      Very much so

  13. Neilia 2 years ago

    Dear Dr Nemechek
    The past few months i have suffered from extreme fatigue, dizziness, and nausea also headaches (not severe) ive tested and its not migraines as the headaches only comes a while after all the above mentiondc symptoms, also i have pain when i eat , feels like where my stomache begins. The fatigue feels like my shoulders suddenly weighs a ton and i cant keep my eyes open . It only gets better when i sleep for an houf or more. Can you maybe give me some kind of diagnosis, as i know its not possible to give a 100% diagnosis when a patient is not seen.
    Regards Neilia
    South africa

    • Author
      Patrick Nemechek, D.O. 2 years ago

      You are suffering from orthostatic intolerance.

      If your labs and heart are generally normal, its from dysfunction of you autonomic nervous system either do to an injury you didn’t recover from, and imbalance of intestinal bacteria or from possibly a side effect of a medication or all of the above.

  14. Robert 2 years ago

    Instead of chicken stock can you take some sort of salt/sodium pills?

    • Author
      Patrick Nemechek, D.O. 2 years ago


  15. Jill Schroeder 2 years ago

    Is this similar to what POTS syndrome is? I’ve always had this lightheadedness symptom when standing and chronic fatigue along with low blood pressure. I’ve recently suffered a mold toxicity exposure and also diagnosed with SIBO and had an infection from yersinia and h.pylori. Fun stuff I know. My symptoms of this lightheadedness/dizziness had gotten dramatically worse and are now accompanied by heart palpitations where my heart rate jumps way up and then drops super low correlating with standing up. My doctor seems to think it is a prolonged QT issue related to an antibiotic I was on, however it continues since being off of it. I’m suspecting POTS and wonder if what you are referring to is related to POTS? Thank you.

    • Author
      Patrick Nemechek, D.O. 2 years ago

      Yes. Most of the symptoms of POTS are from low brain blood pressure leading to inadequate delivery of oxygen.

      POTS just has an exaggerated heart rate response in addition to poor brain blood pressure regulation.

  16. Caroline 2 years ago

    Hi Dr. Nemechek,

    My husband just had an echocardiogram that revealed some mild problems (mitral valve insufficiency and aortic stenosis) and he has high blood pressure and high cholesterol. Do you think this is related to autonomic nervous system damage and do you think your protocol and vagus nerve stimulation would be beneficial for him or harmful? (The doctor wants him to start cholesterol medication which he has always avoided to this point.)

    • Author
      Patrick Nemechek, D.O. 2 years ago

      Mitral valve prolapse and aortic stenosis are both manifestations of are both manifestations of systemic inflammation. My protocol can greatly reduce systemic inflammation and maybe prevent these from worsening.

      Statin cholesterol meds will have no bearing on these issues.

  17. Sara 2 years ago

    both my son and I have these symptoms after receiving a fluoride treatment at the dentist. Does fluoride do anything to the sodium level in our systems?

    • Author
      Patrick Nemechek, D.O. 2 years ago

      Not that I’m aware of. I would look for another cause other than the fluoride specifically.

      Sometimes physical or emotional traumas can injure the autonomics and lead to these symptoms.

  18. Linda Sinnett 2 years ago

    I am a 66 year old female was diagnosed with autonomic dysfunction 3 years ago by a cardiologist but then he left town . Had a neurologist that was helping somewhat but he also left . He said I was having seizures on left side of brain . I also have Afib . I am miserable most all the time . Very little sleep headaches can’t take heat at all . To many symptoms to list !

  19. Esther 2 years ago

    My doctor recommended I use more salt too. I found that doing a workout with electrolytes tablets in my water made a huge huge difference, because otherwise I feel like I’m going to faint.

  20. Del 4 years ago

    I have been diagnosed with NDPH/CFS. I’ve had daily headaches, chronic fatigue, occasional lightheadedness, associated anxiety and depression as a result since 1/16. I’ve been worked up with CT/MRI, blood work everything has come back negative. Meds have not worked. Can anything been done to get rid of the pain and improve my fatigue?

    • Author
      Patrick Nemechek, D.O. 4 years ago

      Yes, your symptoms are very typical of the patients we treat. The majority experienced significant reduction in symptoms within the first 2 months. It requires full autonomic testing in our office to customize the treatment plan.

      People often fly in to Arizona for their first visit and testing and then follow-ups are done via Skype.

      Call 623-208-4226 if you are interested. — Dr. N

  21. Stacie 4 years ago

    I have terrible dizziness and lightheadness all day long. I have am fatigued and depressed all day as welll. The doctors have already told me I have orthostatic hypertension. I was exposed to high levels of toxic mold for 4 years. I have been very ill and drs have not helped me. I just want to feel normal. I tried cholestyramine and changed my diet to starve the mold out. Nothing is working. I’m out of money and ideas.

    • Author
      Patrick Nemechek, D.O. 4 years ago


      If you’ve see several doc’s and they haven’t found a specific cause for you orthostatic hypotension then it is most likely from autonomic dysfunction which we can turn around within a few months. Do yourself a favor and call 623-208-4226 for more information.

      Dr N.

  22. Caroline 4 years ago

    Low blood and lightheadness,Since 2015 i’m living with this sickness,i feel tired in the morning lose concentration ,ringing sounds in my head can’t remember lots of things and dr said i’ve got low blood,i eat lot of beetroot,liver ,salt &drink,sometym my mouth is dry & drink lots of water but i ‘m not beter,i feel so sad cause my life has change is not the same as before & i have to go to work & work.

    • Author
      Patrick Nemechek, D.O. 4 years ago

      Start by supplementing with 2,000-3,000 og omega-3 fatty acids from fish oil.

  23. Eddie Wright 4 years ago

    That would be great how do we go about setting up the skype consult?

    Eddie Wright

    • Author
      Patrick Nemechek, D.O. 4 years ago

      Send me an email ( with a paragraph or 2 about what’s going on.

