Extreme weakness, dizziness and heaviness in the head

The combination of headache and weakness, which may include a feeling of lack of energy, the need to exert great effort to perform normal activities, drowsiness, or muscle weakness, is very common. This can accompany quite a lot of different types of disorders, but it can also indicate overwork and the need to change lifestyle. Doctors are helped to differentiate between pathology and relatively safe conditions not only by the results of laboratory and instrumental diagnostic methods, but also by the characteristics of accompanying symptoms.

Why does mild dizziness occur?

Physiological reasons

Due to a lack of nutrients and a decrease in glucose levels, mild, wave-like dizziness can be observed in fans of strict diets. In the spring months, the condition often occurs in women trying to quickly lose weight for the summer through dietary restrictions and vigorous exercise. Fatigue of the body after winter and unusual physical activity can cause dizziness even with moderate dietary restrictions.

Mild dizziness is often detected in people suffering from chronic fatigue (physical, emotional, intellectual). In the pre-session period and during the session, the symptom sometimes occurs in students. Unpleasant sensations may accompany a period of adaptation to a new job with unusual workloads or burnout due to constant overtime or a long absence of vacation.

Another cause of this disorder is considered to be lack of sleep. The symptom is detected in people with insomnia and shift work at night, and is found in women on maternity leave to care for a child. Sometimes constant dizziness is provoked by hypoxia, caused by insufficient ventilation of domestic and industrial premises.

Pregnancy, menopause

Mild dizziness is considered a common companion of pregnancy. It develops due to changes in the level of hormones in the blood, insufficient adaptation of the body to new conditions, redistribution of blood, and increased tone of the vagus nerve. Another possible cause of the symptom in women is menopause. Dizziness appears against the background of vegetative-vascular and psycho-emotional disorders, instability of blood pressure.

Slight dizziness

Vegetative-vascular dystonia

The symptoms are varied and varied. Constant mild dizziness can be combined with short-term intense ones. They are supplemented by other paroxysmal conditions: fainting, PA. Common manifestations of VSD are tachycardia, a feeling of lack of air, chilliness or, on the contrary, a feeling of heat, weakness, fatigue, headaches, and sleep disturbances.

Cervical osteochondrosis

Dizziness with cervical osteochondrosis is associated with compression of the vertebral artery, which provides blood circulation in the vertebrobasilar region. For minor disorders caused by bone growths, reactive inflammation and compensatory muscle tension, the symptom is weak and constant. With sharp turns of the head, during exacerbation of dizziness, dizziness may intensify.

Anemia

Mild dizziness is characteristic of slightly or moderately severe iron deficiency anemia. Complemented by pale and dry skin, drowsiness, decreased performance, tinnitus, shortness of breath, palpitations during exercise, and high sensitivity to cold. Fainting is possible. Similar symptoms during the recovery period are observed in patients with posthemorrhagic anemia.

Arterial hypotension

Occurs after injuries, against the background of neurocirculatory dystonia, chronic somatic diseases, hypovitaminosis. Accompanied by drowsiness, weakness, apathy, increased fatigue, tachycardia, hyperhidrosis, memory impairment, and emotional instability. With prolonged arterial hypotension in women, the menstrual cycle is disrupted, and in men, potency decreases. Mild dizziness may be accompanied by lightheadedness when changing body position (orthostatic hypotension).

Endocrine disorders

Mild dizziness in hypothyroidism is caused by a decrease in blood pressure and is combined with signs of a slowdown in other physiological and psychological processes: weakness, drowsiness, lethargy, bradycardia, weight gain, fluid retention in tissues with the development of characteristic edema.

In patients with diabetes mellitus, along with dizziness, constant thirst, dry mouth, increased urination, increased amount of urine excreted, increased appetite, delayed wound healing, and frequent pustular infections are detected. With the development of hypoglycemia due to an overdose of insulin, eating disorders or alcohol intake, dizziness quickly intensifies, giving way to fainting states and coma.

Cerebral atherosclerosis

Periodic mild dizziness occurs already at the initial stage of the disease. As atherosclerosis progresses, they become permanent. Headaches, noise in the head, memory impairment, and psycho-emotional disorders are observed. Possible anxiety, suspiciousness, depressive disorders, deterioration of vision and hearing, and unclear speech.

