Which Specialist to See for Dizziness and Nausea Issues?

If you are experiencing dizziness and nausea, you should consult a physician in the field of Internal Medicine or a specialist in Neurology?

Hello, doctor.
Since I started teaching at the age of 23, I have been experiencing dizziness and nausea.
Initially, I consulted a specialist in dizziness, and it was diagnosed as basilar-type migraine.
The doctor said it wouldn't be a serious issue, but I find this problem significantly affects my life, impacting both parenting and work.
I feel dizzy when I bend down to talk to my child, while grading papers, or using the computer.
Sometimes, I even feel nauseous and want to vomit when an episode occurs.
It can last from 3 to 5 minutes, but sometimes it can last all day, accompanied by headaches.
At its worst, I suddenly experience a blackout and cannot stand; I have to lean against something or a wall.
I have undergone multiple blood tests, and there are no signs of anemia.
I also notice that I often misread my notes; I might mispronounce the same word or phrase multiple times, which worries me about my health and clarity of speech.
This is particularly concerning for a teacher.
I have tried various forms of exercise (yoga, swimming, aerobic dance, and circular dance), but I frequently experience these issues during physical activity.
Due to safety concerns, I am hesitant to exercise outside.
My mother, who has suffered from chronic headaches, passed away suddenly last year due to intracranial hemorrhage, which makes me feel the need for proactive treatment.
Doctor, which specialty should I consult, and what tests should I undergo? My child is only 3 years old and needs a healthy mother.
Please help me with your guidance.
Thank you.

Zi, 30~39 year old female. Ask Date: 2008/02/27

Dr. Lin Zijing reply Neurology

Basilar-type migraine is a condition that commonly occurs in young women and is associated with genetics and the menstrual cycle.
It is caused by abnormal secretion of neurotransmitters leading to abnormal spasms of the basilar artery.
Patients may experience dizziness, tinnitus, and occipital headaches, with severe cases presenting symptoms similar to basilar artery ischemia, such as slurred speech, unsteady gait, and blurred vision.
This condition must be differentiated from inner ear disorders, brainstem ischemia, cerebellar lesions, and multiple sclerosis, necessitating relevant diagnostic tests.
Evaluation and treatment can be conducted in a neurology outpatient clinic, where patients may be prescribed vestibular suppressants with calcium channel blocking properties.
Additionally, dietary modifications should include avoiding oranges, tomatoes, cheese, chocolate, and pizza to prevent excessive neurotransmitter production that could lead to further vasoconstriction of the basilar artery.

Reply Date: 2008/02/27

More Info

Dear Concerned Parent,
I understand that you are experiencing significant challenges with dizziness and nausea, which are understandably affecting your daily life, work, and parenting. Given your history and the complexity of your symptoms, it is crucial to approach this situation methodically to identify the underlying causes and find effective treatment options.

Based on your description, it seems you have already consulted various specialists, including family medicine, neurology, otolaryngology (ENT), and dizziness specialists. The diagnosis of basilar-type migraine is a good starting point, as migraines can indeed cause dizziness, nausea, and other neurological symptoms. However, since you are still experiencing debilitating symptoms, it may be beneficial to explore additional avenues.

1. Neurologist: Since you have a history of migraines and are experiencing dizziness, it would be prudent to revisit a neurologist. They can conduct further evaluations, including MRI or CT scans, to rule out any structural issues in the brain that could be contributing to your symptoms. Additionally, they may consider other types of migraines or vestibular disorders that could be causing your dizziness.

2. Vestibular Rehabilitation Specialist: If your dizziness is related to balance issues, a vestibular rehabilitation therapist can provide exercises and strategies to help improve your balance and reduce dizziness. This type of therapy is particularly effective for individuals with vestibular disorders.

3. Psychiatrist or Psychologist: Given the stress and anxiety that your symptoms are causing, consulting with a mental health professional may also be beneficial. Anxiety can exacerbate physical symptoms, and addressing any underlying psychological factors may help alleviate some of your physical discomfort.

4. Endocrinologist: Since you mentioned frequent dizziness and episodes of feeling faint, it may be worthwhile to consult an endocrinologist to check for any hormonal imbalances or metabolic issues that could be contributing to your symptoms.

5. Comprehensive Blood Tests: While you have had blood tests that ruled out anemia, it may be helpful to have a more comprehensive metabolic panel, including thyroid function tests, vitamin levels (such as B12 and D), and electrolyte levels. These can provide insights into other potential causes of your symptoms.

6. Lifestyle Modifications: In addition to seeking medical advice, consider implementing lifestyle changes that may help manage your symptoms. Regular hydration, balanced nutrition, and adequate sleep are essential. You might also explore mindfulness practices or relaxation techniques to help manage stress and anxiety.

7. Monitor Symptoms: Keep a detailed diary of your symptoms, noting when they occur, their duration, and any potential triggers. This information can be invaluable for your healthcare providers in diagnosing and treating your condition.

It is essential to advocate for your health and continue seeking answers until you find a solution that works for you. Given your responsibilities as a mother, it is understandable that you want to prioritize your health for the sake of your child. Do not hesitate to reach out to healthcare providers until you find the right support.

In conclusion, I recommend revisiting a neurologist for further evaluation, considering vestibular rehabilitation, and possibly consulting with an endocrinologist or mental health professional. Your health is paramount, and with the right approach, you can find relief from these distressing symptoms.

Best wishes for your health and well-being.

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