Anxiety as a differential diagnosis?

Specific Illnesses & Conditions VM/MAV
1

It seems like doctors “blame” strange symptoms that they can’t understand on psychological problems. (There was just a post about this). I am sure a lot of us have had that problem. My general physician for example thinks that I am depressed or anxious.

At first I just got pissed off but when I read about it it sounds like anxiety can give a lot of these problems that I (we) have. So, this whole thing with depression- anxiety-etc, is it worth looking into or is it just bullshit?

My GP is sending me to a psychiatrist. I have also decided that I will go to a private migraine clinic to see what they have to say about it.

Anyway, is anxiety a good differential diagnosis? If it truly is anxiety causing my symptoms then I should get better with some anti-anxiety meds, right?

What do you think, should I try it or should I just go to the migraine clinic instead and leave it at that?

Has anyone of you been helped by any anxiety meds?

(By the way, I am from sweden and some year ago we had a comic strip in the newspaper about a guy with an axe in his head sitting at the doctor’s office. He is sitting there with the axe sticking up from his skull and the doctor is sitting in front of his computer asking “When did your headache start?” etc. After a while the guy just stands up and screams “But for fuck sake, I have an axe in my head!!”)

Good day to all of you!

2

I think it’s worth looking into. While mental illness does become a catch-all, if you legitimately have issues that may be anxiety or depression related they should be dealt with like any physical illness anywhere else in the body. While there are certainly people in which anxiety causes all of their symptoms, many of us with MAV and other chronic illnesses do have anxiety and depression too and they can exacerbate each other. It can quickly become a vicious downward spiral, and treatment of the issues are not mutually exclusive. At the very least, learning some new coping mechanisms can be a huge relief.

PS - I would LOVE to see that comic!

3

I think anxiety is one of the main underlying triggers for MAV. I also think there are a lot of people out there who aren’t really aware as to what anxiety is or “feels like” in the body. From personal experience I know that anxiety, prolonged stress, and overactivity of my brain (haha) will take me over the threshold quicker than any foods or other triggers. Well alcohol is right up there too. I also have been watching these boards as well as a Facebook group and anxiety is the THEME among us MAVers. Yet some people will still deny it. An overactive nervous system i.e. anxiety can sneak up on you so it is not always very obvious. My severe vertigo attacks have come on after prolonged weeks of stressful events and was at its chronic peak during the first 3 years of my son’s life. I have been vertigo free since June - 7 months now by recognizing anxiety before it gets its teeth in me. This means using a benzo as needed but not being afraid to use it to settle my nervous system for a while. You don’t want to use those daily but if I need them for a week or so now and then I take it. I’m on no migraine medications. I do take a low dose lexapro to keep my threshold up. Managing MAV takes a pile of self awareness and insight. I’m a yoga teacher so this comes easy to me however it will sneak up on me from time to time. Best of luck, Julie

4

One of the symptoms of my migraine is anxiety - or what I call physiological anxiety. As I explained to Waterston (my neurologist) the physiological symptoms come first, and it’s almost like the psychological plays catch up to “make sense” of the way I feel. Cause I’m actually not stressed or anxious. Asn he said to my hubby when he asked no she isn’t gong mad, it’s the migraine :slight_smile:

Waterston said that this was not uncommon, and that anxiety can be a symptom of migraine. Of course it can “just” be anxiety - but wanted to give you an alternate perspective

5

I agree with this Gabe
ages ago i went to the GP saying “something is wrong with me”
and he said, well you seem like an anxious person
so i said, “try having a beat pounding in your head day and night and see how anxious you look”
is it just an easy bucket to put everything into, like ‘it’s stress’
i feel it happening as part of a cluster of symptoms

6

My understanding of Vestibular Migraine is that it’s a migraine which has caused the brain stem to be irritable which in turn is causing problems with balance and movement (incl vertigo). One of the functions of the brain stem is to provide a sense of balance (vestibular function). Does the irritable brain stem ‘set off’ these other symptoms in the brain, eg nausea, headache, anxiety, etc which come from various other parts of the brain. Which comes first though? neuroskills.com

Presumably, this is why we see a Neurologist for diagnosis and treatment. As to why anti-depressant, anti-epileptic, anti-anxiety or blood pressure meds, etc can calm the brain and restore balance function is a mystery to me! It makes sense to me that being unbalanced 24/7 would trigger anxiety in most people, especially not knowing the cause and not getting a diagnosis for months!

