Unexplained Dizziness: Causes and Solutions

Unexplained dizziness?

Hello Doctor, I have been experiencing a pulsating sensation in the back of my head and a feeling of instability for five years.
It feels like I am walking on cotton.
I have undergone numerous tests and only found a small bone spur in my neck that does not compress any nerves or blood vessels.
My cervical spine is straight, and I have severe obstructive sleep apnea, for which I currently use a CPAP machine.
Recently, with the humid and hot weather, my dizziness has worsened.
While I do not walk off balance, I have a very unstable feeling in my head.
I would like to ask what else I can do to improve the pulsating sensation in the back of my head and the instability.
Thank you.

Alvin, 40~49 year old female. Ask Date: 2021/02/26

Dr. Jiang Junyi reply Neurology

Hello, based on your description, it may be necessary to consider cervical nerve root compression, which is often related to tightness in the cervical muscles and fascia, as well as cervical degeneration.
Symptoms may include pain at the affected site, discomfort, muscle stiffness, or neurological sensations.
Symptoms may worsen upon waking in the morning or with changes in weather, but can be alleviated with stretching activities, and they often recur.
During acute episodes, there may be localized muscle tension and spasms, along with limited mobility.
It is recommended that you perform active exercises under the guidance of a physician to strengthen the muscles surrounding the neck.
It may also be beneficial to consult with a rehabilitation specialist for further evaluation and treatment.
Wishing you good health and peace.
Dr.
Jiang Junyi from Taoyuan Medical Center cares about you.

Reply Date: 2021/02/26

More Info

Understanding unexplained dizziness can be quite complex, as it can stem from a variety of causes, ranging from benign to more serious conditions. In your case, you have been experiencing persistent symptoms for five years, including a sensation of your head "jumping," a feeling of instability, and difficulty walking, which you describe as feeling like you are "walking on cotton." Additionally, you have a history of cervical spine issues and severe obstructive sleep apnea, for which you are using a CPAP machine.
Firstly, it is essential to recognize that dizziness can be multifactorial. Given your symptoms and medical history, several potential causes could be contributing to your dizziness:
1. Cervical Vertigo: Although you mentioned that the small bone spurs in your neck do not compress nerves or blood vessels, they could still be contributing to your symptoms. Cervical vertigo occurs when there is a disturbance in the cervical spine that affects balance and spatial orientation. Physical therapy focusing on neck mobility and strength might help alleviate some of these symptoms.

2. Vestibular Disorders: The vestibular system, which is responsible for balance, can be affected by various conditions. Benign Paroxysmal Positional Vertigo (BPPV) is one such condition that can cause dizziness and is often triggered by changes in head position. A vestibular rehabilitation therapist can perform specific maneuvers to help reposition the crystals in your inner ear, which may alleviate your symptoms.

3. Sleep Apnea: Severe obstructive sleep apnea can lead to chronic fatigue and cognitive impairment, which might manifest as dizziness or a feeling of unsteadiness. Ensuring that your CPAP therapy is effective and that you are getting quality sleep is crucial. Regular follow-ups with your sleep specialist may be necessary to optimize your treatment.

4. Dehydration and Electrolyte Imbalance: Given the recent hot and humid weather, dehydration could exacerbate your dizziness. Ensure you are drinking enough fluids and consider electrolyte-rich drinks, especially if you are sweating more than usual.

5. Medication Side Effects: If you are taking any medications, review them with your healthcare provider, as some can cause dizziness as a side effect. Adjusting the dosage or switching medications might be necessary.

6. Neurological Evaluation: Since your symptoms have persisted for several years, it may be worthwhile to undergo a thorough neurological evaluation. Conditions such as migraines, multiple sclerosis, or other neurological disorders could present with dizziness and require specific management.

7. Psychological Factors: Anxiety and stress can also manifest as physical symptoms, including dizziness. If you feel that anxiety might be contributing to your symptoms, consider discussing this with a mental health professional.

To improve your symptoms, I recommend the following steps:
- Consult with a Physical Therapist: A therapist specializing in vestibular rehabilitation can provide exercises tailored to your specific needs, which may help improve balance and reduce dizziness.

- Regular Follow-ups: Keep regular appointments with your primary care physician, neurologist, and sleep specialist to monitor your conditions and adjust treatments as necessary.

- Lifestyle Modifications: Maintain a healthy diet, stay hydrated, and engage in regular, gentle exercise to improve overall health and potentially alleviate some dizziness.

- Monitor Symptoms: Keep a diary of your symptoms, noting when they occur, their intensity, and any potential triggers. This information can be valuable for your healthcare providers in determining the best course of action.

In conclusion, while unexplained dizziness can be frustrating and debilitating, a comprehensive approach involving multiple healthcare professionals can help identify the underlying causes and develop an effective management plan. Always consult with your healthcare provider before making any changes to your treatment or lifestyle.

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