  24. Eddie Wright 4 years ago

    Hello , my 14 year old son has been experiencing constant headaches for almost 10 months. He was tested for high csf pressure and had 3 spinal taps. There was a period of time where we thought he had a leak and he has kept on bed rest for almost 2 months. He still has constant headaches and is now orthrastaic where his headache worsens the longer he is upright and dizziness occurs. I am going to try the chicken broth test and see how that goes. I’d like to get your opinion and discuss possible treatment options.

    Eddie Wright

    • Author
      Patrick Nemechek, D.O. 4 years ago

      Give it a try. Maybe we need to have a Skype consult to go over everything and your options.

      Dr. N

  25. Kathryn Russell 4 years ago

    Hi Dr. N,

    • Author
      Patrick Nemechek, D.O. 4 years ago

      The key issue is getting down to what is exactly causing your symptoms.

      Good luck, Dr. N

  26. Trish Barrett 4 years ago

    Dear Dr. Nemechek,
    My 18 year old daughter has benn suffering chronic daily headaches and fatigue for several years. Initially at 9 years the pain was occasional. It has become worse. Her fatigue started at 14, maybe coincidentally 1 week after her TDAP vaccine. She is now desperate. Her life is so difficult. She has been to doctors, brain scans, neurologist, endocrinologist, alternative therapy etc. I don’t know what to do now. Her symptoms sound like your diagnosis of orthotic disfunction. We live in Ireland. Can you show her any light in her despair? And mine.
    Trish Barrett

    • Author
      Patrick Nemechek, D.O. 4 years ago


      I’m sure I can help your daughter. I have particular expertise is treating vaccine-related autonomic dysfunction, and have many patients around the word.

      I’ve sent you a private e-mail with more information.

      Dr. N

  27. Christina Kirby 4 years ago

    I am desperate for answers and a doctor who will finally listen to me, not dismiss me and tell me there is nothing wrong and I just need to take vitamins or tell me I’m bipolar, depressed, and have add. Which I do have symptoms of all of those but I know there is something more. For 3 years I have been dizzy literally every single time I stand up no matter how fast or slow. I have to pee allll the time even after just emptying my bladder and having one sip of water. I get extremely tired after every meal even if it’s a bag of chips. I can’t remember anything (I can’t even remember if I’ve taken my medicine so I sometimes take it more than I’m supposed to. I forget something 5 seconds after I’m about to do it.). I have had so much blood work done to try to get to the bottom of this and everything usually comes back right in the edge of the normal range. The only thing that it shows is abnormal is a very high monocytes a1c. I know that has to do with the autoimmune system. Also on your quiz I answered yes to everything except 3 things. Please HELP!! No doctor will listen to me or take the time to go more into depth with my symptoms. This is has affected my quality of life so much in more than one area. Thank you

    • Author
      Patrick Nemechek, D.O. 4 years ago

      It’s very likely you have autonomic dysfunction. You need to see an autonomic specialists.

  28. David McCarthy 4 years ago

    hi. I am 64 and I have been getting dull headaches for some weeks and when I bend over to tie shoe laces get dizzy when I stand up. I also seem to need a short sleep in the afternoon and need to get up in the middle of the night to urinate. Unlike your other comments I tend to have a higher blood pressure 143/82. I do spend a lot of time on IPad ! Eyesight was ok 16 months ago but have made appointment for another test.

    • Author
      Patrick Nemechek, D.O. 4 years ago

      Your symptoms (lightheadedness, nocturia, unexplained fatigue) indicate you have low blood pressure and oxygen delivery to the brain, a condition called cerebral hypoperfusion. With this you can have a low, normal or high blood pressure reading even though the pressure in your brain is lower than required.

      If you labs and heart are generally OK, this is commonly due to autonomic dysfunction.

      Dr. N

  29. Jackie short 4 years ago

    Hello! My 10 year old has fainted on occasions since very young. It started as baby when he fell or got hurt, one time upon waking up and being startled?, a head bump followed by arching of the back and passing out. Some of these were breath holding spells too. Most recently he has fainted at school right before spiking fever and later being sick, and another time before stomac virus. He also fainted 2 months ago when seeing brother get shot… now he is complaining daily of light headless, dizzy, headaches, laughing making him feel like passing out, shaky feelings and more. He even has had lower blood pressures ( I have checked the m… 76/56 or 80/56. He has new heart burn, indigestion burps loudly and even diareaha. Around 2-3 pm he gets out of sort need hydrated and food and is super light headed. He is distracted now, anxious for first time ever, and has terRible time consentrating.What do I do next? Pediatrician acts like he anxious and sensitive and that he is ” just prone to fainting”. Could it be fixed? I have some similar issues myself and have PFO, heart palps, high bp although only 35 and fit, I have fainted in past but never recently . I also just recently devolved indegestion, and heart burn… what is going on with us??

    • Author
      Patrick Nemechek, D.O. 4 years ago

      Poor little guy. It sounds like he has bacterial overgrowth of his small intestine (SIBO) and is accumulating concussion damage with each injury. Every time someone hits their head they have some mild to moderate brain injury. Normally this is not a problem because the brain should completely repair the damage within a few weeks. But SIBO causes the microglia is the brain not to function correctly and the injured brain is only partially repaired, leaving behind some damage. Each successive injury adds more residual brain damage.

      All areas of the brain can be injured but damage to the autonomic nervous system is responsible from sone of the most debilitating symptoms. You sone is having a great deal of difficulty regulating blood pressure and oxygen to the brain because of this accumulated brain injury

      He needs to get his intestinal tract rebalanced and to have his repair mechanism in the brain restored. This is what I am an expert at but can only really help you if you visit my Arizona office for an initial visit. Most follow-ups can be done by Skype.

