Persistent Dizziness: When to See a Neurologist or Psychologist

Q: Persistent Dizziness: When to See a Neurologist or Psychologist

Hello, Miss：<br>You mentioned, "No anemia, no low blood pressure, yet feeling dizzy all day?" Given the recent hot weather, it may be important to consider heat-related illnesses. <br>The primary cause is the dilation of skin microvessels in high-temperature outdoor environments,

1. No anemia, no low blood pressure, yet feeling dizzy all day?

I just finished seeing the doctor, who recommended that I undergo a self-paid scan.
Without the scan, I won't know anything.
So far, I've seen a neurologist twice for issues related to migraines, insomnia, and frequent dizziness and headaches.
However, the last doctor suggested that if things don't improve, I should consider seeing a psychiatrist.
I haven't done that yet and I don't understand why the first issue is related to mental health.
I also have a long cervical spine, but the doctor said that my dizziness is not related to it.
I was tested for anemia, but the results were negative.
My blood pressure is slightly low but not critically low.
Recently, my dizziness has worsened, and I suspect it might be related to the hot weather, but it still occurs in air-conditioned rooms.
I'm unsure what could be causing it.
Regarding my insomnia, I've been sleeping with family members lately, and I often wake up in the middle of the night when the air conditioning is turned off.
I start to feel hot at around 29 degrees Celsius, which isn't extremely hot, but it makes me dizzy, and I can't sleep, feeling restless and extremely tired.
There was one instance when I forgot to turn on the air conditioning at night (around 30 degrees), and I kept waking up throughout the night, in a half-asleep state.
The next morning, during my final exam, I couldn't think clearly and almost submitted a blank paper.
I want to know if it's normal for temperature to have such a significant impact on sleep, or if there might be an underlying issue with me.
Interestingly, I find that even when I stay up all night, my mental state isn't as bad as when I sleep poorly; it feels worse to have poor sleep than to not sleep at all.

Touyun yun, 20~29 year old female. Ask Date: 2024/07/22

Dr. Jiang Junyi reply Neurology

Hello, Miss:
You mentioned, "No anemia, no low blood pressure, yet feeling dizzy all day?" Given the recent hot weather, it may be important to consider heat-related illnesses.
The primary cause is the dilation of skin microvessels in high-temperature outdoor environments, leading to blood pooling in the lower body, which reduces blood flow to the brain and results in symptoms such as dizziness and weakness in the limbs.
Typically, resting in a cool place and replenishing vitamins, fluids, and electrolytes can help alleviate these symptoms.

I wonder if you have been supplementing with electrolytes? Low sodium levels can also cause similar symptoms.
Mild hyponatremia might not be noticeable or may only present as nausea and general weakness.
However, persistent sodium deficiency can lead to headaches and lethargy.
I recommend developing a habit of adequately hydrating and replenishing electrolytes.
Also, pay attention to whether your urination has decreased or if the color has darkened.
Additionally, dizziness can be evaluated through blood tests.
Blood tests can help identify possible underlying conditions such as hyperthyroidism or hypothyroidism, diabetes, recurrent vestibular neuritis, autoimmune diseases, neurosyphilis, and central nervous system disorders.
Autonomic nervous system dysfunction can also lead to symptoms like palpitations and dizziness.

There are many physical symptoms associated with this, such as chest tightness, difficulty breathing, palpitations, gastrointestinal discomfort, and gastroesophageal reflux, which may also be linked to anxiety, mood disturbances, and insomnia related to autonomic nervous system function.
Thank you for your inquiry.
If you have further questions, feel free to discuss them! Wishing you good health, peace, and joy.
Dr.
Jiang Junyi, Hualien Hospital/Taoyuan Hospital

Reply Date: 2024/07/22

More Info

Understanding persistent dizziness can be quite complex, especially when it intertwines with neurological and psychological factors. Your situation involves multiple symptoms, including migraines, insomnia, and frequent dizziness, which can complicate the diagnostic process. Here’s a comprehensive overview of when to consider seeing a neurologist or a psychologist, and how these specialists can help.

Neurological Considerations
Given your history of migraines and dizziness, it’s essential to evaluate these symptoms from a neurological perspective. Migraines can often cause dizziness or vertigo, and they may be accompanied by other symptoms such as nausea or sensitivity to light and sound. The fact that you’ve already consulted with neurologists is a positive step, as they can rule out serious conditions like vestibular disorders, multiple sclerosis, or other neurological issues that could be causing your symptoms.

The recommendation for imaging (like an MRI or CT scan) is typically made to exclude any structural abnormalities in the brain or cervical spine that could be contributing to your symptoms. Even though you have a history of cervical spine issues, the neurologist’s assertion that your dizziness is unrelated to your cervical spine condition is worth considering, as dizziness can stem from various sources, including inner ear problems, neurological conditions, or even systemic issues like anemia or low blood pressure.

Psychological Considerations
On the other hand, the suggestion to see a psychologist or psychiatrist may stem from the understanding that psychological factors can significantly influence physical symptoms. Anxiety and stress can manifest as dizziness, especially in situations where you feel overwhelmed or when your body is under stress, such as during temperature changes or sleep disturbances.
Your description of insomnia and how temperature affects your sleep is particularly relevant. Sleep disturbances can exacerbate anxiety and lead to a cycle of poor sleep and increased daytime fatigue, which can further contribute to feelings of dizziness or lightheadedness. If your insomnia is related to anxiety about your health or other stressors, a mental health professional can provide strategies to manage these feelings, potentially alleviating some of the dizziness you experience.

Temperature and Sleep
Regarding your concerns about temperature affecting your sleep, it is indeed normal for environmental factors to influence sleep quality. The ideal sleeping temperature for most people is typically between 60 to 67 degrees Fahrenheit (15 to 19 degrees Celsius). If your sleeping environment is too warm, it can disrupt your sleep cycle, leading to frequent awakenings and difficulty falling back asleep. This can result in a cumulative effect of sleep deprivation, which can exacerbate feelings of dizziness and fatigue during the day.

Recommendations
1. Follow-Up with Neurologist: If your dizziness persists or worsens, it may be beneficial to follow up with your neurologist for further evaluation. Discuss the possibility of imaging studies to rule out any underlying neurological conditions.

2. Consult a Psychologist: Given the potential psychological components of your symptoms, consider consulting a psychologist. Cognitive-behavioral therapy (CBT) can be particularly effective for managing anxiety and insomnia.

3. Sleep Hygiene: Focus on improving your sleep environment. Ensure your room is cool, dark, and quiet. Consider using a fan or air conditioning to maintain a comfortable temperature throughout the night.

4. Monitor Symptoms: Keep a diary of your symptoms, noting when they occur, their severity, and any potential triggers (like temperature changes or stressful events). This information can be invaluable for both your neurologist and psychologist in understanding your condition.

5. Lifestyle Adjustments: Regular exercise, a balanced diet, and hydration can also help manage dizziness and improve overall well-being. Avoiding caffeine and alcohol, especially close to bedtime, may also improve your sleep quality.

In conclusion, persistent dizziness can arise from a combination of neurological and psychological factors. A multidisciplinary approach involving both a neurologist and a psychologist may provide the best pathway to understanding and managing your symptoms effectively.

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