Dizziness for a long time?
Hello Doctor: I started experiencing sudden dizziness (the sensation of the surroundings spinning) in June of last year (2017).
After visiting an otolaryngologist and taking medication for a week, I felt better.
However, three weeks later, I experienced dizziness again, but this time it felt more like a heavy-headed dizziness (the surroundings did not spin).
I did not take any medication and felt better after 1-2 weeks.
Then, a week later, the heavy-headed dizziness returned, and after that, I experienced continuous dizziness (dizzy every day and all day long).
Later, a specialist in dizziness prescribed me Betahistine for three months, and during that time, I did not experience dizziness.
After finishing the medication (in mid-December), I was fine until November 29 of this year (2018), when the heavy-headed dizziness started again, occasionally accompanied by slight nausea.
I first went to Mackay Memorial Hospital to see a neurologist.
He only asked if my gait was unstable (I said it was normal) and believed it was an inner ear imbalance issue.
When I asked if I needed an MRI, he said it was not necessary.
Then, I went to the otolaryngology department at Mackay, but they thought it was not an inner ear imbalance but rather a psychological issue.
I had no choice but to return to the previous doctor, who prescribed me Betahistine again for one month.
After taking one pill, the heavy-headed sensation suddenly disappeared the next day.
However, after a few days, the type of dizziness changed again, becoming occasional sudden dizziness (with a slight swaying sensation), which is more noticeable when I am active outside, while sitting on my bed at home feels more normal.
I would like to ask the doctor what this condition could be and what tests I should undergo.
Touyun yun, 30~39 year old female. Ask Date: 2018/12/31
Dr. Jiang Junyi reply Neurology
Hello: You mentioned that the effectiveness of taking Cinnarizine may need to consider the issue of unstable microcirculation in the brain.
Cinnarizine is a highly effective vasodilator that can directly promote cerebral circulation, ensuring that brain tissue receives adequate oxygen, thereby activating brain function to improve cerebrovascular sclerosis and the associated impairments.
It can also reduce cerebral vascular spasms and enhance the vasodilatory effect of carbon dioxide partial pressure in the brain's blood vessels.
I recommend that you consult a neurologist to discuss whether to check for autonomic nervous system and cardiovascular risk factors.
Wishing you good health, peace, and happiness.
Dr.
Jiang from Taoyuan Hospital cares about you.
Reply Date: 2018/12/31
More Info
Persistent dizziness can be a complex and frustrating condition, often requiring a thorough evaluation to determine its underlying causes. Based on your description, it appears that you have experienced various forms of dizziness over an extended period, including episodes of vertigo (the sensation that you or your surroundings are spinning) and a more generalized feeling of lightheadedness or imbalance.
Possible Causes of Persistent Dizziness
1. Vestibular Disorders: Given your initial symptoms of vertigo, it is possible that you have a vestibular disorder, which affects the inner ear and balance. Conditions such as Benign Paroxysmal Positional Vertigo (BPPV), vestibular neuritis, or Meniere's disease could be contributing factors.
2. Neurological Issues: Although your neurologist did not find any need for an MRI, it is essential to consider that some neurological conditions can manifest as dizziness. Migraines, for instance, can cause vestibular symptoms, and certain types of headaches can lead to dizziness.
3. Psychogenic Factors: Your experience of dizziness being attributed to psychological factors by some healthcare providers suggests that anxiety or stress could be playing a role. Dizziness can often be exacerbated by anxiety, leading to a cycle of fear and increased symptoms.
4. Medication Side Effects: You mentioned taking medication (賜腦清碇) that seemed to alleviate your symptoms temporarily. It is crucial to consider whether any medications you are taking could be contributing to your dizziness, either as a side effect or through withdrawal.
5. Other Medical Conditions: Conditions such as anemia, dehydration, or cardiovascular issues can also lead to dizziness. A thorough evaluation of your overall health, including blood tests, could help rule out these possibilities.
Recommended Diagnostic Steps
1. Comprehensive Evaluation: A detailed history and physical examination by a healthcare provider specializing in dizziness or balance disorders is essential. This may include a thorough review of your medical history, medication use, and lifestyle factors.
2. Vestibular Testing: Tests such as videonystagmography (VNG) or electronystagmography (ENG) can assess the function of your vestibular system and help identify any abnormalities.
3. Blood Tests: Routine blood tests can check for anemia, electrolyte imbalances, thyroid function, and other conditions that may contribute to dizziness.
4. Imaging Studies: If neurological issues are suspected, an MRI or CT scan may be warranted to rule out structural problems in the brain.
5. Psychological Assessment: If there is a suspicion of anxiety or other psychological factors, a referral to a mental health professional may be beneficial.
Treatment Options
1. Vestibular Rehabilitation Therapy (VRT): If a vestibular disorder is diagnosed, VRT can help improve balance and reduce dizziness through specific exercises.
2. Medications: Depending on the underlying cause, medications may be prescribed to manage symptoms or treat specific conditions.
3. Lifestyle Modifications: Staying hydrated, managing stress, and avoiding triggers (such as certain head movements or environments) can help reduce dizziness.
4. Cognitive Behavioral Therapy (CBT): If anxiety is a contributing factor, CBT can be effective in managing symptoms and improving quality of life.
Conclusion
Persistent dizziness can stem from various causes, and it is essential to approach it with a comprehensive evaluation. Collaborating with specialists in neurology, otolaryngology, and possibly psychology can provide a clearer understanding of your condition and guide you toward effective treatment options. It is crucial to communicate openly with your healthcare providers about your symptoms and any changes you experience, as this will help them tailor their approach to your specific needs.
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