What causes panic attacks when suffering from off balance feeling due to vertigo?
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So I had a bad bout of vertigo the other night around 2am. I woke up almost feel over but caught myself. Continued to feel dizzy after and felt better lying down. I have no other problems, blood pressure is normal so is glucose levels and blood work thyroid ok, no fever (got a physical back in september). I started feeling this off balance feeling more this past sunday while watching football. It seemed to have gotten worse because I also suffer from panic disorder and GAD. I have been homebound agoraphobic since october after a very bad panic attack while driving on the freeway. The vertigo is also worse when I'm around people as opposed to being alone at home. I take no medications for my disorders, only vitamins B-complex and Inositol (500mg twice a day). I was told my severe anxiety make the vertigo feel worse than it is. I've not fallen or passed out due to it. But it's made the last couple of days extremely hard for me. Is it BPPV? I also feel more dizzy when theres more people in this house as opposed to being alone. Could it be anxiety messing with something in my inner ear to cause this? Please help!
Posted Fri, 31 Jan 2014 in Ayurveda
Answered by Dr. Munish Sood 4 hours later
Brief Answer: Clinical Examination Detailed Answer: Dear XXXXXXX Thanks for contacting Ayurveda with your health concern and following guidelines are worth mentioning. When a person comes to my Clinic with complaint of Dizziness, I usually ask them and/or follow the following set of questionnaire and clinical examination: 1. Is giddiness associated with light headedness, nausea? 2. Is giddiness associated with any neurological sign [ make sure you consult a Neurologist to rule out any brain pathology] 3. If giddiness is not promptly controlled, I usually ask for Hemoglobin [for pallor], X-ray: Cervical spine [AP & Lateral] and cardiovascular examination [for any murmur] 4. Since to rule out BPPV [benign paroxysmal positional vertigo] have an ENT checkup [since vestibular symptoms are there] and also Ophthalmic check up for any vision problem. 5. because you had social and general anxiety [work pressure??], this reflects ‘emotional withdrawal symptoms” i.e. you have a constant fear of being judged or evaluated by and has resulted in anxious thoughts and anxious behavior. [correct me if I am wrong] 6. Avoid: excess physical –mental exertion, sun exposure, corrylium, smoking, errhine therapy, betel leaves, gruel, soup, day time sleeping, garlic, ginger, onion, spicy-heavy- junk food, mustard oil, pickles, dehydration,Caffeine,alcohol, tobacco,Artificial sweeteners and highly sweet or salty foods. .Avoid dizziness-inducing activities,like heavy exercise in hot weather, rapidly-moving rides or roller coasters,or heavy drinking. 7. Take: mint, coriander, tomato, cumin, plenty of water, vitamins and mineral supplements, XXXXXXX banana,grapes,dates 8. Lemon juice mixed with sugar in a glass of water helps release stress removing hormones from the body and bring mind at peace/rest. 9. i. Take 1 spoon black pepper powder and 5 spoons jaggery in 4 cup water and boil till 2 cups remain, filter it and drink for 1 month. ii.Take 3 teaspoons of bitter gourd with a glass of water every morning for a month. iii.Mix 4-5 dates in half glass of water and drink 2 times daily for a month. iv. XXXXXXX almond, banana, broccoli, cantaloupe, melon, carrot, cashew nut, corn, cauliflower, grapes, guava, lemon, mango, orange, pineapple, soybean, spinach have anti oxidant so take them in plenty. Do revert back with your concerns and with any health check up reports for Ayurveda line of Management. Dr. Munish Sood Consultant & Physician Naimittika Clinic
Follow-up: What causes panic attacks when suffering from off balance feeling due to vertigo? 23 minutes later
Yes thank you for your response! I do feel lightheaded when anxious and no neurological problems associated with my disorder. I feel like i have pressure at home since I'm the oldest and went to school and haven't finished yet. I also at times during the day if I'm not panicked, i feel depressed because of the state and situation i am in. Also, what position would be best so i don't aggregate whatever the problem of vertigo is? Flat back with one pillow? Thank you again!
Answered by Dr. Munish Sood 30 minutes later
Brief Answer: GAD Detailed Answer: Dear XXXXXXX thanks for reverting back with your concern(s) 1. Because panic attacks are repeatable, which means you feel endangered and unable to escape [correct me if Wrong!!] which means there is ‘fear of fear’ i.e. vicious anxiety- panic- anxiety cycle, thus before taking panic attacks to be due to anxiety or depression make sure you have ruled out following medical conditions like use of excess caffeine, cocaine, amphetamines or heart problem. [since overactive thyroid, low blood glucose came within normal limits thus can be excluded] PS. i. practice relaxation techniques like yoga, [stretching Yoga poses like Dhanurasana, Matsyasana, Janu Shirsasana, Paschimottanasana, Hastapadasana], hot shower, meditation and Pranayam [anulom vilom] which will strengthen the relaxation response of body as opposite to stress response during panic attacks, [i.e. hyperventilation], don’t try to flee away from the situation which will reinforce the perception that your panic attacks are unbearable [remember they are uncomfortable but not life threatening], allow the symptoms to pass and you will gain ability to cope with them. ii. Prescription drugs and procedures available for your problems are: sarpagandha, khus, jatamansi, bramhi, kevada, vacha, tagar, amla, XXXXXXX XXXXXXX ras, mahakalyanak ghrita, manasmitra vatkam, XXXXXXX vati, mann XXXXXXX vati,Ashwagandharishta, sarasvatarishta, stresscom, nasya karma. iii. regarding position, get an ENT check up first, if the BPPV test comes normal [Lift your head slowly, if you feel any dizziness go back to put your head between your legs] Dr. Munish Sood Naimittika
Follow-up: What causes panic attacks when suffering from off balance feeling due to vertigo? 34 hours later
I wake up in the morning very groggy and off balance now. When I have to talk to someone, I feel like I'm tilting to the side or forward like I'm going to fall. Is this part of the vertigo of BPPV maybe? thank you!
Answered by Dr. Munish Sood 12 hours later
Brief Answer: Neuro- Ophthalmologist and Otolarynglogist Opinion Detailed Answer: Dear XXXXXXX Thanks for reverting back with your concern 1. As symptoms are aggravating I will approach the disease as whole i.e. “BALANCE DISORDER”, which requires: i. Neuro- Opthalmology opinion [for eye muscle imbalance] ii. ENT/otolaryngologist Consultation [ for BPPV, Labyrinthitis, Meniere’s disease, Vestibular neuronitis, Perilymph fistula, and in rare cases Mal de debarquement syndrome (MdDS)] to rule out the cause of the unsteadiness with relevant clinical examination like [Epley maneuver: since BPPV is the most common balance disorder] and/or with investigations like electronystagmogram (which measures eye movements and the muscles that control them), or imaging studies of head and brain [to rule out Acoustic Neuroma first] 2. A vestibular rehabilitation therapist can help you in reducing/decreasing dizziness, nausea along with Dietary Regime and life style management as described earlier. Do check for/with necessary/relevant Clinical Examination and Investigations for further line of Management and do let me know the same so that Ayurveda Medicine can be incorporated. Dr. Munish Sood Naimittika