Chronic Dizziness: Causes and Solutions for Relief

Dizziness with an unknown cause?

Hello, doctor.
I have been struggling with dizziness for a long time and would like your help in finding the cause.
The first time I experienced dizziness was about 10 years ago while studying abroad.
During these episodes, the world would spin around me, and I felt dizzy whether I was standing or lying down.
As long as I was awake, I felt dizzy, which made it difficult to walk steadily, and it became so severe that I would vomit whenever I tried to eat.
Eventually, I became afraid to eat and could only manage to drink water.
This condition lasted for nearly 3 to 5 days before it began to ease, and after that, I experienced similar episodes one or two times a year.
About 4 or 5 years ago, without any changes to my routine, I suddenly started feeling dizzy again, but it was not as severe as before.
As long as I had enough energy, I could still walk steadily and eat, but it took about a week for the dizziness to subside.
The frequency increased from one or two times a year to three or four times a year.
When I returned to Taiwan, I happened to have an episode, but this time it was different because I also experienced weakness and tremors in my arms.
I felt dizzy when looking up or down.
I consulted two psychiatrists; the first one said I was iron deficient and prescribed iron supplements (which coincided with the late phase of my menstrual cycle).
However, I felt no improvement, so I went to another hospital where they said I was not iron deficient and conducted tests, but everything came back normal.
They could only prescribe medication for me to try.
The first medication had no effect, and during my follow-up, they prescribed a different medication.
I noticed that the new prescription included B12, which seemed to have some effect, so I have been regularly buying B12 from the pharmacy and taking it daily.
Recently, I have noticed occasional tinnitus, sometimes in my left ear, sometimes in my right, or both at the same time.
During dizziness episodes, I feel a lump in the upper right part of my neck, but it disappears when I am not dizzy.
If I suddenly lie flat while exercising, I feel dizzy, so I tie my hair back to cushion against dizziness.
I also feel dizzy when lying down to sleep, but it resolves after a few seconds.
This situation has persisted until now.
Therefore, I would like to ask for your help in determining what I can do to improve this condition, as it has been a long-standing concern for me.
Thank you.

Jin, 30~39 year old female. Ask Date: 2020/09/01

Dr. Jiang Junyi reply Neurology

Based on your description, it is important to first consider Meniere's disease, as patients may experience recurrent episodes of vertigo accompanied by tinnitus or hearing loss.
During these episodes, resting and using antihistamine anti-vertigo medications along with anxiolytics can be very effective in alleviating symptoms.
As for position-related vertigo, it may be benign paroxysmal positional vertigo (BPPV), which often occurs when turning the head, tilting the head back, or rising from a lying position.
This condition is caused by otoliths dislodging into the posterior semicircular canal.
Lastly, regarding vitamin B12 supplementation, it is advisable to have a blood test at a hospital to check for any deficiencies.
I recommend discussing further evaluation and treatment with a neurologist or an otolaryngologist.
Wishing you good health and peace.
Dr.
Jiang from Taoyuan Hospital cares about you.

Reply Date: 2020/09/01

More Info

Chronic dizziness can be a complex and multifaceted issue, often requiring a thorough evaluation to determine its underlying causes and appropriate treatment options. Based on your description, it appears that you have been experiencing episodes of dizziness for over a decade, with symptoms that have evolved over time. This chronic condition can significantly impact your quality of life, and it is essential to explore potential causes and solutions.

Possible Causes of Chronic Dizziness
1. Vestibular Disorders: Conditions affecting the inner ear, such as Benign Paroxysmal Positional Vertigo (BPPV), Meniere's disease, or vestibular neuritis, can lead to episodes of dizziness and balance issues. These disorders can cause sensations of spinning or lightheadedness, particularly when changing positions.

2. Neurological Issues: Dizziness can also be a symptom of neurological conditions, including migraines (vestibular migraines), multiple sclerosis, or even transient ischemic attacks (TIAs). The presence of arm weakness and tremors during your episodes may warrant further neurological evaluation.

3. Anemia and Nutritional Deficiencies: You mentioned being treated for iron deficiency anemia in the past. Anemia can lead to dizziness due to insufficient oxygen delivery to the brain. Additionally, deficiencies in vitamins such as B12 can also contribute to neurological symptoms, including dizziness and weakness.

4. Medication Side Effects: If you are taking medications for other conditions, it is essential to consider whether any of these could be contributing to your dizziness. Some medications can have side effects that affect balance and coordination.

5. Psychological Factors: Anxiety and stress can manifest physically, leading to symptoms such as dizziness. It is crucial to consider whether psychological factors may be exacerbating your condition.

6. Cervical Issues: The mention of neck discomfort and the sensation of a lump in the neck during dizziness episodes may indicate cervical spine issues, such as cervical spondylosis or muscle tension, which can affect blood flow and nerve function.

Recommended Steps for Relief
1. Comprehensive Evaluation: It is vital to undergo a thorough evaluation by a healthcare professional, ideally a neurologist or an ear, nose, and throat (ENT) specialist. They may recommend imaging studies, such as an MRI or CT scan, to rule out any structural abnormalities.

2. Vestibular Rehabilitation Therapy (VRT): If a vestibular disorder is diagnosed, VRT can help improve balance and reduce dizziness through specific exercises designed to retrain the brain's response to balance signals.

3. Nutritional Assessment: Since you have experienced symptoms related to nutritional deficiencies, a dietitian can help assess your diet and recommend appropriate supplements or dietary changes to address any deficiencies.

4. Medication Review: Discuss with your physician any medications you are currently taking to evaluate their potential side effects and consider alternatives if necessary.

5. Stress Management Techniques: Incorporating stress-reduction techniques such as mindfulness, yoga, or cognitive-behavioral therapy (CBT) may help alleviate symptoms if anxiety is a contributing factor.

6. Follow-Up: Regular follow-up appointments with your healthcare provider are essential to monitor your symptoms and adjust treatment plans as necessary.

Conclusion
Chronic dizziness can stem from various causes, and addressing it often requires a multidisciplinary approach. By working closely with healthcare professionals, you can identify the underlying issues contributing to your symptoms and develop a tailored treatment plan. It is crucial to remain proactive in seeking help and advocating for your health, as managing chronic dizziness can significantly improve your quality of life.

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