Persistent Dizziness for Two Months: Seeking Answers and Solutions

I have been experiencing dizziness for almost two months?

Hello doctor, for the past month and a half, I have been experiencing a constant feeling of dizziness.
It's not the spinning type of dizziness, but rather a dull, pressure-like sensation in the back of my head that lasts all day, and lying down helps alleviate it.
The dizziness is accompanied by a tight feeling in my neck, which is really uncomfortable.
For the past two months, I have been unable to do much because of this discomfort in my head.
I have already seen a neurologist and undergone brainstem auditory evoked potential testing, which showed no issues.
However, I am still feeling dizzy.
Recently, I've also experienced occasional vague pain in certain areas of the back of my head, which is seriously affecting my daily life.
I have even taken a leave of absence from school to try to find the cause.
Should I undergo any additional tests? I am really worried that there might be something wrong in my brain.
Thank you, doctor.

yuyu, 20~29 year old female. Ask Date: 2016/10/23

Dr. Zheng Jueyi reply Otolaryngology

Hello, the symptoms appear less likely to be caused by peripheral issues related to dizziness.
It is still recommended to visit the neurology department at the hospital for further examination and treatment.
Wishing you safety and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the ENT Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2016/10/23

More Info

Persistent dizziness can be a frustrating and debilitating condition, especially when it affects your daily life and activities. Based on your description, it seems that you have been experiencing a sensation of dizziness for over two months, characterized by a feeling of pressure or fullness in the back of your head, along with neck tightness. The fact that lying down provides some relief is an important detail that can help guide further evaluation.

Given that you have already undergone an auditory brainstem response test with normal results, it is reassuring that there are no immediate signs of neurological compromise. However, persistent dizziness warrants a thorough investigation to rule out various potential causes. Here are some considerations and recommendations based on your symptoms:
1. Possible Causes of Dizziness: Dizziness can arise from a multitude of sources, including vestibular disorders, cervical spine issues, migraines, anxiety, or even systemic conditions such as anemia or thyroid dysfunction. The sensation of pressure in the back of your head may suggest a cervical spine issue, particularly if you have any history of neck strain or injury.

2. Cervical Spine Evaluation: Given the associated neck tightness, it may be beneficial to have imaging studies of your cervical spine, such as an MRI or CT scan, to assess for any structural abnormalities, such as herniated discs or cervical spondylosis, which could be contributing to your symptoms.

3. Vestibular Assessment: If not already performed, a comprehensive vestibular evaluation may be warranted. This can include tests for benign paroxysmal positional vertigo (BPPV), vestibular neuritis, or other inner ear disorders that can lead to dizziness.

4. Migraine-Related Dizziness: If you have a history of migraines, it is possible that you are experiencing vestibular migraines, which can cause dizziness without the typical headache. Discussing this possibility with your healthcare provider may lead to appropriate treatment options.

5. Blood Tests: It may be worthwhile to check for common systemic causes of dizziness, such as anemia, electrolyte imbalances, or thyroid dysfunction. A complete blood count (CBC), thyroid function tests, and metabolic panel can provide valuable information.

6. Neurological Consultation: If your symptoms persist despite initial evaluations, a follow-up with a neurologist may be necessary. They may recommend further imaging studies, such as an MRI of the brain, to rule out any intracranial pathology, especially if you have concerns about potential lesions or tumors.

7. Lifestyle Modifications: In the meantime, consider lifestyle modifications that may help alleviate your symptoms. Staying hydrated, managing stress, and avoiding sudden head movements can be beneficial. Physical therapy focusing on vestibular rehabilitation may also provide relief.

8. Follow-Up: It is crucial to maintain open communication with your healthcare provider regarding your symptoms and any changes you experience. If your dizziness worsens or new symptoms arise, seek immediate medical attention.

In conclusion, while your initial tests have not indicated any serious issues, persistent dizziness should not be ignored. A comprehensive approach that includes further evaluation of your cervical spine, vestibular function, and potential systemic causes is essential. Working closely with your healthcare team will help identify the underlying cause and guide you toward effective treatment options. Remember, you are not alone in this, and there are pathways to find relief and regain your quality of life.

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