Headaches, migraines and dizziness

Headaches, migraines and dizziness are common symptoms that may occur separately or together. A headache may feel like pressure, tightness, throbbing, stabbing pain, heaviness, or discomfort affecting one side, both sides, the forehead, temples, back of the head, face, or neck. Dizziness may describe lightheadedness, unsteadiness, a feeling of impending fainting, or the sensation that the person or surroundings are moving or spinning.

Occasional symptoms can be related to dehydration, skipped meals, poor sleep, stress, prolonged screen use, a respiratory infection, or temporary changes in blood pressure. Recurrent or severe symptoms may be associated with migraine, tension-type headache, disorders of the inner ear, medication effects, anemia, blood glucose changes, thyroid disorders, cardiovascular conditions, or neurological disease.

Headache and dizziness are symptoms rather than diagnoses. Their timing, exact character, duration, triggers, associated symptoms, medication use, and effect on daily activity help determine whether the next step should involve monitoring, laboratory testing, an eye examination, vestibular assessment, neurology consultation, imaging, or urgent care.

How headaches, migraines and dizziness may feel

Some headaches develop gradually and feel like a tight band around the head. Others are pulsating, affect one side, worsen with movement, or occur with nausea and sensitivity to light or sound. Head pain may last less than an hour, continue throughout the day, or recur over several days.

Dizziness is a broad term. Distinguishing between different sensations is useful:

• Lightheadedness may feel like faintness, weakness, or an empty sensation in the head.
• Vertigo creates a false feeling of spinning, tilting, or movement.
• Unsteadiness may feel like difficulty walking straight or maintaining balance.
• Visual dizziness may be triggered by screens, supermarkets, crowds, moving patterns, or driving.

Symptoms may occur after standing up, turning the head, missing a meal, exercising, spending time in heat, working at a screen, travelling, or being exposed to strong smells, bright lights, noise, or particular environments.

Relevant features include:

• pressure or tightness across the forehead or around the head
• throbbing or pulsating pain, often on one side
• pain behind the eye or around the temple
• nausea, vomiting, or sensitivity to light, sound, smell, or movement
• flashing lights, zigzag patterns, blind spots, tingling, or temporary speech difficulty
• a spinning sensation triggered by moving or turning the head
• lightheadedness after standing up
• poor balance, veering while walking, or fear of falling
• fatigue, difficulty concentrating, or feeling mentally slowed after an episode

Common causes of headaches, migraines and dizziness

Migraine and other primary headache disorders

Migraine is a neurological condition that may cause moderate or severe headache, nausea, sensitivity to light and sound, dizziness, fatigue, and difficulty concentrating. Pain is often throbbing and may affect one side, although the pattern varies.

Some people experience an aura before or during a migraine. Aura can involve temporary visual changes, tingling, numbness, language difficulty, or other reversible neurological symptoms. Migraine can also cause significant dizziness or vertigo, sometimes with little or no headache.

Tension-type headache more often causes pressure or tightness on both sides of the head. It is usually not accompanied by pronounced nausea or marked worsening with routine movement. Cluster headache causes severe attacks, commonly around one eye, and may occur with tearing, nasal symptoms, or eyelid changes on the affected side.

Sleep, stress, hydration, and daily routine

Insufficient sleep, irregular sleep, stress, prolonged concentration, jaw clenching, neck tension, missed meals, and inadequate fluid intake can contribute to headaches or lightheadedness. Long periods at a computer may combine visual strain, reduced blinking, poor posture, and neck muscle tension.

Excessive caffeine, sudden caffeine withdrawal, alcohol, and irregular meals may also contribute. A headache that follows a repeated pattern after a specific factor is more informative than a single isolated episode.

Inner-ear and balance disorders

The inner ear plays an important role in balance. Benign positional vertigo may cause brief spinning episodes after turning in bed, looking upward, bending down, or changing head position. Other vestibular conditions may cause longer episodes with nausea, imbalance, ringing in the ears, pressure, or hearing changes.

Dizziness with new hearing loss, persistent ear symptoms, or repeated balance problems may require an ear, nose and throat or vestibular assessment. Not every spinning sensation is caused by the ear, so the neurological and cardiovascular context also matters.

