Dizziness: Causes, Symptoms, and When to Seek Help

Q: Dizziness: Causes, Symptoms, and When to Seek Help

Common causes of dizziness： 1. Issues with the vestibular system (often characterized by a spinning sensation), such as benign paroxysmal positional vertigo, Meniere's disease, and vestibular neuritis. 2. Central nervous system problems (often accompanied by f

Dizziness

Over a year ago, I had high blood pressure readings above 150 at the hospital, and a cardiologist prescribed antihypertensive medication for me, which I took for nearly six months.
About a year ago, during a class, I suddenly experienced a blackout and felt dizzy when I turned my head.
I was afraid to move my neck because any slight movement felt like being hit by a ball, causing me to lose consciousness instantly.
This happened four times within three months, and I experienced daily dizziness.
I consulted a neurologist, who found no issues, and an ENT specialist also conducted tests with no findings.
They advised me to monitor my blood pressure daily at home for a month, which ranged from 120 to 140 (they said my blood pressure was fine).
They concluded that my symptoms were likely due to the side effects of the antihypertensive medication I was taking irregularly, so I stopped the medication.
After that, I really did not experience dizziness anymore, but I still feel dizzy every day, as if I might faint at any moment.
Sometimes I have severe pressure in my head, stiffness in the back of my neck, and my vision becomes blurry (with tightness around my eyes), which causes me significant anxiety as I constantly worry about experiencing dizziness again! I don't know how to seek medical advice now.
Could the doctor please provide some suggestions? Thank you.

Xiao Fu, 20~29 year old female. Ask Date: 2008/03/27

Dr. Lin Zijing reply Neurology

Common causes of dizziness:
1.
Issues with the vestibular system (often characterized by a spinning sensation), such as benign paroxysmal positional vertigo, Meniere's disease, and vestibular neuritis.

2.
Central nervous system problems (often accompanied by focal neurological deficits), such as vertebrobasilar insufficiency, brainstem or cerebellar strokes.

3.
Systemic diseases (characterized by feelings of heaviness in the head, darkness, etc.), such as side effects or toxicity from medications, hypertension or hypotension, anemia, arrhythmias, hypoglycemia, anxiety and insomnia, and alcohol consumption.

Your current symptoms seem different from your previous vertigo (spinning sensation) and do not involve a feeling of darkness (possibly indicating hypotension).
I recommend testing your ability to walk in a straight line; if you encounter issues, you may seek assistance from a neurology clinic.

Symptoms such as a feeling of pressure in the head, neck stiffness, and blurred vision (tightness around the eyes) may be caused by muscle tension in the head and neck area.
It is advisable to perform appropriate stretching exercises and avoid poor posture or maintaining the same position for extended periods.
Thank you.

Reply Date: 2008/03/27

More Info

Dizziness can be a perplexing and distressing symptom, often leading to significant anxiety and concern about one's health. Given your history of high blood pressure and the episodes of dizziness you've experienced, it's essential to approach this issue methodically to identify the underlying causes and determine the appropriate treatment.

Understanding Dizziness
Dizziness can manifest in various forms, including lightheadedness, a sensation of spinning (vertigo), or a feeling of being off-balance. The causes of dizziness are numerous and can range from benign to serious. Some common causes include:
1. Vestibular Disorders: Conditions affecting the inner ear, such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, or Meniere's disease, can lead to episodes of dizziness or vertigo.

2. Cardiovascular Issues: Fluctuations in blood pressure, especially orthostatic hypotension (a drop in blood pressure when standing up), can cause dizziness. Your history of high blood pressure and the medications you were taking could have contributed to this.

3. Neurological Conditions: While you mentioned that neurological evaluations did not reveal any issues, conditions such as migraines or transient ischemic attacks (TIAs) can sometimes present with dizziness.

4. Anxiety and Stress: Psychological factors can also play a significant role in dizziness. Anxiety can lead to hyperventilation, which may cause lightheadedness and a feeling of unreality.

5. Medication Side Effects: As you noted, the blood pressure medications you were taking could have contributed to your dizziness. It's crucial to ensure that any medications you take are appropriate for your condition and that you are not experiencing adverse effects.

When to Seek Help
Given your ongoing symptoms of daily dizziness, feelings of brain fog, neck stiffness, and visual disturbances, it is advisable to seek further medical evaluation. Here are some steps you can take:
1. Primary Care Physician: Start by consulting your primary care physician. They can review your medical history, perform a physical examination, and assess your current symptoms in the context of your previous high blood pressure and medication use.

2. Neurologist: If your primary care physician deems it necessary, they may refer you to a neurologist for further evaluation. A neurologist can conduct more specialized tests to rule out any neurological conditions that might be causing your symptoms.

3. Otolaryngologist (ENT): Since dizziness can often be related to inner ear issues, seeing an ENT specialist may be beneficial. They can perform tests to evaluate your vestibular system and determine if there are any underlying ear-related causes.

4. Cardiologist: If there are concerns about your cardiovascular health, especially given your history of high blood pressure, a cardiologist may provide insights into whether your heart health is contributing to your dizziness.

5. Mental Health Professional: If anxiety is a significant factor in your symptoms, consider speaking with a mental health professional. They can help you develop coping strategies and may recommend therapy or medication to manage anxiety.

Conclusion
Dizziness can significantly impact your quality of life, and it's crucial to address it comprehensively. Keep a detailed record of your symptoms, including when they occur, their duration, and any associated factors (like stress or changes in posture). This information will be invaluable to your healthcare providers as they work to determine the cause of your dizziness and develop an appropriate treatment plan. Remember, it's essential to advocate for your health and seek the help you need to find relief from your symptoms.

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