      Dr. N

  30. Isaiah 4 years ago

    Hi Doc. The last eighteen months have been very bad for me. often wake up feeling a little dizzy, I have to sit up for about 10 minutes after waking up lest I fall down after getting out of my bed in the morning. After break fast the condition improves for very few minutes then a hell of symptoms start: red heavy eyes and a nasty feeling, you would mistake it for pepper powder that has gotten into the eyes, brain fog, mental fatigue and complete lack of concentration, bloating and a bit of stomach ‘roaring’ are very common. My mid stomach is very tender, as this happens, the back part of my brain feels heavy and almost dead, when I get to work I cannot even type a sentence, I sometimes feel as if i can fall especially few minutes after lunch. My back leg muscles also ache when these feelings are there. Lately all my joints are producing cracking sound as I walk or stand up. I have done brain MRI, ECG, Endoscopy, colonoscopy, CRP, TSH test, Magnesium level test but they are all normal. This month however, serum calcium levels appeared slightly high 2.75 mmol/l ,. The morning dizziness reduced a bit this week after taking Creon capsules that my doctor prescribed after suspecting indigestion (dyspepsia) mid- mornings and afternoons remain very bad though. My productivity at work on a bad day is almost 10%.
    Please any help? I need back my healthy life!

  31. KevinT 4 years ago

    I am 54, having headache over right eye, along with nausea in stomach and above stomach area for last 3-4 months. It is definitely worse after eating, and certain foods make it much worse (ice cream, etc.). Small bits of food such as banana, salted crackers, seem to be best but I am still very hungry. What do you think or recommend? I will have an endoscopy and colonscopy in two weeks, as I have previous diagnosed GERD with hiatel hernia. Thanks

  32. Tracey 4 years ago

    Hi Dr.,

    I have been feeling ill since January and was diagnosed with Coxsackie B3 virus. I feel like the virus is gone but I still have issues such as dizziness, shortness of breath, ghost vision, muscle twitching, intestinal pain, sinus pressure, headaches, clogged ears, fatigue, heart rate fluctuating from 50-120, joint pain and weakness. I notice symptoms are worse after and during eating. I have seen so many specialists and all my tests and labs are coming back normal. Even the cardiologist says I’m fine but these symptoms won’t go away. I have had episodes that have lasted a month long a few times over the past years that included migraines and extreme fatigue. Your thoughts??


    • Author
      Patrick Nemechek, D.O. 4 years ago

      This is a very common scenario I see in my patients – all testing by the PCP and specialists are normal yet the patient has a wide variety of symptoms.

      It almost always boils down to a combination of SIBO and autonomic dysfunction. Take my SIBO and brain quiz to see if it sounds more like you

      Dr. N

    • Tracey 4 years ago

      Thanks Dr. What is SIBO?

    • Author
      Patrick Nemechek, D.O. 4 years ago

      Small Intestinal Bacterial Overgrowth

  33. Delmar Smith 4 years ago

    Ive had constant headaches for the last 7 months, occasional lightheadness and dizziness. I have been diagnosed with NDPH, but my physchiatrist thinks my sympathetic nervous system is constantly firing, because it senses danger and my parasympathetic needs to be reactivated. Im taking meds to treat the headache but my PCP thinks that my body is in constant fight or flight and stress makes the headaches worse.

    • Author
      Patrick Nemechek, D.O. 4 years ago

      Sounds like autonomic problems (psychiatrist is correct). Assuming labs are generally normal and a patient has no serious heart condition, lightheadedness is a symptom from too little oxygen being delivered to the brain due to impaired autonomic function.

      This is a common cause of headache, and neck tightness/pain (coat hanger pain). The pain is believed to be from scalp/neck muscle pain due to too little oxygen delivery into the muscle itself (similar to heart muscle pain from a narrowed or blocked artery).

      Focus on the autonomics. This is something we can easily make go away at my clinic.

      Dr. N

  34. moe 4 years ago

    I have been having headaches, lightheadedness, dizziness for over a week one. The pain shifts from the back , to the temples. Feels better when I lie down in a dark, quiet room. Have had issues with panic attacks in the not so distant past and the current health issue is not making things any easier. Have had MRI, Scan and ENT checks…I am 53.Help!

    • Author
      Patrick Nemechek, D.O. 4 years ago

      For something that has been going on for just a week, it’s very hard to say.

      I recommend taking both my brain injury quiz and my SIBO quiz to see of if these might be part of your problem

      Dr. N

  35. christopher hand 4 years ago

    i have been having low dull headaches for a long time, and feeling tired even after sleeping
    sometimes dizzy. I exercise to try to make myself feel more energetic.

    • Author
      Patrick Nemechek, D.O. 4 years ago

      Sounds like you have inadequate blood pressure to the brain.

      If a evaluation by your primary physician is unrevealing, it may be from autonomic nervous system damage.

      See my quiz in the side bar

  36. Melissa 4 years ago

    I just turned 40. I am 5ft 4in and weight 200lbs. I work at a job where I sit all day. Most days I wake up but still fill like I am not awake yet. I also have small headaches at the back of my head that feel like if I could just go back to sleep for a little while I would feel better. I have high blood pressure and diabetic. I have had tests on my thyroid and for sleep apena and all have come back fine. I would like to know what causes these headaches and feeling to tired.

    • Author
      Patrick Nemechek, D.O. 4 years ago

      Assuming that any other basic problems such as thyroid or anemia have been addressed, your symptoms are suggestive of low blood pressure and oxygen deliver to the head and brain. This is called orthostatic hypotension, orthostasis, lightheadedness or cerebral hypoperfusion. All these terms generally mean the same thing.

      The headache at the back of your head is from low oxygen levels in the scalp and neck muscles and is called coat hanger pain. The difficulty you experience waking up is also from low blood pressure and poor oxygen delivery to the brain itself.

      The most common cause for this is damage to the autonomic nervous system (ANS) from physical, emotional or inflammatory stress. There is growing evidence that damage to the ANS precedes the onset of conditions such as diabetes and high blood pressure.

      I am a specialist in clinical autonomic dysfunction and can reverse the underlying damage and make many of your systems resolve. The protocol I have developed focuses on suppressing pro-inflammatory cytokines within the central nervous system and does not require the long term use of medications.

      Go to for more information.

      Good luck – Dr. N.

  37. Erin P 4 years ago

    I’ve been having headaches behind the left eye, fatigue, dizziness and feeling “fogged”. Went to the eye doc thinking my eyes were going bad. Eyes are perfect. Doc said could be tumor. Mri scheduled for this week. Could this be OH? I’m almost 29 average height, but overweight (200lbs).