Blood pressure and circulation

A temporary fall in blood pressure when standing can cause lightheadedness, dimmed vision, weakness, or near-fainting. Dehydration, heat, illness, medication, prolonged standing, and autonomic nervous system conditions may contribute.

Very high blood pressure does not usually cause symptoms by itself, but severe elevations associated with headache, chest pain, breathing difficulty, confusion, or neurological changes require urgent assessment.

Abnormal heart rhythm and other cardiovascular conditions may cause dizziness, palpitations, chest discomfort, exercise intolerance, or fainting. Symptoms during exertion or accompanied by loss of consciousness require prompt medical evaluation.

Anemia, glucose changes, and metabolic causes

Iron deficiency and anemia may cause headache, dizziness, fatigue, pale skin, reduced exercise tolerance, shortness of breath, or a rapid heartbeat. The symptoms may develop gradually and can be more noticeable during activity.

Low blood glucose can cause sweating, shaking, hunger, weakness, confusion, headache, or dizziness. High glucose may be associated with thirst, frequent urination, fatigue, and blurred vision.

Thyroid disorders, electrolyte disturbances, vitamin deficiencies, kidney or liver disease, and other metabolic conditions may also contribute. Laboratory testing should be selected according to the full symptom pattern rather than performed as an unrestricted panel.

Vision and eye-related causes

Uncorrected vision, a change in glasses prescription, prolonged near work, dry eyes, or problems coordinating eye movement may contribute to headache, eye strain, visual discomfort, and dizziness.

Headache with sudden loss of vision, double vision, severe eye pain, a markedly red eye, or halos around lights requires urgent assessment. Recurrent symptoms related to reading or screen use may justify an eye examination.

Medication, substances, and withdrawal

Headache or dizziness can occur as a side effect of many medicines, including some blood pressure medicines, sedatives, antidepressants, pain medicines, and other treatments. Starting, stopping, or changing a medicine can be relevant.

Frequent use of acute headache medication can contribute to medication-overuse headache. Prescribed treatment should not be stopped abruptly without medical advice.

Alcohol, recreational substances, nicotine, and exposure to chemicals may also produce symptoms. Carbon monoxide exposure can cause headache, dizziness, weakness, nausea, confusion, chest pain, and loss of consciousness. Similar symptoms affecting several people in the same building are an important warning sign.

Infection, inflammation, and other medical conditions

Respiratory infections may cause headache with fever, nasal symptoms, cough, fatigue, or body aches. Headache and dizziness may also occur after head injury or during recovery from another illness.

Less common but important causes include inflammation affecting blood vessels, infection involving the brain or its coverings, bleeding, stroke, raised pressure within the skull, and other neurological conditions. These are more likely when warning signs or new neurological symptoms are present.

Symptoms that may appear together

Associated symptoms can significantly change the diagnostic direction. Important details include:

• nausea, vomiting, or sensitivity to light and sound
• blurred vision, double vision, flashing lights, or temporary visual loss
• hearing loss, ringing in the ears, or pressure in one ear
• weakness, numbness, facial drooping, or speech difficulty
• palpitations, chest pain, shortness of breath, or fainting
• fever, stiff neck, rash, or marked general illness
• fatigue, pale skin, heavy menstrual bleeding, or reduced exercise tolerance
• thirst, frequent urination, sweating, shaking, or hunger
• neck pain, jaw pain, scalp tenderness, or symptoms after injury
• confusion, memory changes, poor coordination, or difficulty walking

When emergency medical care is needed

Seek emergency medical care if a headache or dizziness occurs with:

• a sudden, extremely severe headache that reaches maximum intensity quickly
• new weakness or numbness on one side of the body
• facial drooping, speech difficulty, confusion, or loss of coordination
• sudden vision loss, persistent double vision, or severe eye pain
• loss of consciousness, seizure, or inability to stand or walk safely
• high fever with a stiff neck, marked light sensitivity, or a non-fading rash
• a recent significant head injury
• chest pain, severe shortness of breath, or a very rapid or irregular heartbeat
• suspected carbon monoxide exposure, especially when several people are affected
• rapid deterioration, repeated vomiting, or unusual drowsiness

New neurological symptoms should not automatically be attributed to migraine, even in a person who has experienced migraine before.

