Expert: Suzan Jackson - 10/16/2009

Question
Dear Dr,
I am a mom with a new baby and 4 yr old. I am exhausted, but have been ill for 2 weeks. I had a headache one morning, which started on the left side of my head and gravitated around my head, more in the front near eyes. Eventually, this turned into dizzy spells mixed in, a vision problem with my right eye (it feels full), and severe fatigue. Right now, I feel queasy. I keep getting dizzy or a short headache when bending at times. My dr thought it was sinus, but it isn't. My obgyn tested me for thyroid and anemia, but it was not the case either. I am so scared about this. I go to a neurologist next week. Are there any other conditions? My bp has been low at home around 90/65 while on Labetalol. Could it be low bp? Thanks so much. Have a great day.

Answer
Dear Kate -

I apologize for not getting back to you sooner.  I've been very, very ill myself for weeks and unable to spend much time at the computer.

I have Chronic Fatigue Syndrome (CFS), an immune system disorder, so that is my only area of expertise.  It's good that you're going to see doctors, including various specialists.  Don't give up if you don't get answers right away!  Persistence is the key to finally getting an accurate diagnosis and treatment.

The official criteria for CFS requires that you have symptoms for at least 6 months before you can be diagnosed with CFS, though it may be apparent by 3 months with an experienced doctor.  Exhaustion, headache, and dizziness can be symptoms of CFS, but they can also be symptoms of many other conditions.  I'm sure you're aware that exhaustion is completely normal for a mom with a new baby and a preschooler, but you're smart not to ignore the other symptoms.

CFS normally causes flu-like symptoms, including recurring sore throat and/or swollen glands, flu-like aches, as well as headaches or other pain, plus cognitive problems and sleep dysfunction.  One of the primary characteristics of CFS is an intolerance to exercise; any kind of mental or physical exertion causes sudden and severe worsening of all symptoms.

Here is a self-quiz for CFS:

http://www.cfids.org/about-cfids/do-i-have-cfids.asp

And here is more information on the diagnosis and treatment of CFS:

http://www.cfids.org/about-cfids/default.asp

If you read the diagnosis page, you'll see a lengthy list of other conditions that have symptoms similar to CFS and should be tested for and excluded before considering a diagnosis of CFS.  Anemia and thyroid problems are on this list, so you're on the right track, but perhaps the list can help guide your doctors in considering other causes.

As for the low blood pressure and dizziness, most people with CFS develop these symptoms as part of two conditions known as Neurally Mediated Hypotension (NMH) and Postural Tachycardia Syndrome (POTS).  However, you can have one or both of these conditions without necessarily having CFS.  Here is an excellent description of diagnosis and treatment of NMH and POTS - it's focused on people with CFS but would apply equally well to someone with just NMH or POTS:

http://www.pediatricnetwork.org/medical/OI/johnshopkins.htm

A neurologist or cardiologist should be familiar with these conditions and should be able to diagnose them.  Diagnosis often requires a tilt-table test (explained in the article).

Good luck with finding some answers and getting some relief.  And if it does turn out that you have CFS, please feel free to contact me again or visit my blog (below).

Sue Jackson

www.livewithcfs.blogspot.com