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dizzy, headache, eye twitching
rebeccajennings posted:
I am 27 and just recently I have been experiencing sudden dizziness that happens several times a day and only last for about 10seconds at a time. For about the past 6 months I have been having eye twitching, sometimes only occuring once a week and other times occuring for several days straight. I also have headaches that are not severe but will last all day and will not dimish with Tylenol. The dizziness is the worrysome part. It has just recently started occuring within the past week. It feels like everything is tilting to the side. I am also very tired and can't focus. Ususally i'm extremely energetic. I know that is is difficult to diagnose Vertigo, but with all the other symptoms i'm not sure if that would be the case. Any advise?
Rod_Moser_PA_PhD responded:
You are correct....vertigo and dizziness may be one of the most difficult medical conditions to diagnose and treat. There can be hundreds of causes, involving nearly every body system, but commonly in the inner ear. Vertigo can also arise from the brain itself. Because you are having headaches and the eye twitching, this would be a primary place to start searching.

The mechanism of vertigo is very complex. People with vertigo will tend to use words such as spinning, tilting, swaying, or rotating. Vertigo is a hallucination or feeling of movement. The most common type of vertigo is a sensation that a person?s surroundings are spinning around them. A subjective sensation (the feeling that the patient himself is spinning) is also reported. The sensation most often arises from a part of the inner ear - the semicircular canals. Under normal conditions, the position and movements of the head are detected by tiny hair cells in the semicircular canals. Movements cause hair cells to transmit impulses to the brain. Calcium carbonate crystals or otoliths that are usually embedded in the membrane may occasionally float freely within the fluid of the semicircular canals. When free-floating crystals migrate to the far ends of the semicircular canal, these crystals cause a person to sense movement when there is none. The various tests that are performed (MRI, CT scans, ENG, etc.) are all important to help pinpoint the location of the problem. Unfortunately, a cause is often not found in many cases, so people (and their medical providers) are often left frustrated.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. The person usually describes bouts of recurring vertigo lasting several minutes or less. Episodes may be as brief as 15 seconds. Specific movements of the head often provoke the attack, usually following a brief delay of several seconds. Patients can often indicate the specific head motion or motions, which tend to trigger an attack. Nystagmus (the rapid twitching of the eyes) is often associated with the vertigo of BPPV, so this is a possibility in our case. Hearing loss and tinnitus are not associated with BPPV.

The second most common cause of vertigo is labyrinthitis. The disease is thought to be a sequel of a viral infection, like a simple cold or even the herpes virus. It is gradual in onset, reaches maximal intensity within one hour, and resolves within 24 hours. The episode is associated with nausea and vomiting. Hearing loss may or may not be seen. There is often a significant phase of dysequilibrium (balance problems) that may persist from days to months.

M?ni?re?s disease, acoustic neuromas, medication side effects, otitis media (middle ear infections), sinusitis, migraines (another possibility in your case), trauma, brainstem dysfunction, multiple sclerosis, diabetes, reactive hypoglycemia, anemia, hypovolemia (loss of blood), hypoxia (low oxygen), hyperventilation syndrome, epilepsy, heart rhythm problems and other heart disease, and various neurological disorders all can cause vertigo. There are even psychogenic causes.

Seeing a specialist that has some expertise in vertigo and balance disorders is often the best way to go. I would suggest that you see a neurologist. Many of these "vertigo" specialists are associated with large, university-based medical centers. I often recommend that patients have a consultation at this level.

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