Dizziness issues?
Hello, doctor.
Thank you very much for your previous response.
I am the person who asked question #195465.
My dizziness issue has been recurring since the second half of last year.
In February of this year, I consulted a neurologist who diagnosed me with vestibular migraine and prescribed me with Betahistine.
Since my dizziness does not occur every month, the doctor advised me to take one tablet before bed when I experience dizziness.
As my condition was stable in February and March, I did not take the medication.
However, starting from late April, close to my menstrual period, I experienced slight dizziness, but it was not severe.
After my menstrual period ended in May, my condition worsened significantly and began to affect my daily life.
I feel dizzy (not vertigo) every afternoon to evening, as if my body is swaying, and I have to exert effort to control my body (but I do not feel unstable or at risk of falling).
I also experience headaches and a feeling of pressure in my head (the headaches and dizziness do not occur simultaneously but alternate, often with a feeling of pressure in my head when I am dizzy).
Since the end of my menstrual period in May, I have been taking Betahistine daily, but my condition has not improved.
I then consulted an ENT specialist, who also believed it to be a circulation issue.
Since I do not experience true vertigo (only occasionally and very rarely), no further tests were arranged.
The ENT doctor prescribed Betahistine for me again.
I have been taking it for about three weeks now, with no noticeable improvement.
I exercise three days a week, but I now feel very uncomfortable and dizzy during workouts, which is quite distressing.
Should I return for further examination, or should I see an internist to check for anemia and thyroid issues? However, I had a thyroid test in April last year that was normal, and blood tests during an emergency visit in January this year also showed no anemia.
I have also undergone autonomic nervous system testing, which was normal.
My mood is stable and relaxed, but the persistent dizziness is truly troubling.
I would like to ask for your advice.
Additionally, I have been closely observing the weather conditions when my dizziness occurs.
Last year, in September, November, and December, and this year in January, when the weather started to get colder, my dizziness was very severe.
In April and May this year, when the weather became hot, it also worsened significantly.
I am uncertain if there is a clear relationship with the changes in weather.
Thank you for your response, and I appreciate your hard work.
Nickname, 20~29 year old female. Ask Date: 2023/06/05
Dr. Jiang Junyi reply Neurology
Hello, Miss: Vestibular migraine may be related to the pathophysiological mechanisms of migraine, such as vasoconstriction and vasodilation, neural hyperexcitability, or central nervous system dysfunction.
It is recommended that you use a medication like Naoqing for prevention during your menstrual period, starting three days before and continuing three days after.
Additionally, consider having a cup of coffee before 10:00 AM to see if your symptoms improve.
Neurologists who specialize in headache medicine are more familiar with these types of conditions, so it may be beneficial to consult one of them.
Thank you for your inquiry, and feel free to discuss further.
Wishing you good health, peace, and happiness.
Dr.
Jiang from Taoyuan Medical Center cares about you.
Reply Date: 2023/06/05
More Info
Recurrent dizziness can be a complex issue, often requiring a multidisciplinary approach for effective diagnosis and treatment. Based on your description, it seems that you have been experiencing episodes of dizziness that have been linked to your menstrual cycle and possibly to migraine-related vertigo. The symptoms you describe—feeling of body swaying, headaches, and the sensation of pressure in your head—are indeed common in migraine-associated dizziness, but they can also be influenced by other factors such as hormonal changes, stress, and even environmental conditions.
From a neurological perspective, migraine-associated vertigo (MAV) is characterized by recurrent episodes of dizziness that can occur with or without headache. It is essential to note that while medications like the one you are taking (often a form of a migraine preventive) can help, they may not work for everyone or may take time to show effectiveness. If you have been taking the medication consistently for three weeks without improvement, it may be worth discussing with your neurologist the possibility of adjusting the dosage or trying a different medication.
On the other hand, the ENT (Ear, Nose, and Throat) perspective is also crucial, especially since dizziness can sometimes stem from inner ear issues or vestibular disorders. The fact that your ENT specialist did not find any significant issues and attributed your symptoms to blood circulation suggests that they may be considering a more systemic cause. However, if your symptoms persist or worsen, it would be prudent to seek a follow-up appointment with your ENT specialist to explore further diagnostic options, such as balance tests or imaging studies, to rule out any underlying vestibular disorders.
Given your concerns about potential anemia or thyroid issues, it might also be beneficial to consult with an internist. Even though your previous tests were normal, symptoms can evolve, and it’s important to rule out any metabolic or systemic conditions that could contribute to your dizziness. Conditions such as anemia, thyroid dysfunction, or even vitamin deficiencies can manifest as dizziness and should be evaluated periodically, especially if you are experiencing recurrent symptoms.
Additionally, your observation regarding the correlation between weather changes and your dizziness is noteworthy. Some individuals are sensitive to changes in barometric pressure, which can exacerbate migraine symptoms or cause vestibular disturbances. Keeping a detailed diary of your symptoms, including the weather conditions, can provide valuable insights for your healthcare providers.
In summary, I recommend the following steps:
1. Follow-up with Neurology: Discuss the lack of improvement with your current medication and explore alternative treatments or dosages.
2. Revisit ENT: If dizziness persists, consider further vestibular testing or imaging to rule out inner ear issues.
3. Consult Internal Medicine: Given your concerns about anemia and thyroid function, a comprehensive evaluation may be warranted.
4. Symptom Diary: Continue to track your symptoms, including any correlations with your menstrual cycle, weather changes, and activities, to provide your doctors with detailed information.
5. Lifestyle Modifications: Maintain regular exercise, stay hydrated, and manage stress through relaxation techniques, as these can help mitigate symptoms.
Dizziness can be multifactorial, and a thorough evaluation is essential for effective management. Don’t hesitate to advocate for your health and seek further evaluations until you find a satisfactory explanation and treatment for your symptoms.
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