Dizziness Starting from the Back of the Head: A Neurology Perspective

Dizziness originating from the back of the head?

I have been receiving treatment in cardiology for 2 years and 4 months.
Twenty years ago, I was treated for Meniere's disease for about a year.
During middle school, I injured my right eardrum while playing basketball, which led to a significant decrease in hearing and subsequently caused tinnitus (some doctors referred to it as "brain noise").

I occasionally experience a type of dizziness that seems to start from the back of my head.
It may occur a few times over the course of a day, one or two days every couple of months, or it might not happen for six months (like this recent episode).
It happens when I am sitting, standing, or even typing (I felt a slight dizziness while posting this).
The symptoms last less than a second, causing a brief swaying sensation either side to side or front to back, similar to feeling dizzy from lack of sleep, but it is not a spinning sensation.

Aside from some discomfort in my stomach, there is no accompanying nausea (dry heaving), no slurred speech, no facial or hand numbness, and no double vision.
I can accurately touch my fingers together and point to my nose.
The cardiology department has indicated that all necessary follow-up tests have returned normal results, and my medication is stable.
Since I do not experience spinning sensations, they do not consider referring me to an otolaryngologist.

I would like to ask Dr.
Gao, in light of my situation, what direction I should consider seeking help? Thank you for your assistance in clarifying this matter.

Mr. Zhang, 50~59 year old female. Ask Date: 2016/01/17

Dr. Gao Chunde reply Neurology

Your symptoms are experienced by many people, often occurring after periods of fatigue or busy tasks, and sometimes around the time of a cold when physical strength is diminished.
Often, examinations reveal no significant issues.
I can only explain that it may be a slight vestibular dysfunction, where the signals regarding head position and movement sent to the brain are inconsistent with the signals from the other vestibular nerve or other visual and proprioceptive inputs, leading to temporary instability.
However, the brain quickly makes judgments to select the correct signals.

Reply Date: 2016/01/17

More Info

Your symptoms of dizziness originating from the back of your head, along with your medical history, suggest a complex interplay of neurological and possibly vestibular issues. Given your previous diagnosis of Meniere's disease and the history of ear trauma, it is essential to consider several factors that could contribute to your current condition.

Firstly, the sensation of dizziness that you describe—occurring intermittently and lasting only a second or so—could be related to several potential causes. One possibility is that it may be linked to cervical spine issues. The neck is closely associated with the vestibular system, which helps maintain balance. If there are any misalignments or issues in the cervical spine, they could potentially affect the nerves that communicate with the vestibular system, leading to dizziness.

Additionally, your history of ear trauma and Meniere's disease is significant. Meniere's disease is characterized by episodes of vertigo, tinnitus, and hearing loss, and it can lead to long-term changes in how the inner ear functions. Even if you are not currently experiencing classic symptoms of Meniere's, the history suggests that your vestibular system may be more sensitive to changes or stressors, which could manifest as brief episodes of dizziness.

Your description of the dizziness not being accompanied by other neurological symptoms—such as slurred speech, facial or limb weakness, or visual disturbances—is reassuring. These symptoms would typically warrant immediate evaluation for more serious conditions, such as a stroke or transient ischemic attack (TIA). Since you have been evaluated by a cardiologist and have had normal follow-up tests, it seems less likely that your symptoms are related to a cardiovascular issue.

Given that your dizziness occurs in various positions (sitting, standing, typing), it may also be worth considering the role of postural changes or even anxiety. Sometimes, anxiety can manifest physically, leading to sensations of dizziness or lightheadedness, particularly if you are feeling stressed or fatigued.

To further investigate your symptoms, I recommend the following steps:
1. Neurological Evaluation: Since your symptoms are neurological in nature, a thorough evaluation by a neurologist is warranted. They may perform specific tests to assess your balance and coordination and may consider imaging studies if they suspect any underlying issues.

2. Vestibular Testing: If the neurologist deems it appropriate, they may refer you for vestibular testing. This can help assess how well your inner ear and brain are working together to maintain balance.

3. Cervical Spine Assessment: Given the potential link between neck issues and dizziness, a consultation with a specialist in physical medicine and rehabilitation or an orthopedic spine specialist may be beneficial. They can evaluate your cervical spine for any structural issues that might be contributing to your symptoms.

4. Lifestyle and Stress Management: Since anxiety and stress can exacerbate dizziness, consider incorporating stress management techniques such as mindfulness, yoga, or physical therapy focused on relaxation and posture.

5. Follow-Up on Ear Symptoms: If you experience any changes in hearing or tinnitus, it may be worth revisiting an ENT specialist, especially considering your history of ear issues.

In conclusion, while your symptoms may not currently indicate a severe underlying condition, a multidisciplinary approach involving neurology, vestibular assessment, and possibly cervical spine evaluation will provide a comprehensive understanding of your dizziness. This will help tailor an effective management plan to address your symptoms and improve your quality of life.

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