When to arrange a medical assessment

A medical assessment is recommended when headaches, migraines, or dizziness:

• repeatedly return or become more frequent
• change significantly from the usual pattern
• regularly wake the person during the night
• begin after coughing, straining, bending, or physical exertion
• are associated with vomiting, visual symptoms, hearing changes, or imbalance
• interfere with work, driving, sleep, exercise, or normal activity
• occur during pregnancy or after childbirth
• begin after a new medicine or dose change
• are associated with anemia symptoms, abnormal bleeding, palpitations, or weight change
• require frequent use of pain medication

How headaches, migraines and dizziness are usually diagnosed

Symptom history and neurological examination

The assessment usually starts with the exact location, character, intensity, frequency, duration, and triggers of the symptoms. A doctor may ask about aura, nausea, light sensitivity, hearing symptoms, balance, fainting, injuries, infections, menstrual patterns, pregnancy, medication, alcohol, sleep, and family history.

The examination may include blood pressure while lying and standing, pulse, temperature, vision, eye movements, hearing, balance, coordination, strength, sensation, reflexes, speech, and examination of the neck and ears.

Laboratory testing

Laboratory tests are not required for every typical headache or brief episode of dizziness. Depending on the accompanying symptoms, testing may include:

• complete blood count and iron status
• blood glucose or longer-term glucose measurement
• electrolytes and kidney function
• thyroid function
• inflammatory markers
• vitamin levels when a deficiency is clinically suspected
• pregnancy testing when relevant

The purpose of testing is to investigate a suspected contributing condition, not to confirm migraine or tension-type headache through a blood result.

Eye, ear, cardiovascular, and functional assessment

An eye examination may be useful when symptoms are related to visual work, eye pain, double vision, or a possible change in prescription. Hearing and vestibular testing may be considered for recurrent vertigo, hearing loss, or tinnitus.

An electrocardiogram, heart monitoring, or further cardiovascular assessment may be appropriate when dizziness occurs with palpitations, exertion, fainting, chest discomfort, or an abnormal pulse.

Imaging and specialist assessment

Brain imaging is not routinely required for every headache or dizziness episode. CT or MRI may be considered when the pattern is unusual, neurological findings are present, symptoms follow injury, the headache changes significantly, or another structural cause is suspected.

Depending on the dominant pattern, the next specialist may be a neurologist, ear, nose and throat specialist, ophthalmologist, cardiologist, internist, or another appropriate clinician.

What the next step may involve

The next step depends on whether the pattern is most consistent with migraine, a tension-type headache, a vestibular problem, a circulatory issue, a metabolic condition, medication effects, or another cause.

Recurring headaches may be assessed with a symptom diary and a treatment plan based on the headache type, frequency, associated symptoms, and medication history. Dizziness triggered by head movement may require vestibular examination and, when appropriate, targeted repositioning treatment.

Laboratory testing may be useful when fatigue, pallor, abnormal bleeding, glucose-related symptoms, weight changes, or other general signs are present. Cardiovascular testing may be more relevant when episodes occur after standing, during exertion, or with palpitations and fainting.

Regular sleep, adequate hydration, consistent meals, appropriate screen breaks, and recording reproducible triggers may support medical assessment. They should not delay evaluation when symptoms are severe, new, progressive, or associated with warning signs.

Starting repeated dietary restrictions or supplements solely because headaches or dizziness appear after eating may obscure the pattern. Food-related evaluation should be based on a consistent history and clinically appropriate testing.

What to prepare before a medical appointment

Before an appointment or ZagrebMed inquiry, prepare information about:

• when the symptoms started and whether the pattern has changed
• the location, character, intensity, and duration of the headache
• whether dizziness means spinning, faintness, or imbalance
• frequency and time of day of the episodes
• possible links with meals, sleep, menstruation, stress, exercise, posture, travel, or screens
• nausea, vision changes, hearing symptoms, weakness, numbness, palpitations, or fainting
• medication, supplements, caffeine, alcohol, and pain medicine use
• blood pressure, glucose, temperature, or pulse measurements if available
• previous blood tests, eye or hearing examinations, heart tests, imaging, or specialist reports
• a short headache and dizziness diary and any questions you want clarified

If headaches, migraines, or dizziness persist, repeatedly return, or interfere with daily activities, you can send ZagrebMed a description of the pattern and available medical records. ZagrebMed can help connect the symptoms with appropriate laboratory testing, diagnostic assessment, or specialist consultation in Zagreb.