Unexplained Dizziness: A Student's Journey Through Neurology

I'm experiencing dizziness of unknown origin..?

Hello Dr.
Yeh, I am a university student.
For the past month, I have been experiencing some dizziness that I initially didn't pay much attention to, but it has become uncomfortable.
The dizziness occurs intermittently, and this past week, I have also experienced headaches.
When I feel dizzy, there is a heavy sensation in the back of my head, and I feel tightness in the T-shaped area between my eyebrows and nose.
If I have a headache, it feels like a sudden sharp pain.
In January, I experienced an unexplained fainting episode that lasted only a few seconds, and due to an injury, I went to the emergency room where I had an ECG and blood tests.
After six hours of observation, the emergency physician said they couldn't determine the cause, suggesting it might be due to poor air quality.
Then in April, my dizziness began, and I thought it was a residual effect from the head injury.
I visited a neurosurgeon at Renai Hospital in Taipei.
After listening to my description, the doctor prescribed two medications: a cardiovascular drug and an anti-dizziness medication, advising me to take them for a week and return for further examination if the dizziness persisted.
After a week of taking the medication, my symptoms did not improve, so I went to the neurosurgery department at Taipei Veterans General Hospital.
After hearing my concerns, the doctor arranged for a CT scan, which showed no issues.
However, when I asked why I was still experiencing dizziness, he did not provide a detailed answer.
The doctor prescribed three medications: a pain reliever, an antipyretic, and a gastrointestinal medication, along with one that seems related to the central nervous system.

If my symptoms do not improve with the medication and I continue to feel dizzy, what should I do? Should I ignore it, or should I consider seeing a neurologist? Please advise me.
Thank you.

Xiao Guai, 20~29 year old female. Ask Date: 2001/05/04

Dr. Ye Boshou reply Neurology

There are many causes of dizziness, which can be primarily classified into central causes (such as dysfunction of the brainstem or cerebellum) and peripheral causes (such as imbalance or inflammation of the inner ear).
Another symptom to consider is unexplained brief episodes of unconsciousness lasting a few seconds, with a normal CT scan and no response to medication.
It is recommended to consult a neurologist for clinical diagnosis.

Reply Date: 2001/05/04

More Info

Understanding unexplained dizziness, especially in a young adult like yourself, can be quite complex and concerning. Your symptoms of dizziness, headaches, and the sensation of pressure in your head, combined with a previous episode of fainting, warrant a thorough evaluation. It’s important to recognize that dizziness can stem from a variety of causes, including vestibular disorders, neurological issues, cardiovascular problems, or even anxiety and stress.

Given your history of fainting and the recent onset of dizziness and headaches, it’s crucial to consider both neurological and non-neurological factors. The fact that you experienced a fainting episode in January, followed by dizziness and headaches, suggests that there may be an underlying issue that needs to be addressed. While the CT scan results were normal, which is reassuring, it does not completely rule out all potential causes of your symptoms.

1. Vestibular Disorders: These are conditions that affect the inner ear and can lead to dizziness and balance issues. Benign Paroxysmal Positional Vertigo (BPPV) is one common cause that can be triggered by changes in head position. Other vestibular disorders can also cause similar symptoms.

2. Migraines: Migraines can present with dizziness and headaches, sometimes referred to as vestibular migraines. These can occur even without the typical headache symptoms and may lead to sensations of dizziness or vertigo.

3. Anxiety and Stress: Given that you are a university student, the pressures of academic life can lead to increased anxiety, which can manifest physically as dizziness, headaches, and tension in the head and neck. The tightness you feel in the T-shaped area between your eyebrows and nose could be tension-related.

4. Cervical Issues: If you have a history of head trauma, it’s also worth considering whether there may be cervical spine issues contributing to your symptoms. Tension in the neck can lead to headaches and dizziness.

5. Cardiovascular Factors: Although your heart tests were normal, it’s still important to consider that fluctuations in blood pressure or heart rate can lead to dizziness. Orthostatic hypotension, where blood pressure drops upon standing, can also cause dizziness.

Given the complexity of your symptoms and the fact that the medications prescribed have not alleviated your condition, it would be advisable to seek a second opinion, particularly from a neurologist. A neurologist can conduct a more comprehensive evaluation, which may include additional tests such as an MRI, vestibular testing, or even a referral to an ear, nose, and throat (ENT) specialist if vestibular issues are suspected.

In the meantime, keep a symptom diary to track when your dizziness occurs, its duration, and any associated factors (like stress levels, sleep quality, or dietary changes). This information can be invaluable for your healthcare provider in determining the underlying cause of your symptoms.

Lastly, do not hesitate to advocate for your health. If you feel that your concerns are not being adequately addressed, it’s important to seek further evaluation until you find the answers you need. Your health and well-being are paramount, and persistent symptoms like yours deserve thorough investigation and care.

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