Dizziness and Neck Pain: When to Seek Medical Advice

Dizziness and neck pain?

Hello, Dr.
Jiang.
For the past two or three days, I have occasionally experienced dizziness (a sensation of swaying or mild shaking while sitting or lying down).
I often wake up in the middle of the night, and when I do, I feel some pain near the occipital bone at the back of my head.
In the morning, after some activity at work, the pain lessens, but by the evening, it returns, and I wake up again at night with pain.
Additionally, I have a feeling of pressure and pain from the center of my forehead to the right eye socket, and there is mild congestion and pain in my right nostril.
This morning, I also woke up with a feeling of fullness in my ears and discomfort in several areas.
I would like to ask Dr.
Jiang: 1.
Should I be concerned about my brain, or is this related to the ear, nose, and throat, or possibly ophthalmology? 2.
What could these symptoms indicate? I am particularly worried about a potential brain issue.
Thank you, doctor, for taking the time to clarify my concerns.

KK, 30~39 year old female. Ask Date: 2022/05/11

Dr. Jiang Junyi reply Neurology

Dear Mr.
KK,
You mentioned experiencing a sensation of swelling and pain from the center of your forehead to the right eye socket, along with mild nasal congestion and pain on the right side, and ear fullness upon waking this morning.
It is important to first consider benign paroxysmal positional vertigo (BPPV).
The characteristic symptoms include brief episodes of dizziness related to changes in head position, such as bending over, tilting back, lying down, getting up, turning over, or suddenly turning your head.
These episodes may be accompanied by nausea, vomiting, palpitations, cold sweats, and a feeling of weakness.
I recommend that you consult an otolaryngologist (ENT specialist) to rule out any dizziness caused by eustachian tube dysfunction.
Sometimes, nasolacrimal duct obstruction can also lead to symptoms similar to yours.
Thank you for your inquiry, and feel free to discuss any related questions further!
Wishing you good health and peace,
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2022/05/11

More Info

Hello! Thank you for reaching out with your concerns regarding dizziness and neck pain. Based on the symptoms you've described, it’s important to consider a few potential causes and when to seek medical advice.

1. Understanding Your Symptoms: The dizziness you’re experiencing, particularly the sensation of swaying or shaking while sitting or lying down, can be indicative of several conditions. This could range from benign issues like vestibular disorders (which affect balance) to more serious concerns such as cervical spine issues or even neurological conditions. The pain in the occipital region (the back of your head) that worsens at night and the pressure around your eyes and nose could suggest a few possibilities, including tension headaches, sinusitis, or even migraines.

2. Potential Causes:
- Cervical Issues: Neck pain can often lead to referred pain in the head and can cause dizziness, especially if there is any nerve compression or muscle tension.

- Vestibular Disorders: Conditions affecting the inner ear can lead to dizziness and balance issues. This could include benign paroxysmal positional vertigo (BPPV), vestibular neuritis, or Meniere's disease.

- Sinusitis: Inflammation of the sinuses can cause facial pain, pressure, and can also lead to dizziness, especially if the inner ear is affected.

- Migraine: Migraines can present with a variety of symptoms, including neck pain, dizziness, and visual disturbances. The pressure you feel in your forehead and around your eyes could be related to a migraine.

- Neurological Concerns: While less common, it’s essential to rule out any serious neurological issues, especially if symptoms persist or worsen.

3. When to Seek Medical Advice: Given your symptoms, it would be prudent to consult a healthcare professional. Here are some guidelines on when to seek medical attention:
- If the dizziness is persistent and affects your daily activities.

- If you experience additional symptoms such as severe headache, vision changes, weakness, or numbness.

- If the neck pain is severe or accompanied by neurological symptoms (like tingling or weakness in the arms or legs).

- If you have a history of head trauma or if the symptoms are sudden and severe.

4. Which Specialist to See: Based on your symptoms, it may be beneficial to start with a primary care physician who can evaluate your symptoms and potentially refer you to a specialist. Depending on their findings, you might be directed to:
- An Ear, Nose, and Throat (ENT) specialist for issues related to dizziness and sinus pain.

- A Neurologist if there are concerns about neurological conditions.

- A Physical Therapist specializing in vestibular rehabilitation if balance issues are prominent.

5. Diagnostic Tests: Your doctor may recommend various tests to determine the underlying cause of your symptoms. These could include imaging studies like an MRI or CT scan to assess the brain and cervical spine, or balance tests to evaluate vestibular function.

In conclusion, while your symptoms could be related to several benign conditions, it’s crucial to monitor them closely and seek medical advice to rule out any serious issues. Early intervention can often lead to better outcomes, so don’t hesitate to reach out to a healthcare provider. Take care, and I hope you find relief soon!

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