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Neurology (Expert Forum)
rebound nystagmus vertigo and headache
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rebound nystagmus vertigo and headache
by m00ch, Mar 06, 2007 12:00AM
I am a 35 year old male with a "basically" normal MRI MRA and MRV of the brain, and MRI of cerv. spine. And normal blood tests. I also had a normal Video-Nystagmogram(?)-the one where water is squirted in your ears as the camera record your eyes..this too was normal (a terrifying test as I became severely dizzy).
I have had--a constant non throbbing headache, on the top of my head, and the front of my head mostly. I have also had--extreme dizziness in a horizontal position, that the room will not stop spinning until I stand up again. This will also happen if I'm standing but I tilt my head back/look up.. These "episodes" as I call them usually last a few days at a time then I am not so dizzy for a few weeks or so.
When I am dizzy any movement of my eyes will seem to aggrivate the symptoms, and, I seem to get what I think "might" be what I understand to be rebound nystagmus..when I look my eyes in either direction, and look forward again, the room "bounces around" for a short while. The movements of my eyes in either left or right direction feels stiff. Can you please..help..I have seen 3 neurologists.
I have had--a constant non throbbing headache, on the top of my head, and the front of my head mostly. I have also had--extreme dizziness in a horizontal position, that the room will not stop spinning until I stand up again. This will also happen if I'm standing but I tilt my head back/look up.. These "episodes" as I call them usually last a few days at a time then I am not so dizzy for a few weeks or so.
When I am dizzy any movement of my eyes will seem to aggrivate the symptoms, and, I seem to get what I think "might" be what I understand to be rebound nystagmus..when I look my eyes in either direction, and look forward again, the room "bounces around" for a short while. The movements of my eyes in either left or right direction feels stiff. Can you please..help..I have seen 3 neurologists.
Doctor's Answer
by Forum-M.D.-SH, Apr 02, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms that you describe are consistent with BPPV (benign paroxysmal positional vertigo) with some migraine headaches as well. Dizziness/vertigo can be broken down into 2 basic causes, problems in the ear/vestibular canals gives rise to peripheral Dizziness/vertigo, and the brain/cerebellum gives rise to central Dizziness/vertigo. Peripheral vertigo is more likely to be positional (changes with position) and is also more likely to be intermittent. Central Dizziness/vertigo is constant despite positional changes and gets progressively worse overtime (for example: a brain tumor or stroke in the cerebellum). It sounds like you have had a good work up (MRI/MRA/MRV) to evaluate for a central cause of your Dizziness/vertigo, and it is normal (as I would suspect). The difficulty in finding the reason behind your symptoms with peripheral Dizziness/vertigo tests (such as the video-nystagmogram etc) is that your symptoms are intermittent and if you are not having your symptoms at the time, it will be hard to diagnose. BPPV is most often caused by otoliths (pieces of calcium/debris) that break off in your vestibular canals and cause the wrong signals to be generated. These otoliths work there way out of the canal with time and the symptoms resolve, at least for a while. There is also a series of head manipulations (Eply maneuver), which can often provide relief to patients with BPPV by moving the otoliths out of the canal. Patients with vestibular problems also often have chronic neck problems. These neck problems then give rise to headaches due to contraction of the muscles in the neck that pinches nerves (such as the greater occipital nerve) and provides a trigger for the headache.
For the symptoms that you describe I would suggest a prophylactic medication against headaches/muscle relaxant for the neck called tizanidine (zanaflex). This is a daily medication and will help (after 3-4 weeks) to calm down the headaches. I would also suggest neck physical therapy, by a physical therapist that understands the role of the neck in headache disorders. If/when you Dizziness/vertigo symptoms reccur I would present to a neurologist for the eply maneuver and possible trigger point injections if any focal areas of tenderness are found in your neck region.
I hope this has been helpful.
The symptoms that you describe are consistent with BPPV (benign paroxysmal positional vertigo) with some migraine headaches as well. Dizziness/vertigo can be broken down into 2 basic causes, problems in the ear/vestibular canals gives rise to peripheral Dizziness/vertigo, and the brain/cerebellum gives rise to central Dizziness/vertigo. Peripheral vertigo is more likely to be positional (changes with position) and is also more likely to be intermittent. Central Dizziness/vertigo is constant despite positional changes and gets progressively worse overtime (for example: a brain tumor or stroke in the cerebellum). It sounds like you have had a good work up (MRI/MRA/MRV) to evaluate for a central cause of your Dizziness/vertigo, and it is normal (as I would suspect). The difficulty in finding the reason behind your symptoms with peripheral Dizziness/vertigo tests (such as the video-nystagmogram etc) is that your symptoms are intermittent and if you are not having your symptoms at the time, it will be hard to diagnose. BPPV is most often caused by otoliths (pieces of calcium/debris) that break off in your vestibular canals and cause the wrong signals to be generated. These otoliths work there way out of the canal with time and the symptoms resolve, at least for a while. There is also a series of head manipulations (Eply maneuver), which can often provide relief to patients with BPPV by moving the otoliths out of the canal. Patients with vestibular problems also often have chronic neck problems. These neck problems then give rise to headaches due to contraction of the muscles in the neck that pinches nerves (such as the greater occipital nerve) and provides a trigger for the headache.
For the symptoms that you describe I would suggest a prophylactic medication against headaches/muscle relaxant for the neck called tizanidine (zanaflex). This is a daily medication and will help (after 3-4 weeks) to calm down the headaches. I would also suggest neck physical therapy, by a physical therapist that understands the role of the neck in headache disorders. If/when you Dizziness/vertigo symptoms reccur I would present to a neurologist for the eply maneuver and possible trigger point injections if any focal areas of tenderness are found in your neck region.
I hope this has been helpful.
I have the VNG test set up for next week. How bad was it. From what you wrote I am now scared to take it. Did the dizzyness subside after a while and how bad was it. I am getting nervous now thinking about it.
bppv is caused by crystals forming in the canals in the inner ear that control balance. There are exercises you can do to dislodge the crystals. Any ENT specialising in dizziness/balance will know about this.
Of course it might be something else, dizziness can be caused by all sorts of things.