Persistent Dizziness: When to Seek Neurological Help

What is the problem?

Hello, Doctor Gao.
I have been experiencing dizziness for almost a month now.
The symptom is that my forehead feels very hot, as if I have a fever, even when I sleep.
However, I do not have a fever.
I feel lethargic every day.
My blood pressure is normal, and I do not have nausea or loss of appetite.
Could you please advise me on what might be the issue? Do I need to undergo any examinations? Which specialty should I consult? Thank you.

wu, 30~39 year old female. Ask Date: 2016/03/04

Dr. Gao Chunde reply Neurology

Sometimes, insufficient sleep or chronic stress and fatigue can lead to muscle tension in the head and neck, resulting in similar symptoms.
However, when seeking medical attention, the physician will conduct a thorough evaluation to determine if there are other causes unrelated to stress or sleep issues, and may arrange for further examinations if necessary.
Patients can initially consult either a family medicine physician or a neurologist.

Reply Date: 2016/03/04

More Info

Persistent dizziness can be a perplexing and distressing symptom, especially when it lasts for an extended period, as you have described. Given your symptoms of a warm sensation in your forehead, a general feeling of heaviness, and the absence of fever, nausea, or appetite loss, it is essential to consider several potential underlying causes.
Dizziness can arise from various sources, including vestibular disorders, neurological issues, cardiovascular problems, or even psychological factors. In your case, the sensation of warmth in the forehead, combined with persistent dizziness, may suggest a few possibilities:
1. Vestibular Disorders: Conditions affecting the inner ear, such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, or Meniere's disease, can lead to dizziness. These conditions often present with spinning sensations, balance issues, and sometimes associated symptoms like tinnitus or hearing changes.

2. Neurological Conditions: Given the duration of your symptoms, it is prudent to consider neurological causes. Conditions such as migraines (which can present with dizziness and warmth), multiple sclerosis, or even transient ischemic attacks (TIAs) could be potential culprits. The sensation of heat in the forehead could also be related to migraine activity.

3. Cardiovascular Issues: Although your blood pressure is normal, other cardiovascular issues, such as orthostatic hypotension (a drop in blood pressure when standing up), could lead to dizziness. It might be worthwhile to monitor your blood pressure in different positions (lying down, sitting, and standing).

4. Psychological Factors: Anxiety and stress can manifest physically, leading to symptoms such as dizziness and a sensation of warmth. If you have been under significant stress, this could be a contributing factor.

5. Other Medical Conditions: Conditions such as thyroid disorders, anemia, or even dehydration can lead to dizziness. A thorough evaluation of your overall health, including blood tests, may be necessary to rule out these conditions.

Given the complexity of your symptoms and their persistence, it is advisable to seek medical attention. The first step would be to consult a primary care physician or a neurologist. They can perform a comprehensive evaluation, which may include a physical examination, neurological assessment, and possibly imaging studies (like an MRI or CT scan) or vestibular testing to determine the underlying cause of your dizziness.

In summary, while dizziness can stem from various sources, the duration and nature of your symptoms warrant a thorough investigation. Seeking help from a healthcare professional, particularly a neurologist, would be a prudent step to ensure that any serious underlying conditions are identified and managed appropriately. Early intervention can often lead to better outcomes, so do not hesitate to seek the care you need.

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