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Suggest Treatment For Constant Dizziness And Headache

Posted on Thu, 1 Oct 2015

Question: Hello, From 1 1/2 year I have been suffering with dizziness. First time I had head pressure for which I went to ENT doctor, and he prescribed Ipratropium bromide and then flucticasone propionate after few months later. After 1 month my dizziness and headaches started bad, neurologist did all possible MRI's to rule out any big issue. Had ear balance exam and hearing test. Everything was normal .. except CT Scan of sinus which said chronic sinusitis. The doctor prescribed prednisone and my dizziness is much worst. I am in 30's and takes hard to do anything with dizziness , my ears feel stufy also .. especially left year is so bad. Doc looked into the ear and said everything looks ok. But I don't have solution yet. Any help is appreciated. Thanks.

Answered by Dr. Sumit Bhatti (49 minutes later)

Brief Answer:
Rule out Migraine associated vertigo.

Detailed Answer:
Hi,

Thank you for your query.

1. Migraine associated vertigo should be ruled out. Treatment of the migraine will stop the dizziness.

2. Check if the vertigo is positional, that is if it occurs on change of position against gravity.

3. With normal hearing tests, it is unlikely to be Ménière's Disease unless you have Fluctuating hearing loss and tinnitus that worsens during the dizziness.

4. Hypothyroidism and chronic sinusitis will worsen the dizziness and may be the cause for a stuffy ear.

5. Add details of your dizziness, headaches and current medications for further treatment options.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumit Bhatti (15 minutes later)

Thanks doctor for the reply.

When I have dizziness, I am having lots of trouble to balance myself.. I feel like mostly I am walking on the moon :( .. Also along with this sometimes I get head pressure (as if something is kept on my head) .. I have dizziness almost everyday .. it aggrevates a lot when I go to park, if I do lot of bending work at home etc (which I have to do with small kids, and also with work at office). I also do have ringing in the ear .. mostly right ear and only some days during night. Currently I am just taking synthyroid, saline rinses sometimes and some ayurvedic supplements with ayurvedic nasal drops. The doctor said I do have normal haemoglobin levels but my Iron store is very low (however when I take slow Fe, I get constipated a lot).
1 more question doctor .. why is migraine ruled out here? I have never tried any migraine medications.
Also my thyroid levels are normal.

Answered by Dr. Sumit Bhatti (10 minutes later)

Brief Answer:
To rule out means to check again if it has been missed.

Detailed Answer:
Hi,

Thank you for writing back.

1. To rule out means to check again if MAV has been missed. This also means a trial with anti migraine medication.

2. With tinnitus, early Ménière's Disease is possible.

3. Cervical spine should be checked as you have a problem while bending down.

4. It is good to hear that your thyroid function is within normal limits.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumit Bhatti (41 minutes later)

Got it.

1. Are there any on the counter medications for migraine? or do I need to consult any doctor for it? Can migraines cause dizziness everyday .. sometimes without headaches as well?

2. How can Menieres disease be identified and treated?

3. My neurologist did MRI of cervical spine, MRA of cervical spine and MRI on lumbar spine as well.

Can any vitamin deficiency cause these issues?

Thanks for answering the questions.

Answered by Dr. Sumit Bhatti (8 hours later)

Brief Answer:
Discussed below:

Detailed Answer:
Hi,

Thank you for your query.

1. You should consult a Neurologist for the treatment of Migraine as the medication is different from regular painkillers. Migraines and cluster Headaches can cause dizziness everyday. Migraine variants can lead to dizziness without headaches.

2. Meniere's disease is diagnosed on the following criteria:
a. Vertigo
b. Fluctuating hearing loss
c. Tinnitus
d. Fullness in the ear
There is usually nausea and vomiting, the hearing usually worsens during an attack and the tinnitus also worsens. You should get a PTA (Pure Tone Audiogram) to document any hearing loss. Meniere's disease usually causes low frequency hearing loss initially ( Audiogram sloping to left). Meniere's disease should normally respond to a salt restricted diet, acetazolamide (diamox) and high dose betahistine (Vertin).

3. Check if any findings in the MRis was significant. Otherwise neck exercises and physiotherapy should suffice, sometimes with anti-inflammatory medication and muscle relaxants.

4. A general examination to rule out common causes of dizziness such as anemia, blood pressure and blood sugar level changes, weakness, nutritional and vitamin deficiencies should be done.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumit Bhatti (16 hours later)

Thanks so much doctor for the detail answers.

My neurologist suggested amitriptyline 10mg everyday.. but I wanted to take second opinion for it. Is that a common medication for migraine?

Thanks again.
Just wanted to mention my blood pressure top number has always been between 90-100 .. not sure if it is considered low blood pressure.

Answered by Dr. Sumit Bhatti (9 hours later)

Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for writing back.

1. Amitriptyline is one of the medications used for migraine prophylaxis. There are many other medications that can be tried out to select the best medication. These include beta blockers, ergotamine, flunaeizine, triptans.

2. Above 100 would be considered normal for systolic blood pressure, 90 would be borderline low for systolic blood pressure.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Sumit Bhatti (31 minutes later)

Thanks again doctor for being so kind in answering all the questions.

* I was very concerned about using Amitriptyline, Is it true that body will get used to it once started and I might need to continue it life long.. since I am only 30. And also is it true I need to use it for minimum of 3 months once started.

Answered by Dr. Sumit Bhatti (21 hours later)

Brief Answer:
There is no cause for worry.

Detailed Answer:
Hi,

Thank you for writing back.

1. Amitriptyline is a safe and widely used medication.

2. A two week trial is enough to see if it works.

2. You will not have to use it lifelong. Other medication should also be tried.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumit Bhatti (13 hours later)

Thank you so much doctor for all the information.

Answered by Dr. Sumit Bhatti (2 hours later)

Brief Answer:
Thank you.

Detailed Answer:
Hi,

Thank you for writing back.

Wishing you a speedy recovery,

Regards.

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar