Having head pressure, throbbing, pain, lightheaded, fatigue for 4months? had head/neck mri, mra and ct scan, blood work. what next? no meds help.

It could be one: Of those obscure diseases that cause fatigue, such as lyme disease, chronic fatigue syndrome, fibromyalgia, etc. I assume all common medical conditions have been excluded with all of your tests. Consult a pain management specialist for your headaches.

See a neurologist: These symptoms may represent a headache or other neurological condition. You should keep a log of the location, timing, duration, and intensity of these episodes and take the log with you to a neurologist. https://www.aan.com/Guidelines/Home/ByTopic?topicId=16