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Forum Name: Neurology Topics

Question: stress-induced head tremors... tests inconclusive


 DaPoohz - Thu Apr 30, 2009 8:47 pm

I am a 32 year-old female, who has been experiencing occasional head tremors since April 12, 2009. It started after a weekend full of stressful and exhausting wedding events in my role as Maid of Honor. The first episode occurred at the end of an orgasm when my teeth began to chatter uncontrollably, which was shortly followed by my first head tremors. Since then, the tremors have been consistently "no-no" head movements and a few inconsistent full body tremors (2-3 times). I am always conscious when the tremors occur and they don't last more than 5 seconds. I have noticed that sometimes I will daze off and the tremors will begin, however there have been a few instances where the dazes did not precede the tremors. In my opinion, the tremors are consistently preceded by stress and/or anxiety.

My immediate medical tests following an ER visit included: a CT scan with no contrast, MRI, MRA with contrast, blood work, EKG and EEG. All of my test results were normal and a diagnosis given by a neurologist was inconclusive. I do have a history of self-diagnosed anxiety where I get heart palpitations, shaky hands, lump in the throat and chest tightening when I am nervous about something. In addition, I worry about various things in life consistently, exhibit qualities of a perfectionist, easily stress out and am always worried about and focus on worst case scenarios, which has affected sleep, caused stress and anxiety, and has disabled me in certain instances. However, I have never experienced tremors prior to April 12. The only medication I was on at the time, where I did miss a couple of doses, was Amoxicillin- Clavulanate for a finger abscess and began taking it a week prior to the first tremor episode. In addition, I was an occasional coffee drinker averaging no more than one cup of coffee a day until I was advised to eliminate caffeine. Also, I am a non-smoker, occasional drinker(3-4 times per month), and I haven't used any dietary supplements/vitamins other than protein powder(not recently). I have researched a few sites online regarding tremors but I'm still uncertain about the next steps I should take. I appreciate any professional advice and/or feedback from others who have experienced similar symptoms. Thank you.
 John Kenyon, CNA - Fri May 15, 2009 9:50 pm

User avatar Hello --

While this problem warrants a neurology consult to rule out some unsusual and tremendously coincidental physiological cause, I believe you've named the culprit in anxiety and stress, and with a history of self-diagnosed but classic generalized anxiety disorder (GAD), you are a prime candidate to have developed now stress/anxiety-related tic, manifesting as that side-to-side head tremor (classic tic) and this and the whole syndrome should be evaluated professionally and treated (if you and I are correct) with a combination of medication and congitive behavioral therapy (CBT) to ratchet down the level of anxiety and probably unnoticed stress/tension (which is often the direct cause of these head tics).

Everything you've described as observed on your own is classic for GAD with new onset of muscle tics probably secondary to intense muscle tension in the neck and upper back. The combination of medication and CBT can be extremely effective and can really improve your quality of life. Further, CBT is a self-limited form of psychotherapy which is interactive and not traditional talk therapy but is aimed at helping the patient to learn to recognize the symptoms and triggers and how to manage them consciously to great effect. Once this is accomplished medication may or may not be required for an indefinite period, but is more than worth the release from the extremely unpleasant physical symptoms associated with GAD. My one caveat would be that every presumptive anxiety patient be given a competent neurological survey to make certain there's no underlying physical problem causing some or all of the symptoms. While this is unlikely in your case, it is possible and one ought never allow one's symptoms to be summarily charged off to anxiety even when it appears the logical first choice diagnosis.

I hope this is helpful. Good luck to you and please follow up with us here as needed.
 DaPoohz - Wed May 27, 2009 7:02 pm

Hello Mr. Kenyon -

Thank you for your response. I had not really considered tics, however have started to research it as another viable option. I do have another question for you. My next step was to consult with a Neuropyschiatrist, since their specialities involve both Neurology and Psychiatry. Thus, I would be covering all bases in one visit and potentially be consulted by someone who is familiar with my symptoms and can recommend a potential plan of action. However, due to the availabilty of the specialist in my insurance plan, it will not be possible to meet with him until late July. I am eager to take the next steps in the process, in order to identify and execute a plan to cope with my anxiety and stress and make sure that it is not a physical matter. I have considered going to see another Neurologist, however I believe they will examine my normal test results and give me the same feedback as the prior Neurologist. In addition, I have considered finding a Psychiatrist/Psychologist specializing in Cognitive Behavior Therapy, as my next consult. However, I believe this may be skipping a step in the process since it has not been confirmed that it is just Cognitive Behavior Therapy and a lifestyle change that is needed. In your opinion, what would you advise my next steps should be and the type of specialist that I should consult next?

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