    • Author
      Patrick Nemechek, D.O. 4 years ago

      If the MRI and your labs are OK, there is a very good chance it could be orthostatic hypotension from autonomic dysfunction.

      This is what we specialize in reversing.

  38. Pramila 4 years ago

    Hi have similar symptoms of OH, feel dizzi when get suddenly up, i feel more spinning when get out of vehicle, I couldn’t balance my body. Hand tremor after 3-4 hour of eating fatigue ,mental confusion, sweating energy less person. I feel discomfort around my forehead and level such that they didn’t supplied with nutrition. I am so much worried . I consulted with cardiologist,did ECG n ECHO ,though the ECG shows slight ectopic beat but the ECHO reports shows normal heart conditions. I did all biometric test all r normal. Any one could help me to get rid out of this symptoms

    • Author
      Patrick Nemechek, D.O. 4 years ago

      You more than likely have some autonomic issues. You need to find someone who can perform autonomic testing in your area. If they aren’t available, fly to AZ for a quick visit and we’ll test you here.

      Dr. N

  39. Kara Bruneshefski 4 years ago

    Hello I have quite a lot of symptoms which include lightheadedness constant fatigue diareah peeing a lot numbness in arms and legs pins and needles and electric shock feelings. Nobody can find what’s wrong with me in my blood work although I do have a vitamin b12 deficiency which I have been having the shots for but I’m still feeling very low energy extremely low energy all the time and very bad headaches do you think it could be what you have been talking about oh I’m sorry I also have brain fog and poor concentration and memory have suffered both one stroke and one seizure when I was around 20-25 years old I’m currently almost 31 years old I pray I can find the answers because nobody wants to feel that way and sorry for writing so much but I had to get it out thank you very much have a great day

  40. Louise 4 years ago

    I’m a vegetarian. Will vegetable stock or years extract work?

    • Author
      Patrick Nemechek, D.O. 4 years ago

      As long as it has plenty of salt in it.

  41. Stan Zoledziowski 4 years ago

    Than you for your advice .

  42. Tanya 4 years ago

    I have a lot of the symptoms and more of what people are talking about. Light headed and presure in my head upon standing and nausea and exhausted and tired all the time and so on. I v been diagnosed with POTS by by heart specialist. But I have been waiting to see a POTS specialist in Calgary but he just received my vitals from my doctor and he said I don’t meet the criteria and has declined my referral. I don’t understand. I have all the symptoms and feel like crappie. My hearth specialist has diagnosed many people for years with pots so. It’s very frustrating. What do you think?

    • Author
      Patrick Nemechek, D.O. 4 years ago

      I think may doctors can’t see the forest for the trees. POTS is not even a precise diagnosis, its a grouping of patients with some similar features. Thats why the term has the word “Syndrome” in it. I hear about patients having this problem all the time. I actually think many of the doc’s don’t know how to help the patients.

      Regardless if they call your lightheadedness POTS, neurogenic orthostatic hypotension or vasovagal syncope, you more than likely have an autonomic disorder (especially since you cardiologist has looked for other causes), and you need assistance.

      It may be beyond your financial ability, but wee have many Canadians fly down to Arizona for their first autonomic evaluation and then we help them via Skype follow-up appointments.

      For more info go to

  43. Shawna 4 years ago

    Hi Dr, your article was very informative and I think I have this problem. My blood pressure drops 30 pts when I stand, my head hurts, scalp hurts, I have a coat hanger in my neck, I’m so fatigued I can’t hardly function, I also have trouble with my ears being plugged ( had tubes put in in December to no avail). I have tingling all over my body, nerve pain in my sciatic on the right side and burning pain in my ankles behind the ankle bone. My endo said its my adrenals and take more pred but I think it might be my ANS because that doesn’t seem to be helping. Any help would be so appreciated, thank you.

    • Author
      Patrick Nemechek, D.O. 4 years ago

      I think your autonomics might be contributing to the symptoms.

      You may need to find a neurologist who specializes in autonomics or head out to Arizona for an evaluation at my office.

      Dr. N

  44. roshawn sample 4 years ago

    hi Doctor, I have been seen by neurologist and rheumatologist. I consistently have headaches, at first I thought it was sinus, but meds are not working. Now I feel dizzy, numbness in right side of face and now my hands and neck hurt. My MRI came back fine and blood work showed slight inflammation, but not a lot. this has been going on for 2 years. I know something is wrong, my hands ache and stiff, but this headache is ridiculous.

    • Author
      Patrick Nemechek, D.O. 4 years ago

      Your probably are suffering from orthostatic hypotension, a common cause of dizziness, headaches and neck pain and hand numbness often referred to as coathanger pain.

  45. Melanie 4 years ago

    I’ve had dizziness/unbalanced/light headed feeling for 6 months along with headaches everyday. Progressively getting worse along with fatigue. All started after finished a round of Clomid. All tests have come back normal (MRI, Holter monitor). I tried increasing my salt, tried Florinef for 3 weeks. Nothing is helping. Was on prednisone when ENT thought it was a virus, worked for 2 weeks then symptoms came back. What do I do?

    • Author
      Patrick Nemechek, D.O. 4 years ago

      If salt and Florinef have no benefit, pressure or fluid in the sinuses can sometimes causes vertigo (spinning) and dysequilibrium (the floor is shifting)

  46. Andrea 4 years ago

    Hello, My 12 year old daughter has suffered from low grade chronic headaches since the fall of 2014. We discovered she had a benign DNET low grade glioma in the parietal region of her brain and had the tumor resected on April 27, 2015. The surgery and post-op visits have gone well however, she continues to have constant headaches. It is rare if she doe NOT have a headache. Aside from a post-operative seizure on May 4, 2015, she has no other health concerns. At that point, she was started on Keppra and weaned off this past January, 2016. She exhibited lightheadedness this past week upon standing after laying down for a while. This was during her period. I have tried chiropractic, logging her food, headaches and have an appointment for food allergy testing tomorrow. Her neurologists have recommended a few preventative migraine medicines but I as I research them I am concerned about side effects. What type of physician would be able to diagnose OH?

