Dizziness: Insights on Treatment and Management

Q: Dizziness: Insights on Treatment and Management

Dear Inquirer： Based on your inquiry and the literal description provided, it appears that you are experiencing unstable blood pressure, along with a sensation of floating or discomfort while walking. <br>This may be attributed to long-term hypertension leading to cerebrovascular

I would like to ask about my dizziness?

Hello Doctor: Recently, during the winter, my blood pressure suddenly spiked to around 150/90, and there was even one instance where it reached 185/11X.
I often experienced palpitations, and later I noticed a sensation of lightheadedness while walking, as if the ground was swaying or like walking on a deck.
This sensation occurs whenever I walk, with varying degrees of severity, and has persisted for three months.
I subsequently consulted an otolaryngologist and a neurologist.
After examinations, the otolaryngologist prescribed Euclidan and Deanxit, while the neurologist prescribed Cerenin.
After consideration, I decided to take the medication prescribed by the neurologist, which is Cerenin 40 mg, two tablets daily.
However, being cautious, I initially took only one to one and a half tablets daily.
On the first day of taking Cerenin, I noticed that the discomfort while walking improved by 75% to 85%.
After continuing the medication for over a month, I have now increased the dosage to two tablets daily, and the discomfort has improved by about 90%.
However, I have not fully recovered; sometimes I feel normal while walking, but at other times I still experience some discomfort, especially when hiking or walking longer distances.
I read online that this condition resembles poor circulation in the brainstem, which usually occurs in the elderly, causing dizziness and lightheadedness due to long-term poor blood circulation.
So, if I indeed have poor circulation in the brainstem, Cerenin is effective, but the key point is that the discomfort has not been eradicated, which makes me anxious and depressed.
I would like to ask the doctor: 1.
I once read in Dr.
Yang Yi-Chiang's book that "Cerenin has a mild effect with few side effects, but its drawback is that the therapeutic effect is slow and gradual." Is this true? Is there a chance for me to fully recover if I continue taking the medication? 2.
I have seen many doctors advocate that medications for dizziness should be taken for at least three months or even six months.
Can I take Cerenin long-term?

Yan, 20~29 year old female. Ask Date: 2008/07/12

Dr. Chen Jianzhi reply Otolaryngology

Dear Inquirer: Based on your inquiry and the literal description provided, it appears that you are experiencing unstable blood pressure, along with a sensation of floating or discomfort while walking.
This may be attributed to long-term hypertension leading to cerebrovascular sclerosis, resulting in insufficient oxygen supply to the cerebellum, particularly worsening after walking for a period of time.
I recommend the following actions:
1.
Continue taking Cerenin; its side effects are generally minimal, and it can be taken long-term.
Patients typically require 3 to 6 months of treatment for improvement, and achieving a complete cure can be quite challenging.

2.
If you experience dizziness after exercising, it is advisable to squat down or sit for a while until the oxygen supply to the cerebellum is restored before resuming activity.

3.
Blood pressure must be well-controlled to prevent further sclerosis of the cerebral vessels.

4.
If you have issues with hyperlipidemia, it is also essential to manage your lipid levels effectively to ensure proper blood flow.

5.
Minimize exposure to stocks, politics, controversies, or other sources of unnecessary stress, and consider incorporating slow aerobic exercises such as Tai Chi to improve your body's meridian circulation and alleviate dizziness.

Sincerely,
Dr.
Chien-Chih Chen
Attending Physician, Department of Otolaryngology, Taoyuan General Hospital, Ministry of Health and Welfare
Attending Physician, Sleep Medicine Center, Taoyuan General Hospital, Ministry of Health and Welfare
Lecturer, Department of Medicine, Fu Jen Catholic University

Reply Date: 2008/07/12

More Info

Dizziness can be a perplexing and distressing symptom, and understanding its underlying causes is crucial for effective management and treatment. Based on your description, it seems you are experiencing a combination of symptoms that may be related to several factors, including blood pressure fluctuations, potential vestibular issues, and possibly even anxiety.

Firstly, your history of elevated blood pressure, particularly the spikes you mentioned, could contribute to feelings of dizziness or lightheadedness. High blood pressure can affect blood flow to the brain, leading to symptoms such as dizziness, especially during physical activity. It's important to monitor your blood pressure regularly and discuss any significant changes with your healthcare provider. Managing blood pressure through lifestyle changes, medication, or both can help alleviate some of the dizziness you are experiencing.

The sensation of walking on a "wobbly" surface, as you described, could also indicate a vestibular (inner ear) issue or a neurological condition. The medications prescribed by your ENT and neurologist, such as Cerenin (which contains the active ingredient betahistine), are often used to treat vestibular disorders and can help improve blood flow in the inner ear, thereby reducing dizziness. Your observation that the medication has significantly improved your symptoms is encouraging, but it's understandable that you are concerned about the persistence of some symptoms.

Regarding your questions:
1. Cerenin's Effectiveness and Duration of Treatment: It is true that Cerenin is considered to have a milder effect and fewer side effects compared to other medications used for dizziness. However, its therapeutic effects can take time to manifest fully, and some patients may require several weeks to months to experience the maximum benefit. Continuing the medication as prescribed is essential, and many patients find that their symptoms gradually improve over time. While complete resolution may not always be achievable, significant improvement is often possible. It is advisable to maintain open communication with your prescribing physician about your progress and any concerns you may have.

2. Long-term Use of Cerenin: Many healthcare providers recommend a trial of dizziness medications for at least three to six months, especially if the patient is experiencing ongoing symptoms. Cerenin can generally be taken long-term, but this decision should be made in consultation with your healthcare provider, who can assess your individual situation and monitor for any potential side effects or complications. Regular follow-ups are important to evaluate the effectiveness of the treatment and make any necessary adjustments.

In addition to medication, consider incorporating lifestyle modifications that may help manage your symptoms. These can include:
- Hydration: Ensure you are well-hydrated, as dehydration can exacerbate dizziness.

- Diet: A balanced diet that supports cardiovascular health can be beneficial. Reducing salt intake may help manage blood pressure.

- Physical Activity: Engage in gentle exercises, such as walking or balance training, which can improve vestibular function and overall well-being.

- Stress Management: Techniques such as mindfulness, yoga, or cognitive-behavioral therapy can help address anxiety and stress, which may contribute to your symptoms.

In conclusion, while your symptoms may be concerning, there are various avenues for treatment and management. Continue to work closely with your healthcare providers, and do not hesitate to seek a second opinion or further evaluation if you feel your concerns are not being adequately addressed. Your health and well-being are paramount, and with the right approach, you can work towards improving your quality of life.

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