Is it the theory that anxiety can trigger a massive migraine which can affect the brain stem and other parts of the brain and cause all these complicated symptoms?

Barb
I edited this post because I find it all very confusing but am trying to work my way through this maze!

7

I think many doctors like to jump right to the anxiety (or depression) thing, sometimes no doubt because they have no idea what’s really wrong with you or what to do about it, but they know they can TREAT the anxiety (or depression). So they cut to the chase and try to do that.

Which, of course, leaves the patient feeling like the doctor is just blaming anxiety for your symptoms and ignoring deeper causes. Major fail on the doc’s part.

I had this experience recently with a new PCP (granted, a young 'un, a resident doctor, and now my ex-PCP). I felt like anxiety was the first and foremost thing he and his teachers latched onto and put above all else. This is what they teach new doctors to do. One of their first questions, delivered in a very solicitous manner supposed no doubt to make me feel like they really “cared” and to not make me mad, was “Have you ever seen a psychiatrist about all this?” and “Gosh, this must all have been really hard for you!”–instead of actually asking me in any detail about my symptoms, history, etc. and really listening to me. I felt ridiculously patronized and disappointed.

I have no patience for that kind of thing anymore. Especially because I’m not an anxious person, and whatever anxiety I DO have is 98 percent CAUSED by doctors ascribing my symptoms to anxiety right out of the gate!! Grrrrr.

Such a difference when I went back to my previous PCP (whom I’d only seen before for a short time) and addressed the migraine question with her. Not only was she knowledgeable (surprise!), she didn’t say a word about anxiety, just settled with me on a trial of nortriptyline, which BTW is working, and WHY couldn’t someone have done what she did 15 years ago, or even 10 years, or 5 years! Because SHE listened and also TRUSTED me, treated me like I had some intelligence and knowledge of my own situation, and she just went straight to the heart of the matter.

That said, secondary anxiety is pretty much part of the package with dizziness, since the vestibular system is closely tied to the sympathetic nervous system, the fight-or-flight response. It’s only natural that there’s a tight relation between dizziness and anxiety. Treating anxiety is the right thing to do–BUT doctors still need to help patients get to the root of the dizziness problem, first and foremost! And not just assume that treating anxiety will just solve the dizziness problem. Dizziness CAN be caused primarily by anxiety, but doctors should not conclude that until they have looked thoroughly and competently at other possible causes.

8

Severe anxiety can cause all kinds of physical issues and sensations, but until you are full checked out it should never be dismissed as being “all in your head”. For me, anxiety has been a prime component of MAV, but not the true cause if the condition itself - it’s a byproduct at best. However, since crossing the anxiety line, I now deal with MAV and anxiety issues. On top of it, the anxiety issues have evolved into areas that don’t even involve MAV.

But my MAV is due to physical issues, and I have taken all the health tests possible which prove it. It is not imaginary. But through the process, I unfortunately encountered some doctors that wanted to write off my condition as “mental problems” as soon as they heard that I suffer from anxiety. While at one doctor, I actually can remember the moment when I saw his face literally change expression as soon as he read my paperwork. He just kind of paused and said “it says here that you suffer from anxiety…” and he basically dismissed all my issues as a result as he went through his tests. I never went back to him, nor would I recommend him to anyone.