    • Author
      Patrick Nemechek, D.O. 4 years ago

      A cardiologist can help especially if they do a tilt-table test.

      Dr. N

  47. Jewel 4 years ago

    Dr. N,

    Thank you for your article. My 13-year-old son (average weight & height) suffers from fatigue, headaches, light sensitivity, neck stiffness, and light-headedness despite drinking a lot of water throughout the day. He seems to crave cereal and salty foods like corn chips but enjoys eating fruit and many vegetables as well. He has dyslexia and very slow processing although that seems to be getting even slower over the last year and lately he is sleeping half the day and it is very difficult to get him going. He also has tonsils so large they touch each other and the nurse commented that his oxygen level was slightly lower than normal at his physical last week. I am trying the chicken broth to get him going but was wondering if his tonsils may have something to do with this as well. Since he never had tonsil infections we chose not to remove them but now I am wondering if we should rethink that decision.

    • Author
      Patrick Nemechek, D.O. 4 years ago

      The fatigue, lightheadedness, fatigue, neck stiffness and slowing cognition are possibly all sings of cerebral hypoperfusion. If his labs are generally normal, he may have autonomic dysfunction. This can in part be from SIBO and from possible underlying concussion damage. Its hard toimage if the tonsils have anything to do with it. I’ve found that dyslexia may reverse if SIBO is treated as well. – Dr. N

  48. Scott Shane 4 years ago

    Hi Dr. N,
    All my symptoms seem to line up as someone suffering from OH. I’ve been drinking chx broth for 3 days now and it seems to be helping but there are still some heavy bouts with this at various points in the day. My concern is that you recommend a no-low carb diet which I have been on for 6 years now as a no Starch diet due to my Ankylosing Spodylitis, I’m sure a few carbs sneak in with some foods on occasion but overall I’m low to no carb free, so I’m wondering how will I treat my OH if I’m already not taking in carbs? Many thanks to you for sharing your knowledge and remedy to this problem on this website.

    • Author
      Patrick Nemechek, D.O. 4 years ago

      Scott, the underlying issue is more than lightly with damage to the sympathetic branch of the autonomic nervous system.

      The only way to fully address this is to see what underlying damage exists with autonomic testing.

      If sympathetic damage exists, you’ll need to significantly reduce your levels of neuroinflammation via shifting the balance of omega3-6 fatty acids in the brain, treating SIBO if it exists and possible utilizing vagus nerve stimulation.

      Many of my patients fly in to AZ for testing and treatment plan development, and then follows are done via Skype with very few needing follow-up visits in AZ.

      Dr. N

  49. Jane 4 years ago

    I’ve been suffering a number of ailments the last year. I’m dizzy and lightheaded, and have intense headaches all the time. I have anemia, stomach pain, pounding rate rate, and anxiety. It’s worse when I get up from a chair and especially after I eat. I go thru phases were I just don’t want to eat anything! I’ve lost 40 lbs since last June. I had an endoscopy which came back normal for celiac and ulcers. I’ve been on prilosec and zantac for diagnosed GERD and hiatal hernia, but it doesn’t help much with my symptoms. I’ve been trying to eliminate gluten from my diet which has helped. I feel like my primary Doc has done all she can do and sent me to a therapist who prescribed anti-depressents and anti-anxiety pills. I don’t want to take anymore medication and I don’t feel depressed other than the constant worry about what is wrong with me. Maybe you can help.

    • Author
      Patrick Nemechek, D.O. 4 years ago

      Have them look into treating SIBO with Xifaxan

  50. Aggie 4 years ago

    I’ve been struggling for a few years with headaches and dizziness which occur every 3 – 4 weeks. Lately it’s become worse which I’ve attributed to menopause. I am 52 years old. Also, I have been extremely fatigued and have gained weight which is very easy for me to do apparently, even though I watch how I eat. I’ve been told I’m insulin resistant and there is diabetes in my family. I wake up with numbness in my hands and it’s very hard to wake up. Just very tired….Feel so out of sorts.

    • Author
      Patrick Nemechek, D.O. 4 years ago


      recent studies are making clear that many of the symptoms associated with PMS as well as menopause are due to damage of the autonomic nervous system compounded by the temporary but repetitive (PMS) or permanent (menopause) decline in progesterone levels.

      Many individuals with damage to the autonomic nervous system have difficulty regulating blood pressure and oxygen into their brain. This is referred to as orthostatic hypotension. Low brain oxygen commonly causes headaches, neck tightness, dizziness, increased hunger of salt and carbohydrate containing foods, anxiousness, poor concentration and memory and weight gain.

      I have developed techniques that can reverse the underlying damage and stop the symptoms. You can read more about it at

      Dr. N

  51. Nick 4 years ago

    I am a fairly active 66 yr. old. Play hockey twice a week and walk 2 or 3 rounds of golf a week.
    I had a kidney stone attack that required 4 procedures and 4 general anesthesias in a 3 week period. I now get headaches on the right side of my head every morning. Feeling “out of it” and fatigue are my constant companions. It has been 6 weeks since it began. Family doctor gave me air sickness medication that added drowsiness to my symptoms. What next?

    • Author
      Patrick Nemechek, D.O. 4 years ago

      You many of developed SIBO from the general anesthesia. This can cause a lot of these symptoms

  52. Riley 4 years ago

    Hi Dr. N

    im 18 years old and have recently started lifting weights in the gym everyday. I have been taking supplements such as mass gainer which contains a high amount of carbs. For the past week I have been experiencing dizziness, lightheadedness and fatigue and the feeling of being ‘zoned – out’. Are the supplements giving me these symptoms?

    Thank you

    • Author
      Patrick Nemechek, D.O. 4 years ago

      Veery possibly. Many supplements also contain some ingredients that aren’t listed on the label.

      Stop it and see what you think.

