Balance Problem

13 mo. ago I had sudden episode of dizziness so bad I fell to ground. Heart racing and very sweaty, had to lie in bed for hours. Since, I have a daily ‘balance problem’. Feels similar to being on a boat all day and then get back on dry land, or feeling like head is cloudy, or feeling like hangover from alcohol. Sometimes hard to concentrate. I would NOT describe it as dizzy, spinning feeling. I’m 38 yr male, otherwise very healthy 6’1”, 150 lbs, no other illnesses, no history of probs, normal BP. Rarely drink alcohol, non smoker. No abnormal headaches. I generally feel this problem daily. Feel good when I first wake, worse as day goes on. Other things that seem to make it worse are driving long distances in car, staring at computer screen for long time, and sometimes walking down grocery store aisle. Next saw a balance specialist at ENT clinic. They ran many tests: hearing tests, a rotating seat test, test with warm/cold fluid in my ear while tracking light on a wall. Concluded my inner ears were working normally. Next tried PT to resolve balance prob: walking in straight line while moving head up down left and right etc but did not help. I also had eye check at the ophthalmologist, results normal. Next had MRI performed on my head, w/o contrast, looking for problems with balance system, results normal. After 6 months of PT with no improvement, PT guessed the symptoms maybe ‘atypical migraine’. She prescribed Clonazepam 0.5 mg tablet, 1/4 of tab in AM and another 1/4 of tab in PM. Good news is that I did show good improvement after starting meds but after 4 months, symptoms are now back as they were before I started the meds.  Exercising 2-3x per week also seems to help. Did I get an accurate diagnosis? Other possible causes? Is there anything else to alleviate the symptoms?  I don’t want to increase the meds unless I have to. I have annual checkup with my regular Dr in a month, should I push to have other tests performed to find the root cause? THANKS!

[Esteban Cheng-Ching, MD]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to examine you and obtain a detailed history, I can not tell you what the exact cause of your symptoms is or how to treat them. However I will try to provide you with some useful information.
Balance problems and gait disturbance can be produced by multiple conditions and the cause should be investigated. Central nervous system problems can produce balance problems, including movement disorders like Parkinson or other brain disorders, however you would have other manifestations as well. Spinal cord disorders, peripheral nerve problems, and muscle problems can also produce problems in your gait and your balance, but again, you would be exhibiting other manifestations of these, like weakness, numbness, tingling or other sensory manifestations.
Certainly vestibular disorders or problems in the middle ear can produce the symptoms that you have, including vertigo, unsteady gait, dizziness, balance issues, and gait instability. But seems that you have had already vestibular work up.
Autonomic disorders which affect multiple organ systems can be associated with dizziness and balance problems, specially when changing position from sitting or lying down to standing up. The autonomic nervous system controls involuntary activity in the system, and if there is problems patients can have orthostatic hypotension, heart rate abnormalities, and other symptoms. In order to suspect this the history and the exam helps, including orthostatic vital sign measurement. There are studies to work this up, if suspected, like tilt table testing, or cardioautonomic testing. However I am not sure if this is what you need from your description.
Heart conditions like arrhythmias or problems with the perfusion can produce dizziness, and unsteadiness if the brain perfusion is not enough.
Migraine usually manifests as a headache, however sometimes can be present without headaches with other manifestations, but not usually constant, and so persistent, and not usually with the manifestations you describe. However it is not fair to question a diagnosis without being able to obtain the full history and exam.
From your description it is difficult for me to give you a diagnosis, or to know if the diagnosis given is correct or not. Without being able to obtain a detailed history and examine you, I cannot tell you what the cause of your problems is. I think that you should see a neurologist, and if you are concerned, obtain a different opinion, in order to be able to determine what the cause of your symptoms is.
I hope this information is useful.