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Pressure in Head/Ears, Vertigo, Nausea, Fatigue
TigerGrad2010 posted:
I am a 23 year old female with no pre-existing health conditions outside of scoliosis which I had corrective surgery on 11 years ago.
For the past three weeks I have been having problems with extreme fatigue, dizziness, and nausea 24/7. I came extremely close to blacking out while in the shower Monday morning so I went to the ER,, where I was treated for dehydration and vertigo and sent home. I was given meclizine for the nausea and dizziness by the ER doctor which didn't seem to help at all. I rarely have full spins of the room but instead have little shifts from right to left that don't seem to have any correlation with the position of my head.. but do have a full shift of the room upon standing and lying down. The nausea was so debilitating that I had to have my GP call me in a prescription for zofran to put me at a point where I could at least get out of bed. I had to take the week off from work because I just could not function normally due to the nausea and fatigue.
Today I met with a vestibular specialist who seemed positive that I had BPPV and promptly manipulated my head to move the crystals in my ears. I felt worse after the procedure as he had made me dizzy a few times before doing the manipulation, but for some reason my vision felt more clear i.e. color was richer, lines were sharper, etc. but I was still having some dizziness. He said it should clear up within the next two days but if not he would want to do the manipulation again.
The dizziness seems to have subsided a bit but I have been having extreme pressure in my head and ears on and off for the past few days and I feel if the pressure subsided I would feel normal again which I so desperately want. The pressure usually starts in my ears and moves to the front before enveloping my entire head. It feels foggy and my head feels very heavy. I have ear pain in my right ear sporadically which is the side the dizziness originates from. I tried a sinus headache pill which didn't alleviate the pressure. I am not congested at all so I'm not sure if the pressure is at all related to the vertigo.
I have had a CT Scan, EKG, and blood work done and everything was the picture of perfect health. I want to feel normal again, PLEASE HELP!
Rod Moser, PA, PhD responded:
Although your posting was very thorough, it is not possible for me to diagnose (determine a specific cause of your symptoms) based soley on the information you have shared, let alone treat you without the ability to take a thorough medical history and examine you first hand. Obviously, this is not something we can accomplish over the Internet. There can be HUNDREDS of different causes, and it may take even more tests to narrow them down.

Based on what you have shared, you do need to see a neurologist (or ENT) for a higher-level examination.

Here is some BPPV information you may find helpful:

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. The patient usually has episodes of recurring vertigo lasting several minutes or as brief as 15 seconds. Specific movements of the head often provoke the attack, usually following a brief delay of several seconds. People quickly realize the specific head motion or motions, which tends to trigger an attack. Hearing loss and tinnitus (ringing in the ears) are not associated with BPPV.

The sensation of vertigo most often arises from the semicircular canals of the labyrinth. Under normal conditions, the position and linear movement of the head is detected by the semicircular canals. This will cause tiny "hair cells" in the canal to transmit impulses to the brain to help us stay upright. Calcium carbonate crystals or otoliths that are usually embedded in the membrane may occasionally float freely within the fluid in these canals. When these free-floating crystals migrate into the back part of the semicircular canal it may cause a person to sense movement when there is none.

The Epley positional maneuver has been designed to remove this "crystal debris" from the back of the semicircular canal in cases of BPPV. This works in most people, although the symptoms of BPPV can come back.
TigerGrad2010 replied to Rod Moser, PA, PhD's response:
Thank you so much for all of your helpful information!! I had the Epley positional maneuver done today and have not really noticed a large difference in my symptoms.Is there a time period that I should know whether the maneuver was a success? Do you think the ear/head pressure is unrelated to the BPPV? Should the Epley maneuver not be successful for me, do you think the issues will resolve themselves eventually or should I go ahead and try to get in with a neuro-otologists?
I apologize for all the questions but I am just at a loss for what could be going on and I cannot continue to take days off of work because I can barely function!
Rod Moser, PA, PhD replied to TigerGrad2010's response:
Were you diagnosed based solely on your clinical symptoms, or did you have a thorough diagnostic work-up, including imaging studies? The Epley would only help for BPPV, and yes, it may need to be repeated over and over again to work....again, assuming that your diagnosis is correct.

There is nothing wrong with getting an appointment with a neuro or neurotologist. Since this can take time to get the ball rolling, you can always cancel the appointment if you are 100% better. Sometimes, even after exhaustive diagnostic tests, the underlying cause is not found. BPPV is probably the most common cause, but the fact you are feeling head pressure and congestion (not typical BPPV symptoms), your medical provider should at least consider other possible causes, or the possibility that you have more than one disease process or condition going on at the same time.

I know you are very concerned, so having that second opinion is probably a good idea.