      Dr. N

  53. Marisa 4 years ago

    I am writing a concerned wife.. My husband is 38 and for the last 2years he has been suffering from lightheadedness, blurry vision, neck pain on the left side ,tiredness , at times arms are tingling.rapid heartbeat etc. He has had many tests and al have come back clear.. But he does not feel fine… I came across your article and website and wanted your opinion.. We live in Boston area wondering if you have and suggestions!!
    Best Marisa

    • Author
      Patrick Nemechek, D.O. 4 years ago

      You may want to have him take the autonomic assessment qui on my practice website, Sounds like he may have autonomic dysfunction

  54. Denise 4 years ago

    Do you see Orthostatic Hypotension related to Celiac?
    My 13 year old has had a chronic headache for 4 months. She has dizzy spells, foggy brain and frequent urination. She was diagnosed with celiac a month ago from a blood test. (Only mild stomach ailments and those are recent.) Could the Celiac damage have caused Orthostatic symptoms?

    • Author
      Patrick Nemechek, D.O. 4 years ago

      Maybe but she may also have bacterial overgrowth of the gut called SIBO. 70-80% of individuals with Celiac also have SIBO. SIBO can easily contribute to her orthostatic issues

  55. Brian 4 years ago

    Hi, Dr. Nemechek. I have been lightheaded for 4 months. I first noticed when I was working out and my heart rate shot up 30 bpm! I instantly felt lightheaded and rubbery from head to toe. I stopped of course, then have had numerous tests ran. My heart is good. I tell them I feel a lack of blood flow in brain area when it happens. I really feel it has to do with my nervous system. Other symptoms include warm sensations in both legs and arms. I have also had severe acid reflux for years. I was in a car accident months before my acid reflux started so, I think it makes perfect sense. Thoughts?

    • Author
      Patrick Nemechek, D.O. 4 years ago

      You right, you sound like you suffered concussion damage to your autonomic nervous system during the car accident and have not recovered.

  56. Fiona Sharma 4 years ago

    Hi, I’ve been trying to find out why I have not been feeling myself lately.
    It started a month and half ago with problems going to the toilet, along with wind and stomach churning. This eased off and no longer have problems with this but lightheadness & chills started around the same time along with headaches/heavy head, tiredness and aching on each side of my head close to neck. I’m getting concerned as can’t seem to get any answers other than suspected irritable bowl syndrome plus anxiety and stress. I wouldn’t say I’m anxious other than wondering what’s wrong with me?

    • Author
      Patrick Nemechek, D.O. 4 years ago


      See if you can find some inulin fiber. This helps reverse an imbalance in intestinal bacteria called SIBO and may help your symptoms a great deal.

      About 1/2 – 1 tsp per day mixed into hot or cold food/liquid is very helpful.

      Dr. N

  57. Carrie Ann 4 years ago

    I was in a rollover car accident 2 years ago. I have a feeling of being disconnected, sensory overstimulation, headaches right front and also lower right with right neck and shoulder pain. I have irritability and anxiety as well. I feel “dizzy” for lack of a better word often. It seems my brain needs to reset mid day or these symptoms continue to be out of control. Could this be relevant?

    • Author
      Patrick Nemechek, D.O. 4 years ago


      Sounds like you may of suffered a concussion that has not resolved, and are suffering from some autonomic nervous system damage know as cerebral hypoperfusion (i.e. low blood pressure to head and neck). You need a program to help restore your autonomic nervous system. This is what I do all the time. Try taking out test at

      Dr. N

  58. Marilyn 4 years ago

    I have had Addison’s Disease since 1999 and luckily, up until May 2015, have been most healthy and living a beautiful life. In February 2015 my endocrinologist reduced my Cortef by 10 mgs daily. I was unaware that the Cortef reduction should have been gradual. After five weeks on the lower Cortef dose I began feeling unwell and in May 2015 I went into Addison’s crisis and since that day in May I have never recovered. I have constant headaches, often very severe, lightheadness upon standing and sitting, frequent boughts with vertigo, anxiety, insomnia, frequent urinaion, indigestion…the list goes on. Could the sudden reduction cause ANS? Thank you.

    • Author
      Patrick Nemechek, D.O. 4 years ago


      A quick reduction in Cortef in your instance might be able to cause such a severe decline in blood pressure to the brain to trigger some dysautonomia or possible it triggered a secondary process such as SIBO which can also worsen autonomic functioning.

      Dr. N

  59. Carmen 4 years ago

    Hi there. I have some of these symptoms.
    I had a stroke due a artery dissection in June 2015.
    The last 3 months I have been dealing with muscle pain. I feel light headed ( feeling I might pass out) off.

    A month ago I started having heart palpitations. For 2 weeks my neck hurts off and on and my muscles feel weak.
    I went to the ER 3 times and they assured me my heart is fine my thyroid tests came back fine and that I am probably having anxiety attacks. Some of it probably is.
    I also stopped taking my birth control pills a few days ago. Maybe thinking that messes with my hormones.
    Maybe you can point me I. The right direction.

    • Author
      Patrick Nemechek, D.O. 4 years ago


      Many intracranial events (stroke, concussion, infections, biopsies, chemo or radiation therapy, heat exhaustion) can result in secondary damage to the autonomic nervous system.

      This damage cause make it difficult to regulate blood pressure and oxygen into the brain, and is known as orthostatic hypotension. The resulting symptoms can be headaches, neck tightness, fatigue, poor concentration/memory, anxiety, increased hunger, palpitations and tachycardia.

      Take my autonomic quiz at You may need to see an autonomic specialist to get this diagnosed and hopefully repaired. This is what I do in my Arizona clinic. Many people travel here from all over the country for this kind of assistance.

      Dr. N

  60. WIlmari 4 years ago

    good day

    I would like advice. im not sure what is going on as im so tired of this feeling. I am on an antidepressant called Lorien but this happened even when I was on a different one aswell. I get this dizzy feeling, hurting behind my eyes, ending in a headache. when I eat it feels better but within a few minutes the feeling is back. I can go to sleep and the next morning ill wake up feeling better no dizziness or eyes hurting but with a headache. I don’t know how to explaine to people how im feeing when they asking what is wrong. these days I just try and hide it as im so tired of not knowing how to explain.

    please please will you be able to help


    • Author
      Patrick Nemechek, D.O. 4 years ago

      Sounds like you may have orthostatic intolerance. Many things including autonomic dysfunction and SIBO can cause this.