Acute infections

Mild dizziness often accompanies acute infectious diseases: ARVI, foodborne illnesses, sore throat, coronavirus infection, etc. The symptom occurs against the background of intoxication, general hyperthermia, weakness, weakness, muscle pain. With respiratory infections, catarrhal phenomena are observed, with intestinal infections - nausea, vomiting, and stool disorders.

Neurotic disorders

Prolonged mild dizziness is most characteristic of neurasthenia, but can also be observed in other disorders of the neurotic spectrum, especially anxiety and dissociative ones. Dizziness is detected as part of a vegetative symptom complex, which also includes tachycardia, blood pressure fluctuations, a feeling of lack of air, muscle twitching, and dyspeptic disorders. Affective disorders include melancholy, sadness, hopelessness, and low mood.

Taking medications

Mild dizziness is a side effect of some medications or occurs due to long-term use. The symptom can be provoked by the following drugs:

• Sedatives
  : tranquilizers, barbiturates.
• Suppressing vestibular function
  : antihistamines and anticholinergics, benzodiazepines.
• Ototoxic
  : aminoglycosides, NSAIDs.
• Causing hypotension
  : diuretics, vasodilators, adrenergic blockers, calcium channel blockers, tricyclic antidepressants.
• Provoking hypoglycemia
  : antidiabetic, monoamine oxidase inhibitors.

What else could be causing the symptoms?

Weakness and headache can be manifestations of a number of physiological (i.e. normal) and pathological conditions.

Dehydration is a condition that occurs when fluid loss exceeds fluid intake, for example, with diarrhea and vomiting. A lack of fluid in the body is indicated by thirst, a feeling of restlessness, loss of strength, weakness, lack of urination, decreased blood pressure and increased pulse, as well as cool and damp extremities 9.

Taking certain medications —headache and weakness can be side effects of many medications, including diuretics, antihypertensives, and others10.

Menstruation - hormonal changes that occur on the eve of and during menstruation can contribute to headaches and weakness. In 25-90% of women (according to various sources), premenstrual syndrome occurs 2-10 days before the start of menstruation. This is a complex of symptoms indicating cyclic neuropsychic, vascular, metabolic and hormonal disorders10.

PMS has about 150 symptoms that can occur in different combinations. More often, women experience increased fatigue, engorgement and tenderness of the mammary glands, bloating, nausea, drowsiness, back and lower back pain, and headache11.

Diagnostics

A general practitioner will determine the cause of mild dizziness. If necessary, psychiatrists, neurologists, and endocrinologists are involved in the examination. During the interview, the specialist determines the time of occurrence of the symptom and the accompanying circumstances. Identifies living conditions, features of the daily routine and other factors that can provoke physiological disorders. Determines the presence of diagnosed somatic pathologies.

During the examination, the doctor pays attention to external changes that may indicate the nature of the disease causing dizziness, for example, pale and dry skin with anemia or swelling with hypothyroidism. The examination plan is drawn up taking into account the suspected cause of the symptom and may include:

• Visualization techniques
  . For osteochondrosis, radiography and CT of the cervical spine are informative. For patients with atherosclerosis, ultrasound examination or MRI of cerebral vessels is indicated. Sonography helps assess the condition of the thyroid gland in patients with hypothyroidism. In addition, ultrasound and radiation diagnostic methods are used to exclude other pathologies in VSD and arterial hypotension.
• Electrophysiological studies
  . ECG is a screening diagnostic method that allows you to detect arrhythmias, hypokalemia, ischemia and organic changes in the myocardium. It is carried out as part of differential diagnosis to determine the causes of secondary hypotension. EEG is included in the basic examination program for dizziness and makes it possible to identify disturbances in the functioning of the central nervous system.
• Lab tests
  . Anemia is confirmed by the results of a clinical blood test. In diabetes mellitus, glucose levels are determined. To assess the severity of hypothyroidism, a thyroid hormone test is prescribed. To identify viruses that cause acute infections, PCR and ELISA are performed.

Neurological examination

When should you see a doctor?

