Hi XXXXXXX
Thanks for writing in.
I am a medical specialist with an additional degree in sub specialty of Cardiology.
I read your mail with diligence. You have this additional problem of dizziness, there has been associated lightheadedness and vomiting . Let us see what causes and you can tell us something more and we reach the diagnosis.

My intuitive diagnosis in you is migraine. Everything which you have described can occur, however there are other causes which have to be excluded though there is very little to support them. But to list those is necessary if only for exclusion.

Dizziness can be caused by problems in the brain or the inner ear, though the cause may lie outside.
1. In a patient of hypertension on treatment which you are not (though actual measurement has yet not been done, therefore remains to be excluded as cause no 1) postural hypotension is one of the commonest cause. To counter this and otherwise also you break an action into small components for example if you are lying down and you have to go outside the room, it should be four step process:
a. From lying position to sitting position in bed.
b. Please hang your legs besides the bed.
c. Now stand but not walk if you are not dizzy then
d. Walk on. This way you will avoid fall.
Management would be getting your BP measured in lying down, sitting and standing posture. A couple of normal readings will exclude this as a cause.
Meanwhile, we have to exclude another silent disease though possibility is more remote, simply considering your age.
2.Complications from diabetes can cause can lead to lowered blood flow to the brain, causing symptoms which may make one feel like things are moving around her/him or she/he is moving around the things ...these symptoms are are called Vertigo whereas dizziness is usually used to denote light headedness. In any case hypoglycemia or hyperglycemia the first neurological symptoms may be dizziness.
Management: A fasting blood sugar done after 10-12 hours after dinner would exclude this and any remote worry.

3. If you have heart flutters, what I am curious to know, how far you have been investigated for this. For to me these denote arrhythmias of heart for which your doctor should- apart from physically examining you thoroughly- may need to perform certain tests like Holter if EKG has not been sufficient to find out the nature of arrhythmia. Additional advantage of Holter is symptom correlation (in your case with dizziness and arrhythmias). That is third major cause excluded.

4. Cervical Spondylosis: When osteophytes arising from cervical press on verterbral artery, a condition called Verterbro Basillar Insufficiency is produced which can manifest as dizziness. A cervical spine x-ray or cervical spine scan is good enough to diagnose. A cervical support collar may be required as part of treatment. This could be a possibility in your case but in absence any supporting symptoms, I would say 4th important cause to be excluded.

Apart from following are the cause of Vertigo which may at some stage behave like an episode of dizziness therefore kept in mind

a). Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo and is characterized by the sensation of motion initiated by sudden head movements or moving the head in a certain direction.

b).Vertigo may also be caused by inflammation within the inner ear (labyrinthitis or vestibular neuritis), which is characterized by the sudden onset of vertigo and may be associated with hearing loss. For both, your seeing a doctor will suffice for exclusion. Personally, I do not think you have either.

c).Meniere's disease is composed of a triad of symptoms including: episodes of vertigo, ringing in the ears (tinnitis), and hearing loss. People can be asymptomatic in between episodes. Same examination will exclude this also.

d). Head trauma and neck injury may also result in vertigo, which usually goes away on its own. It may start with or end with dizzi spells. Without history of trauma I am not serious in considering this as a cause.
So, in the end we come to the diagnosis which we named before. Medical Literature - I have taken the XXXXXXX of paraphrasing it in layperson's language. But if certain point is not clear you are most welcome to write to me I will clarify:

e).Dizziness and Migraine
Precipitating Factors
Various factors have been identified as being migraine triggers, including
physical activity, Physical activity - Heavy exertion or changes in sleep pattern
can initiate migraine. I QUOTE
'Dizziness is one of the most common complaints in medicine reported more common in women. Thus, 3%-4% of the population can be expected to experience both dizziness and migraine. In reality, however, the co occurrence of symptoms is much higher than that. Specifically, vertigo, which is the sensation of perceived motion without actually moving, is reported by up to one third of people who have migraine, and general dizziness or unsteadiness is reported by up to three quarters of all patients with migraine.
Although migraine is a common cause of dizziness, it is often not correctly diagnosed until years after the patient initially seeks medical care for complaints of dizziness. The delay is due, in part, to the fact that most patients and many physicians think of migraine only in terms of headache, when it is actually an organic neurological syndrome.. Less than half of all migraine sufferers have received a diagnosis of migraine from their health care provider. Furthermore, vertigo is not usually thought to be result , so most patients who have migrainous vertigo (MV) cannot be classified using the existing criteria. Recently, diagnostic criteria have been proposed that separate definite MV from probable MV and that conceptualize MV as an episodic vestibular disorder.
Migraine is now believed to be a genetically based neurological disorder in which certain triggers start a series of events including functional changes in the trigeminal (sensory nerve supplying the face and head) nerve system and imbalances in brain chemicals, such as serotonin, that regulate pain. As a result, the trigeminal nerve releases chemicals that irritate and cause swelling of blood vessels on the surface of the brain, sending pain signals to the brainstem. MV may occur at any age and has a female preponderance. XXXXXXX

I would urge you to see your doctor so that cause can be establised thereafter treatment begins. If you have any question for me, I will be more than happy to answer the same as soon as possible. Regards.

With Best Wishes


Dr Anil Grover,
Medical Specialist & Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW

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