During the physical tests, I also went through 4 weeks of group anxiety therapy, and after that I did 3 months of vestibular rehab. I would credit both of these as basically saving my life. I now see a counselor at work occasionally, plus I see a psychologist as needed outside of work. I do not take any meds for the anxiety. My vertigo is usually always there to some degree, I just have learned to react to it differently. But in the end, I know it is real and that, in and of itself, is somewhat therapeutic.

The bottom line is to have all the tests done that you can, hopefully by doctors who will take you seriously and not just dismiss your symptoms. Whether the cause is physical, mental, or a combination of the two - help is out there.

No matter what - **Never **give up!

9

To MAV1138 (sorry if I missed your name…)

I just had to comment on that moment when you see the doctor’s expression change. I have seen that so many times. From interested puzzlement and question-asking to a smug, satisfied little smile. “Anxious. Oh yeah, that’s the ticket; I’m off the hook, no need to investigate further!”

You can see that expression change in two seconds flat.

:frowning:

Nancy

10

— Begin quote from “Nancy W”

To MAV1138 (sorry if I missed your name…)

I just had to comment on that moment when you see the doctor’s expression change. I have seen that so many times. From interested puzzlement and question-asking to a smug, satisfied little smile. “Anxious. Oh yeah, that’s the ticket; I’m off the hook, no need to investigate further!”

You can see that expression change in two seconds flat.

:frowning:

Nancy

— End quote

That look alone makes me want to send my diagnosis letter to every single doctor who has ever done this to me with a covering note telling them to educate themselves on migraine.

11

— Begin quote from “dizzyhell”

— Begin quote from “Nancy W”

To MAV1138 (sorry if I missed your name…)

I just had to comment on that moment when you see the doctor’s expression change. I have seen that so many times. From interested puzzlement and question-asking to a smug, satisfied little smile. “Anxious. Oh yeah, that’s the ticket; I’m off the hook, no need to investigate further!”
You can see that expression change in two seconds flat.
:frowning:
Nancy

— End quote

That look alone makes me want to send my diagnosis letter to every single doctor who has ever done this to me with a covering note telling them to educate themselves on migraine.

— End quote

I agree with both of you, and it is really disheartening when it happens - I think what I have found through this whole ordeal is that most of the doctors don’t know the cause(s) of this condition, and even fewer of them can really treat it correctly. I can count on one hand how many doctors I have encountered that seem to care enough about you or take you seriously. Most of them struck me that they would rather be out playing golf than dealing with patients.

Frank

12

Hi!

Thanks for the interesting discussion.

It is a bit late but I want to update anyway. I went to the psychiatrist that my GP sent me to but he just sort of waved it off. He said “no, it is not psychological in nature”. I even tried to say that I actually did have a few panic attacks earlier but he just said that everybody have those, more or less. He recommended me to see a neurologist instead. But he was a nice guy, he even apologized for the health care system not being able to treat me yet. He also said that I need a bit of luck to find not just a neurologist but a neurologist who is interested in headaches. He said that my symptoms were too specific and too constant for being psychologically caused. He said that anxiety and other things usually causes diffuse symptoms that tend to change back and forth over time. That is how I understood him at least.

I guess the psychiatrists get tired of the GPs just sending a lot of patients they can not diagnose themselves. I can imagine that if you educate yourself to become a psychiatrist then you want to meet patients with psychiatric diseases and not be used as some kind of dust bin by the other docs for hard to diagnose patients.

Anyway, I just wanted to share…

Best regards!

13

Drs have tried to lump me and my symptoms into the anxiety bucket. I know we all suffer from anxiety issues, which like MAV, I believe are a by product of an over active brain. Anxiety and MAV certainly work hand in hand. Though, my explanation is this. Symptoms always come first, then anxiety. When I am feeling good, which isn’t to often, than my anxiety is low. When my symptoms ramp up so does my anxiety. If our anxiety were the issue, then treating the anxiety, which can be easy to do, would eleviate our MAV symptoms. We all know it does not!