Brief Answer:
You may need to see an ENT specialist & vestibular rehabilitation therapist

Detailed Answer:
Hi there,

It sounds like you have had an extensive work up since you have gotten to the point of seeing a neurologist. Dizziness is always a difficult symptom to ascertain. It is important to distinguish between vertigo, presyncope (feels like you are going to black out; vision and hearing may become obscured), disequilibrium (off balance), and light-headedness (vague, inconsistent symptoms, no rotational component). Vertigo is the sensation of movement ("room spinning") when no movement is actually occurring; results from peripheral or central causes or may be induced by medications/anxiety disorders. Dizziness is a symptom of a neurological disorder which can be caused by dysfunction of the inner ear all the way to the brain and brain stem. Vertigo accounts for about 50% of cases of dizziness; >90% of these patients are diagnosed with peripheral causes such as benign paroxysmal positional vertigo, inflammation of the ear, shingles, Meniere disease, otosclerosis, lymphatic fistula. Elderly patients with risk factors for cerebrovascular disease are more likely to experience central causes such as cerebellar tumor, stokes/TIAs, migraine, multiple sclerosis. Occasionally dizziness is caused by cervical or psychological disorders. Therefore, almost anything can cause dizziness, and you should have already had an extensive work up.

Most people with dizziness will also endorse headaches just like you have. Therefore, you need to treat your migraines and headaches promptly, and more importantly, prophylactically. Your PCP and or neurogist can give you medications to help with treat them effectively and efficiently. If you are on any medications that can cause ototoxic dysfunction, you should get them switched. You doctor can give you a list, or you can find a list on the internet. You also need a full ear exam, probably by an Ear, Nose, Throat (ENT) doctor. You need an MRI with and without contrast, as well as a CT scan with contrast of the head, neck, and arteries. You should also get a full cardiac work up, in addition to routine screening blood work with thyroid panel, electrolyte panel, metabolic panel, endocrine panel, vitamins. You should also have an inflammatory work up including rheumatoid arthritis, lupus, psoriasis, and blood work looking for inflammatory markers. If you have had these, and it has all been negative, you might benefit from a lumbar puncture. You can try to increase your fluid intake, and decrease your salt intake. You can also discuss with your doctor about a steroid trial. You may want to see a vestibular rehabilitation therapist who will be an expert at inner ear issues. Physical therapy might also give you benefit. You can try eliminating coffee and caffeine from your diet.

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