Persistent Dizziness, Nausea, and Head Pain in Seniors

Headache, dizziness, nausea, and warm feet?

Hello Doctor, I would like to ask about my grandmother.
She often experiences dizziness, and a few days ago while cooking in the kitchen, she suddenly felt lightheaded.
Sometimes at night, she feels a tightness in her stomach and wants to vomit.
My grandmother needs to take sleeping pills to sleep, but she still doesn't sleep well.
Occasionally, her feet feel uncomfortably warm, and she suffers from severe migraines.
Additionally, her mouth often feels sore and dry, with reduced saliva production.
Dr.
Jiang, what should we do about these symptoms? She has seen a doctor, but there has been no improvement, and the episodes occur frequently.

Emma, 20~29 year old female. Ask Date: 2015/12/24

Dr. Jiang Junyi reply Neurology

Hello, based on your description, your grandmother has many symptoms.
First, we should consider Benign Paroxysmal Positional Vertigo (BPPV), characterized by brief episodes of dizziness related to changes in head position, such as bending over, tilting back, lying down, getting up, turning over, or sudden head movements.
These episodes may be accompanied by symptoms like nausea, vomiting, palpitations, cold sweats, and feelings of weakness.
The exact cause is often unknown, but it can be related to inflammation, degeneration, or displacement of otoliths in the inner ear's vestibular system due to head trauma.
When the head position changes, the movement of these otoliths within the semicircular canals can alter the neural signals from the inner ear, resulting in vertigo.
BPPV is more common in females.
As for the symptom of dry mouth, it may be due to medication effects or sympathetic nervous system activation caused by physical discomfort.
Given the numerous drug interactions and potential side effects, I recommend simplifying the medical approach by finding a trustworthy mid-sized hospital for integrated care: consult an otolaryngologist for evaluation and treatment, and consider seeing a psychiatrist or neurologist for adjustments to sleep medications, among other options.
Wishing you and your grandmother good health, peace, and happiness.
Dr.
Tao, Neurology, cares for you.

Reply Date: 2015/12/24

More Info

Understanding persistent dizziness, nausea, and head pain in seniors is crucial, especially given the complexity of symptoms and the potential underlying health issues that can affect older adults. Your grandmother's symptoms, including dizziness, nausea, headaches, and oral dryness, warrant a comprehensive evaluation to determine their root causes and appropriate management strategies.

Possible Causes of Symptoms
1. Vestibular Disorders: Dizziness in seniors can often be attributed to vestibular disorders, which affect the inner ear and balance. Conditions such as benign paroxysmal positional vertigo (BPPV) or vestibular neuritis can lead to episodes of dizziness, especially when changing positions.

2. Medication Side Effects: Given that your grandmother takes sleep medications, it's essential to consider the side effects of these drugs. Many sedatives can cause dizziness, confusion, and even exacerbate feelings of nausea. A review of her medications by a healthcare provider could help identify any potential culprits.

3. Dehydration and Nutritional Deficiencies: Seniors are at higher risk for dehydration, which can lead to dizziness and nausea. Additionally, deficiencies in essential vitamins and minerals, such as vitamin B12 or potassium, can contribute to neurological symptoms, including dizziness and headaches.

4. Cardiovascular Issues: Conditions such as orthostatic hypotension (a drop in blood pressure when standing) can cause dizziness and lightheadedness. It's important to monitor her blood pressure regularly, especially when transitioning from sitting or lying down to standing.

5. Gastrointestinal Problems: The feelings of nausea and stomach discomfort could indicate gastrointestinal issues, such as gastritis or gastroesophageal reflux disease (GERD). These conditions can also lead to a sensation of fullness or discomfort in the stomach.

6. Neurological Conditions: Persistent headaches and dizziness can sometimes be indicative of more serious neurological conditions, such as migraines or even transient ischemic attacks (TIAs). Given her age, it is crucial to rule out any significant neurological issues.

7. Dry Mouth and Oral Health: The symptoms of dry mouth and mouth sores could be related to medications, dehydration, or even autoimmune conditions like Sjögren's syndrome. This can lead to discomfort and difficulty swallowing, which may contribute to nausea.

Recommendations for Management
1. Comprehensive Medical Evaluation: It is essential for your grandmother to undergo a thorough medical evaluation, including a review of her medications, blood tests to check for deficiencies, and possibly imaging studies if neurological issues are suspected.

2. Hydration and Nutrition: Encourage her to stay well-hydrated and maintain a balanced diet rich in vitamins and minerals. If she has difficulty eating or drinking, consider consulting a dietitian.

3. Medication Review: Schedule an appointment with her healthcare provider to review her current medications. They may adjust dosages or switch to alternatives that have fewer side effects.

4. Physical Therapy: If her dizziness is related to balance issues, vestibular rehabilitation therapy may be beneficial. A physical therapist can provide exercises to improve balance and reduce dizziness.

5. Regular Monitoring: Keep track of her symptoms, including when they occur and any potential triggers. This information can be invaluable for her healthcare provider in diagnosing and managing her condition.

6. Oral Care: For her dry mouth, consider using saliva substitutes or mouth rinses designed for dry mouth relief. Regular dental check-ups are also important to address any oral health issues.

7. Sleep Hygiene: Encourage good sleep hygiene practices, such as maintaining a regular sleep schedule, creating a comfortable sleep environment, and avoiding stimulants before bedtime.

Conclusion
Your grandmother's symptoms are concerning and should not be overlooked. A multidisciplinary approach involving her primary care physician, possibly a neurologist, and other specialists will be key to identifying the underlying causes and developing an effective treatment plan. Early intervention can significantly improve her quality of life and reduce the frequency and severity of her symptoms.

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