DEAR DR. ROACH: I’ve recently been seen by my primary care physician and would like your take on some issues. I’ve been experiencing a throbbing sensation in my neck, which relates to my pulse. Sometimes it feels like I am wearing something snug on my neck, like a turtleneck or necktie.

I can almost always “hear” the blood flowing through my veins. Oftentimes this pulse affects my hearing (I have a fan running under my desk, for instance, that I can hear coming in and out) and I sometimes see tiny lights flashing with my pulse as well.

This almost never causes me any pain, but sometimes I end up with a bad headache or a tender neck.

I am a 52-year-old female, 5 foot 3 inches tall and weigh 160 pounds. I am not in great physical shape. I have asked my doctor if that could be the reason for this, and the suggestion was brushed off. Instead she ordered a carotid Doppler screen, an MRI and MRA of my head. These are obviously expensive tests that I would like to avoid, but can’t seem to get any great answers as to why I need them. She says she is “casting a big net” to find out what’s wrong with me. Could this just be hormones? Or my weight? — L.T.

ANSWER: I think your doctor is concerned about abnormal blood flow in your brain. The sensation of being able to “hear” your pulse — an actual sound sensation that comes and goes with the pulse rate — is called pulsatile tinnitus and is suggestive of an aneurism, blockages in the arteries of the skull, tumors in the skull bone or abnormalities of the veins. Not everyone with pulsatile tinnitus will have any of these, but the risk is high enough that she wants to be sure that you have none of these life-threatening conditions.

Some evidence suggests that people who are very overweight, usually much more so than you are, are more likely to have pulsatile tinnitus. This can be from high blood pressure or high pressure inside the fluid of the brain. Weight reduction can reduce this sensation.

One other concern I have is that a wide pulse pressure (the difference between the top number of your blood pressure, the systolic, and the lower number, the diastolic) can lead to similar symptoms. This can be tested easily, by checking your blood pressure. If the pulse pressure is wide (greater than 40), that might need looking into.

DEAR DR. ROACH: There has been much reporting of the effect of not getting enough sun during the winter months.

In your professional opinion, can some people get depressed from too much summer?

When I lived in the Southwest, all that heat and sun from May to October seemed to really get to me. I wished for a cloudy day often. Is it because I was raised in the depressing North? — J.R.W.

ANSWER: Seasonal affective disorder is a type of major depression with recurrent seasonal onset and remission. Although it usually is described as beginning in late fall and early winter, and going away in spring or summer, some people can have symptoms that begin in spring and go away in fall. People with spring-onset SAD more frequently have insomnia, poor appetite and weight loss.

Light therapy is used only for fall-onset SAD. Both medication and psychotherapy, especially cognitive behavioral therapy, are used for spring-onset SAD.

I don’t know whether being brought up in the North predisposes one to the spring-onset form of SAD. I don’t find the North particularly depressing.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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