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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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