      I recommend discussing this with your physician.

      Dr. N

  61. Tracy Dumka 4 years ago

    I’ve had Chronic Fatigue Syndrome for over 10 years & recently have been diagnosed with Rheumatoid Arthritis, but lately I’ve developed more extreme weakness, lightheadedness, faintness & fatigue when I get up for any length of time to do something. Could these symptoms be from ANS malfunction, brain inflammation or general inflammation or just something I have to live with due to my existing medical conditions? I’ve had these symptoms in the past, but not for a long time. What should I do?

    • Author
      Patrick Nemechek, D.O. 4 years ago

      CFS/Myalgic Encephalitis is a chronic inflammatory process most like related to abnormally activated microglia within the brain. The metabolic inflammation from rheumatoid arthritis can easily compound these issues. You need someone to help reduce your neuroinflammation with a program directed at the reduction of microglia.

      Dr. N

  62. Phillis 4 years ago

    I understand that reducing carbs is essential. But I wonder if that is enough to repair the ANS? Especially since I believe my ANS has been damaged by SIBO.

    My symptoms vary so rapidly I can usually tell if something I ate the day before has had an effect on me(dry skin around eyes). Or if something is really bad I’ll get a symptom straight away – like reflux. The fact that it can be such a quick turned around must be significant. Unfortunately it is chronic. I’ve tried fish oil, reducing carbs and just about every diet but my problems are always threatening to come back at a moments notice!

    Looking back it’s pretty obvious I’ve had SIBO since early childhood. It was classed as eczema and just kept at bay with creams.


    • Author
      Patrick Nemechek, D.O. 4 years ago

      Recovery of autonomic damage requires multiple things in concert: high concentration of DHA supplementation, supplementation with EVOO, reversal of SIBo with antibiotics and often vagus nerve stimulation (depending on other factors). When these things are done in unison, complete recovery occurs over a 8-12 month period.

      Dr. N

  63. Phillis 4 years ago

    I suspect carbs may be the root of my health problems. It’s the first time I’ve heard of carbs causing damage to the ANS though. How widely known is it?

    What would be a way of speeding up ANS recovery besides reducing carbs?

    • Author
      Patrick Nemechek, D.O. 4 years ago

      In a body that is broken by excessive linoleic acid (i.e. soy oil, vegetable oil, margarine and shortenings – a state known as endoplasmic reticular stress, and thought to be a large proportion of the population) excess carbs stimulate the production of excess inflammatory cytokines which are very capable of causing impairment in autonomic functioning especially of the parasympathetic branch. This can be measures a a reduction in heart rate variability.

  64. ken sansom 4 years ago

    thank you for advice.iam going to try the salt as I never put salt on anything,i have felt lethargic for a few weeks now and get headaches,the tiredness and back of the neck horrible.i am going to physio also because I was a plasterer for many years and have found it very helpful.i have had this before and have found it helps.thank you very much.

    • Author
      Patrick Nemechek, D.O. 4 years ago

      Remember, if increasing salt intake helps alleviate some of your symptoms, there is a good chance a portion of your symptoms are from low blood pressure to the brain (cerebral hypoperfusion). If the symptoms are better after lying flat for 15-20 minutes it means the same thing.

  65. Tami 4 years ago

    I’ve been light headed now for almost 7 years. Right after my trip ins were born. I have Chronic Anxiety and Panic attacks. I he doctors keep telling me it’s from the anxiety, and one had me go see therapist to see if I had Vertigo, which I did not. My light headedness is constant. I’m usually laying on my stomach, to help ease it but it still is there. I feel like I’m gonna fall out if a chair if it doesn’t have support, I can’t drive, I can’t go anywhere for fear of fainting! I know some of it is Anxiety. Is the symptoms you AT talking about? I also got t rapid heart rate after I eat! My doctors aren’t saying anything, so hoping you could shed some light!

    • Tami 4 years ago

      I’m also taking 2 different medications for high blood pressure, but this was after the light headedness!

    • Author
      Patrick Nemechek, D.O. 4 years ago


      Unfortunately, it sounds like you may of suffered some autonomic damage with the delivery of your triplets. Lightheadedness and anxiety are very common problems when this occurs. Lightheadedness indicates LOW blood pressure in your brain. The HIGH reading in the arm is often a compensatory reaction by the body to drive more blood and oxygen upward to the head. After eating, your body shunts approximately a 1/3 of the blood used to maintain blood pressure to the head into the intestinal tract, and if your nervous system is not working correctly, you will get less blood and oxygen to the brain. This is why your symptoms worsen after meals.

      When the brain is not receiving enough oxygen, it begins to panic in a way and release a powerful stress hormone called noradrenaline. This commonly causes anxiety that improves when lying flat, and with pressure on the abdomen which is why you feel better lying flat on your abdomen. They specifically sell abdominal binders to help with orthostatic hypotension (the formal name for your lightheadedness).

      Typically some or all of the blood pressure medication you are on is only making things worse. They were prescribed simply because the pressure reading in the arm was elevated, and the provider did not carefully question you or listen to you enough to realize your primary symptoms represent low blood pressure to the brain.

      You need to work with a doctor or even nurse practitioner (they often listen better than my colleagues) to slowly lower your BP meds. I often have my patients check AM BP readings twice every AM, every day and a running log. You’ll often find the pressure does rally go up when meds are decreased. Later in the day the BP can bounce around alot because of the underlying autonomic damage you most likely suffered with the birth of your children (see post on Broken Mommies).

      If you can’t find someone to help you, we have many patients from around the country who fly to Arizona once a year a see me for a visit with follow-ups being done by Skype.

      Good luck – Dr. N

  66. Dru 4 years ago

    Having similar symptoms, I suspect a correlation with my root canals, do you know of this?

