Dizziness while walking?
Hello, doctor.
I have been experiencing episodes of dizziness intermittently over the years, but it has become more frequent in the past six months.
Two years ago, I suspected a stroke and went to a major hospital to see a neurologist, where I underwent a CT scan of the brain and a carotid ultrasound, both of which were normal.
I have also had multiple checks with a cardiologist, including ECGs and echocardiograms, all of which were normal.
My blood pressure at home is usually around the 120s to 140s, but I am not taking any antihypertensive medication.
Recently, I visited an ENT specialist, who told me that my dizziness is not the type that involves a spinning sensation, so it is not within their scope.
They prescribed me a week’s worth of anti-dizziness medication, including Dimenhydrinate, Meclizine, and Betahistine, to be taken once in the morning and once at night.
However, I only take them when I feel more dizzy.
After taking the medication, my dizziness alleviates, but it gradually returns after the medication wears off or the next day.
Since last year, I have had difficulty falling asleep and have been taking half a tablet of Anxiolytic medication before bed for over six months, which now allows me to sleep around seven to eight hours.
I feel relatively good in the morning, but my dizziness becomes more pronounced in the afternoon, especially at dusk, although it gradually improves at night, particularly just before bed when I hardly feel dizzy.
Resting in bed for a while in the afternoon helps alleviate the symptoms.
I don’t experience much dizziness when stationary, but it becomes more noticeable when I walk outside.
The dizziness feels heavy-headed, sometimes accompanied by headaches, affecting my gait and causing occasional fright, but I do not feel unbalanced, as I can perform single-leg exercises without issues.
I wonder if taking half a tablet of Anxiolytic for so long could still have strong side effects; this is just one of my speculations.
I have maintained a habit of exercising, walking about 4 to 5 kilometers almost every day.
I used to swim, but since the pandemic, I have switched to walking, typically for about 1 to 2 hours each time.
Sometimes I wonder if I might be overexerting myself, or if lack of sleep or poor sleep quality could be causing the dizziness.
Currently, aside from the Anxiolytic, I am not regularly taking any other medications.
My total cholesterol is within a safe range (around 190), with slightly elevated LDL cholesterol (around 140), but other parameters, including blood sugar, are normal.
I have a history of kyphosis, and I sometimes notice that when I practice standing straight against a wall, my breathing feels smoother, and my dizziness temporarily improves.
I wonder if this is related to my long-standing poor posture.
Given my various speculations, I have developed different associations.
Additionally, I have a history of hyperthyroidism, but recent blood tests have returned normal results.
I am 167 cm tall and weigh about 68 kg.
I would like to ask you, doctor, what direction I should take to seek treatment for this dizziness? I have already consulted cardiology, neurology, ENT, family medicine, and psychiatry, and I am truly unsure which specialty I should see next.
Ong Picton, 60~69 year old female. Ask Date: 2022/06/04
Dr. Hong Weibin reply Neurology
Hello: The majority of dizziness is caused by degenerative abnormalities of the vestibular structures in the inner ear.
If you have already undergone thorough examinations and no dangerous underlying conditions have been found, the focus should be on identifying factors that exacerbate or alleviate the dizziness, and avoiding the exacerbating factors.
Vestibular rehabilitation exercises may be beneficial for you.
Reply Date: 2022/06/04
More Info
Persistent dizziness can be a challenging symptom to manage, especially when it has been ongoing for several years and has recently intensified. Given your comprehensive medical history and the various specialists you have consulted, it’s important to take a systematic approach to identify the underlying cause of your dizziness and to determine the most appropriate treatment options.
Understanding Dizziness
Dizziness can manifest in different forms, including vertigo (the sensation of spinning), lightheadedness, and imbalance. The fact that your dizziness is not characterized by a spinning sensation suggests that it may not be related to vestibular disorders, which are often managed by otolaryngologists (ear, nose, and throat specialists). Instead, your symptoms may be more aligned with other potential causes, such as:
1. Cervical Issues: Given your history of poor posture (e.g., kyphosis), it’s possible that cervical spine issues could be contributing to your dizziness. Poor posture can lead to muscle tension and nerve compression, which may affect balance and spatial orientation.
2. Vestibular System Dysfunction: Even if you do not experience classic vertigo, dysfunction in the vestibular system can still lead to feelings of unsteadiness or imbalance. This could be due to a variety of factors, including age-related changes or previous inner ear infections.
3. Medication Side Effects: You mentioned taking medications such as Anban (a sleep aid) and other anti-dizziness medications. While these can help alleviate symptoms, they may also have side effects that could contribute to feelings of dizziness or imbalance. It’s worth discussing with your physician whether these medications are still appropriate for you.
4. Anxiety and Stress: Chronic anxiety can manifest physically, leading to symptoms such as dizziness. If you have been experiencing increased stress or anxiety, this could be a contributing factor. Cognitive behavioral therapy (CBT) or other forms of psychological support may be beneficial.
5. Sleep Quality: Sleep disturbances can significantly impact overall health and contribute to feelings of dizziness. Since you have been taking a sleep aid for an extended period, it may be worth evaluating your sleep hygiene and discussing alternative strategies for improving sleep quality.
Next Steps for Treatment
Given the multifactorial nature of your symptoms, here are some recommendations for further evaluation and management:
1. Neurology Consultation: Since you have already seen a neurologist, it may be beneficial to return for a follow-up, particularly if your symptoms have changed or worsened. They may consider additional imaging studies or tests to rule out any neurological causes.
2. Physical Therapy: A physical therapist specializing in vestibular rehabilitation can help assess your balance and provide exercises to improve stability and reduce dizziness. They can also address any musculoskeletal issues related to posture.
3. Cervical Spine Evaluation: A consultation with an orthopedic specialist or a chiropractor may help assess whether cervical spine issues are contributing to your symptoms. They can recommend appropriate interventions, such as physical therapy or adjustments.
4. Psychiatric Evaluation: If anxiety or stress is suspected to be a contributing factor, a referral to a mental health professional could be beneficial. They can provide coping strategies and therapeutic interventions to help manage anxiety.
5. Lifestyle Modifications: Continue to engage in regular physical activity, as this can improve overall health and potentially reduce dizziness. Additionally, focus on maintaining good posture and consider exercises that strengthen the core and back muscles.
6. Medication Review: Schedule a medication review with your primary care physician to evaluate the necessity and dosage of your current medications, particularly the sleep aid and any dizziness medications.
Conclusion
Persistent dizziness can be complex and may require a multidisciplinary approach to effectively manage. It’s essential to communicate openly with your healthcare providers about your symptoms, concerns, and any changes you notice. By working collaboratively, you can develop a comprehensive treatment plan that addresses the various aspects of your health and improves your quality of life. Remember, it’s important to advocate for yourself and seek further evaluations if you feel your concerns are not being adequately addressed.
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