Sometimes headaches and fatigue require immediate medical attention. Alarm signals, when they appear, you should call an ambulance12,13:

• sudden severe headache;
• headache, fatigue in combination with limited ability to tilt the head forward, bringing the chin closer to the chest (stiff neck);
• confusion;
• visual impairment;
• sensory disturbances, such as numbness of the limbs;
• speech disorder.

In the absence of alarms, consultation with a doctor may be necessary routinely in cases where the cause of headaches and fatigue is unknown.

References

1. Nikitin S. S. et al. Clinical recommendations for the provision of medical care to patients with Pompe disease // Neuromuscular diseases, 2021. Vol. 6. No. 1.
2. Clinical recommendations. Pompe disease, 2021
3. Morozova O. G. Migraine: modern ideas about classification, diagnosis, therapy and prevention (Part I) // Emergency Medicine, 2012. No. 4 (43).
4. Stuklov N.I., Mitchenkova A.A. Anemia and iron deficiency. Global problems and solution algorithms // Therapy, 2021. T. 24. No. 6. P.147-155.
5. Federal clinical guidelines for the treatment of iron deficiency anemia, 2015.
6. Fibromyalgia. MSD Handbook (accessed 09/18/2019).
7. Smirnov V.S. Modern means of prevention and treatment of influenza and ARVI // St. Petersburg: FARMIndex. – 2008.
8. Kovrov G.V., Lebedev M.A., Palatov S.Yu. Depression in general practice //Russian Medical Journal, 2010. T. 8. No. 18. P. 504-8.
9. Initial treatment of dehydration in acute malnutrition. World Health Organization. URL: https://www.who.int/elena/titles/bbc/dehydration_sam/ru/ (accessed September 19, 2019).
10. Clinical pharmacology and pharmacotherapy: textbook. – 3rd ed., add. and processed / ed. V.G. Kukesa, A.K. Starodubtseva. – M.: GEOTAR-Media, 2012. – 832 p.
11. Prilepskaya V.N., Mezhevitinova E.A. Premenstrual syndrome //Gynecology, 2005. T. 7. No. 4. P. 210-214.
12. Semenov V.M., Zenkova S.K., Dmitrachenko T.I. Purulent meningitis: features of the clinical course, variant of differential diagnosis //Medical alphabet, 2011. T. 2. No. 11. P. 24-30.
13. Parfenov V. A., Khasanova D. R. Ischemic stroke, 2012.

GZEA.PD.18.09.0435r

Treatment

Conservative therapy

Mild dizziness caused by physiological factors is eliminated by normalizing nutrition, daily routine, reducing stress levels, and ensuring sufficient ventilation in the premises. To normalize the condition of women during menopause, hormone replacement therapy is carried out and antidepressants are prescribed.

In case of dizziness caused by taking medications, the dose is adjusted, the drug is discontinued or replaced. Therapeutic tactics for other pathologies are determined by the nature of the disease:

• VSD
  . The most important role is played by non-drug measures: correction of the work and rest regime, elimination of physical inactivity and unnecessary emotional influences, psychotherapy, physiotherapy. If the effectiveness is insufficient, tranquilizers, antidepressants, nootropics, and sedatives are used.
• Cerebral atherosclerosis
  . A special diet, regular exercise, and avoidance of smoking and alcohol consumption are required. Drug correction of hyperlipidemia is carried out. Antiplatelet agents, vascular agents, B vitamins, and nootropics are used.
• Arterial hypotension
  . Treatment of the underlying disease is required. Therapeutic and recreational activities include massage, hydrotherapy, acupuncture, aromatherapy, exercise therapy. Herbal adaptogens, cerebroprotectors, antioxidants, and antidepressants are effective.
• Cervical osteochondrosis
  . During periods of exacerbation, wearing a Shants collar is recommended. As part of drug therapy, NSAIDs, muscle relaxants, and painkillers are used.
• Endocrine diseases
  . For patients with diabetes mellitus, mild dizziness requires adjustment of diet, insulin therapy regimen, or treatment with hypoglycemic drugs. Hypothyroidism requires replacement therapy with levothyroxine.

For iron deficiency anemia, a nutritious diet with a high content of heme iron and taking iron supplements are recommended. Patients with neurotic disorders are given psychotherapy and prescribed antidepressants and tranquilizers.