    • Author
      Patrick Nemechek, D.O. 4 years ago

      Your gut might of been knocked out of balance by antibiotics some receive with dental work, or pre-existing SIBO was the cause of your dental problems.

  67. Kellie 4 years ago

    Hi there I am so glad I stumbled on to this page. I have been experiencing a lot of the symptoms that everyone is talking about. My experience is I will have alittle nausea when I first wake up then it will subside. I get to work and feel ok standing for about 30 or so minutes and suddenly feel hot cold clammy sweat then my arm get heavy and weak, dizzy and light headed, hard to take breaths, have a really hard time concentrating and my vision is a little off… That is when I am searching to sit down before I pass out. Once I’m sitting down I do not feel as bad… but once I get back up it happens all over again. I can not even work that way so I end up clocking out and going home. This continues to happen a lot. I have been to the ER and they say its kidney failure. Its more then that. I have a Primary Dr. I think maybe I should ask him about OH and OI.

  68. Isabel 4 years ago

    I took it last night around 8pm it was 140/90. But I will take more often.

    thank you

  69. Isabel 4 years ago

    I have high blood pressure currently on 2 kind of medications. My headaches have come back and fatigue, dizzy spells. I have been taking alot of advils for the headaches and have to take 3 to 4 at a time.

    • Author
      Patrick Nemechek, D.O. 4 years ago

      check your blood pressure twice each morning and take a weeks worth of readings to your PCP. You might be overtreated on BP meds.

    • Author
      Patrick Nemechek, D.O. 4 years ago

      Usually a few weeks to a couple months

  70. sarah 4 years ago

    I have been getting headaches for quite a while now and I get them everyday. Also I feel fatigue and drowsy and have fainted two times. I have tried increasing my water in take but it hasnt improved anything. I asked my GP for a scan but they said I dont need it, is there anything you advise me to do?

    • Author
      Patrick Nemechek, D.O. 4 years ago

      If your testing is normal, you probably are having orthostatic hypotension from autonomic dysfunction. You need to see an autonomic specialist such as myself.

  71. Kimberley 4 years ago

    I am a (very) healthy 55 yo female. I had been having some of the above systems , only not headache–more of a pressure in my head. After reading your article, I took 1/4 teaspoon of sea salt and in a few hours felt symptoms markedly improved. I’m going to keep your suggestions up. Thanks so much for your post!

    • Author
      Patrick Nemechek, D.O. 4 years ago

      Sea salt, pickles, chicken broth! This is only the first step. Now you need to watch my screencast on metabolic inflammation and start getting your autonomics to recover.

      Dr. N

  72. Roberta Nati 4 years ago

    I’ve made a visit to the ER due to the most excruciating headache ever ! Along with it came, nausea, lightheaded (I needed to hold the walls so I wouldn’t Crack my head), pain in the back of my eyes (switched from L-R),problems with digestive system. Cat scan was done but, not to be accurate and so they suggested spinal tap. That was a horror show! 1 resident and 2 Dr’s = 9 tries and no csf..Still have headache, nausea neck pain and stiffness etc. . Where are you located Dr. N

  73. Melinda Stuckey 4 years ago

    I recently had a head injury were I fainted and busted my skull open. Before that I had headaches but after they stopped for a few weeks. I didn’t have it checked out due to a pregnancy. Now that I’ve had my baby the pain from headaches has worsened, I easily get light headed or dizzy, my energy has decreased, I have hot/cold spells, and nothing I do makes the pain in my head stop. It’s so bad it brings me to tears. What should I do?

    • Author
      Patrick Nemechek, D.O. 4 years ago

      You’ve had a concussion and damaged your autonomic nervous system. This is the cause for the headaches worsening. You need autonomic testing and a program to reverse the damage. The only advice I can give is for you to try to make an appointment in my office for testing. If you don’t live in the Phoenix area, we can do most follow-up visits by phone after the initial face-to-face visit.

      Dr. N

  74. cyndi 4 years ago

    Additional to my prev post – have also had mild concussion and trauma in the last year, which I see affects the autonomic system, so may be another factor. However my Dr does not see any of it as connected.

    • Author
      Patrick Nemechek, D.O. 4 years ago

      The concussion has everything to do with it. You have both autonomic damage and SIBO. Get both treated and your symptoms will go away for good.

      Dr. N

    • amatullah 4 years ago

      Hii. I am 19 years old female. I have been taking zertec tablets for the past 10 years for allergies. I recently stopped taking it and I now get terrible headaches nausea dizzyness and fatique which settles a bit when I lie down. I also feel hot cold and have concentration problems. I have a very bad gastric reflux and also urinate very often. I stress a lot and find myself nervous and anxious very often please help

    • Author
      Patrick Nemechek, D.O. 4 years ago

      You have a very unusual set of symptoms that might be related to autonomic dysfunction.

      You might consider a phone/Skype consultation so we can review things more thoroughly.

      You can find info at my practice website,

      Dr. N

  75. cyndi 4 years ago

    Having these attacks since diagnosed with gallstones, reflux, hiatal hernia and possible IBS a few months back. Due to the gallstones (waiting for op) and these other conditions I cannot currently eat fat or protein and struggle with eating anything. Taking prebiotics and can just about digest banana or plain mashed potato occasionally, but cannot see how to deal with this as cannot replace carbs with anything. The surgeon also recommends low fat diet after gallbladder removal.

  76. Cathy Madison 5 years ago

    December 20 – at 2:00am
    Woke up feeling nausea and having cramps. Went to the bathroom and began to sweat and was drenched with sweat began to get cold and hot. A,few minutes later my face was pale felt dizzy,head began to get light headed like was going to faint. I kept my composure and was seeing black spots. My arms and hands began to feel as though they were asleep no circulation. My hands began to get stiff to were i could close them. This,went on for about 45 mintues. I finally walked into my room feeling so cold and pale.

    • Gabby Jones 5 years ago

      I feel the same way, but not normally with cramps. I had period cramps today, which has led to the dizziness, nauseous, and sleepiness. I start off hot, go to cold, go to cold, to hot.

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