Dizziness: Causes, Symptoms, and Treatment Options - Neurology

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Dizziness symptoms


Hello, doctor.
I've been troubled by dizziness for a long time, and the more I think about it, the worse it gets.
My dizziness symptoms have persisted for over two months.
I've seen an ENT specialist, a traditional Chinese medicine practitioner, and a neurologist.
My symptoms usually present as a floating, heavy sensation, and sometimes I experience a pressure-like pain in my temples, though it’s not severe.
Occasionally, I also feel discomfort in my neck.
When I change positions while sleeping, it can trigger a spinning sensation.
The doctor diagnosed me with benign paroxysmal positional vertigo (BPPV) and performed a canalith repositioning maneuver.
After two weeks, the spinning sensation has improved somewhat, but I still experience some dizziness when lying down and turning my head.
My hearing test results showed some impairment, but I have had hearing issues since childhood, as I experienced BPPV back then as well.
I wonder if that could be related.
However, I still feel groggy throughout the day, so I’m considering whether there might be other causes.
I have arranged for a neurology examination tomorrow.
I would like to ask, with my constant floating sensation and occasional spinning due to head position changes, what could be the underlying issue? Is it more likely related to an ear problem or a neurological issue? By the way, a while ago, I saw a traditional Chinese medicine doctor who mentioned that I tend to be anxious and that this could easily lead to thyroid issues.
Should I get checked for that? If so, which specialty should I consult?

Jiajia, 20~29 year old female. Ask Date: 2020/02/23

Dr. Hong Weibin reply Neurology


Hello: Your condition may be peripheral vertigo, with a higher likelihood of Meniere's disease.
You may seek assistance from an otolaryngologist or a neurologist specialized in the treatment of dizziness.
Wishing you health and safety.

Reply Date: 2020/02/23

More Info


Dizziness can be a perplexing and distressing symptom, often leading to a cascade of anxiety and concern about underlying health issues. Your description of a persistent sensation of floating and heaviness, coupled with episodes of vertigo when changing head positions, suggests a complex interplay of factors that may be contributing to your symptoms.
Based on your history, it seems that you have been diagnosed with Benign Paroxysmal Positional Vertigo (BPPV), which is a common cause of vertigo resulting from dislodged calcium carbonate crystals (otoconia) in the inner ear. The fact that you underwent an Epley maneuver (a repositioning technique) and experienced some improvement is a positive sign, but it is not uncommon for symptoms to persist or recur, especially if there are other underlying issues.

Your symptoms of a floating sensation and occasional pressure-like pain in the temples could also suggest a tension-type headache or even migraine-associated vertigo, particularly if you have a history of headaches. The neck discomfort you mentioned may be contributing to your dizziness, as cervical issues can also lead to vestibular symptoms.
It's important to consider other potential causes of dizziness as well. These can include vestibular neuritis (inflammation of the vestibular nerve), Meniere's disease (characterized by episodes of vertigo, tinnitus, and hearing loss), or even central causes such as migraines or neurological disorders. Given your history of hearing loss and previous episodes of BPPV, it would be prudent to continue your evaluation with a neurologist, as you have scheduled. They can assess for any central causes of your symptoms and may recommend imaging studies if indicated.

Regarding the anxiety and potential thyroid issues mentioned by your traditional medicine practitioner, it is indeed possible for anxiety to exacerbate dizziness. Anxiety can lead to hyperventilation, which may cause lightheadedness and a sense of unreality. If you have symptoms suggestive of thyroid dysfunction (such as changes in weight, energy levels, or mood), it may be worthwhile to have your thyroid function tested. An endocrinologist would be the appropriate specialist to consult for this concern.

In summary, your dizziness could stem from a combination of vestibular issues (like BPPV), tension-type headaches, and possibly anxiety or thyroid-related concerns. It is essential to follow up with your neurologist for a comprehensive evaluation and consider consulting an endocrinologist if thyroid issues are suspected. Additionally, managing anxiety through cognitive-behavioral therapy or relaxation techniques may also help alleviate some of your symptoms.
In the meantime, maintaining a healthy lifestyle, staying hydrated, and avoiding sudden head movements can help manage your symptoms. If you experience any new or worsening symptoms, such as severe headaches, visual disturbances, or changes in consciousness, seek medical attention promptly.

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