Dizziness: Causes, Symptoms, and Treatment Options

Regarding the issue of dizziness?

Hello, Doctor! About a year ago, I experienced dizziness and consulted a neurologist.
The doctor conducted a series of physical tests and an EEG, indicating that there were no issues.
The dizziness lasted for about a month before improving.
However, it started again earlier this year.
The main symptom is that I do not feel dizzy when I am completely still, but I experience dizziness when I quickly turn my head, look up, look down, or when I move my head while walking.
The dizziness is not severe enough to feel like the room is spinning, but it is more pronounced in the afternoons and evenings after eating, accompanied by a feeling of fatigue and a sense of lightheadedness.
Three months ago, I visited a cardiologist and was diagnosed with ventricular arrhythmia.
I am currently on medication (Inderal 10mg) to manage it, but the dizziness still comes and goes.
I am unsure if this medication is related to lower blood pressure.
Additionally, I have chronic sinusitis, so I would like to consult with you, thank you!

Sam, 30~39 year old female. Ask Date: 2016/06/23

Dr. Jiang Junyi reply Neurology

Hello, based on your description, benign paroxysmal positional vertigo (BPPV) should be considered first.
The symptoms are characterized by brief episodes of dizziness related to changes in head position, such as bending over, tilting back, lying down, getting up, turning over, or suddenly turning the head.
These movements can trigger vertigo, which may be accompanied by symptoms such as nausea, vomiting, palpitations, cold sweats, and a feeling of weakness.
The exact cause is often unknown, but it can be due to inflammation, degeneration, or head trauma that leads to the displacement of otoliths from the utricle into the semicircular canals of the inner ear.
When the head position changes, the movement of these otoliths within the semicircular canals alters the neural signals from the inner ear, resulting in vertigo.
It is recommended that you consult an otolaryngologist to discuss examination and treatment options.
Wishing you good health and peace.

Reply Date: 2016/06/23

More Info

Dizziness can be a complex symptom with various underlying causes, and understanding its origins is crucial for effective management. Based on your description, it seems that your dizziness is influenced by several factors, including your history of heart arrhythmia, medication use, and possibly chronic sinusitis.

Causes of Dizziness
1. Vestibular Disorders: Dizziness can often stem from issues within the inner ear, which is responsible for balance. Conditions such as Benign Paroxysmal Positional Vertigo (BPPV) can cause dizziness when you change positions, such as turning your head quickly or bending down.
2. Cardiovascular Issues: Given your diagnosis of ventricular arrhythmia and the medication you are taking (Inderal, a beta-blocker), it's possible that your dizziness is related to fluctuations in blood pressure. Beta-blockers can lower heart rate and blood pressure, which may lead to feelings of lightheadedness, especially when standing up quickly or after exertion.

3. Neurological Factors: Although previous neurological evaluations were normal, it’s important to consider that dizziness can sometimes be a residual symptom of a past issue or a new one that may not have been detected yet.
4. Chronic Sinusitis: Your chronic sinusitis could also contribute to feelings of dizziness. Sinus pressure can affect balance and lead to a sensation of fullness in the head, which might be perceived as dizziness.

5. Fatigue and Stress: You mentioned that dizziness is more pronounced when you are tired or after meals. Fatigue can exacerbate feelings of dizziness, and postprandial hypotension (a drop in blood pressure after eating) could also be a factor.

Symptoms
The symptoms you describe—dizziness when moving your head, feelings of fatigue, and a sensation of heaviness in the head—are common in various conditions. The fact that you do not experience dizziness when still is indicative of a positional or vestibular issue rather than a systemic one.

Treatment Options
1. Medication Review: It’s essential to discuss your current medications with your healthcare provider. If Inderal is contributing to your symptoms, your doctor may consider adjusting the dosage or switching to a different medication.

2. Vestibular Rehabilitation: If your dizziness is related to vestibular dysfunction, vestibular rehabilitation therapy (VRT) can be beneficial. This therapy involves exercises designed to improve balance and reduce dizziness.

3. Sinus Management: Addressing your chronic sinusitis may help alleviate some of the dizziness. This could involve nasal corticosteroids, saline rinses, or other treatments as recommended by an ENT specialist.

4. Lifestyle Modifications: Staying hydrated, avoiding sudden movements, and managing stress can help mitigate dizziness. Additionally, ensuring you have regular meals and monitoring your blood pressure can be beneficial.

5. Follow-Up: Regular follow-up with your healthcare providers is crucial. If your symptoms persist or worsen, further investigations, such as imaging studies or referrals to specialists, may be warranted.

Conclusion
Dizziness can arise from a multitude of factors, and it often requires a comprehensive approach to diagnosis and treatment. Given your complex medical history, it is advisable to maintain open communication with your healthcare team, ensuring that all aspects of your health are considered in managing your symptoms. If dizziness continues to impact your quality of life, do not hesitate to seek further evaluation or a second opinion.

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