Disequilibrium, Back Pain, Nausea, Headaches, etc.

I have a rather long list of symptoms, but the most troubling are:

Disequilibrium - I spontaneously stumble or fall to the left
Dizziness - this is almost constant, even when I'm sitting down
Back Pain - seems to radiate from a point along my spine, directly between the shoulder blades; usually it's an ache, but sometimes I have stabbing pains or even a sort of cold, numb sensation
Headaches - these are usually preceded by a feeling of pressure; sometimes I have brief but intense stabbing pains in a specific point at the back of my head on the right side
Nausea - this is most intense when I first get up in the morning, but it also strikes randomly throughout the day
Shooting, stabbing pain - mostly in my arms and hands, though this sometimes effects other parts of my body also
Neck Pain - usually coincides with the back pain and is always on the right side
Tremors - I have occasional, slight tremors in my hands and sometimes just a general shaky feeling
Insomnia and Fatigue - I often have trouble falling asleep and regardless of how much sleep I did or didn't get, I often feel as if I have little to no energy during the day

The insomnia and dizziness started about 10 years ago.  The other symptoms have developed and escalated over the years.  I don't feel comfortable driving and that, along with the symptoms themselves, has kept me from working.  I have recently been advised to apply for Medicaid and intend to do so as soon as possible, but the process, I know, will take time.  I've already been dealing with these symptoms for a long time, and I'm not sure how much longer I should wait before I see someone.  Is this likely to be something serious that I should seek care for right away?  My thanks, in advance.

[Christopher R Newey, DO]

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 a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

As you know, dizziness can have many causes. Vertigo, or "room-spinning dizziness" can be caused by several different types of inner ear problems and less commonly from central nervous system diseases. Cervical disease (such as a herniated disc in the cervical (neck) region or arthritis of the spine) can cause vertigo, though this is not common. More often, the dizziness is not room-spinning per se but rather a wooziness (perhaps what you mean by disequilibrium) or sort of light-headed dizziness. I will refer to this as cervicogenic dizziness. This notion of cervicogenic dizziness is not accepted by all medical practioners, it is controversial, as it is not well researched, difficult to diagnose, and difficult to conduct research on. However, it may be diagnosed in someone with neck pathology and dizziness in which no other cause is found. Therefore, it is a diagnosis of exclusion, after inner-ear and brain problems are excluded.

Patients with dizziness due to neck pathology (cervicogenic dizziness) often complain of dizziness that is worse with particular head movements and when the head is maintained in one specific posture for prolonged periods. Neck pain and a headache in the occipital region (the back of the head above the neck) may be associated with the dizziness. The dizziness may last minutes to hours after assuming certain head positions.

Other causes of vertigo can include inner ear problems, of which there are a variety including Menniere's disease (which is marked by episodes of vertigo, ear-ringing (tinnitus) and hearing loss), Benign positional vertigo (BPPV) which is marked by episodes of vertigo brought on by head movement, brain tumors (this would be apparent on MRI), certain toxic drugs (specific medications), neuropathy, basilar migraines, and certain infections.

You have many symptoms that may not all be from the same etiology. I suggest you follow up with a neurologist to get a history and examination to evaluate the dizziness and headaches. You will need to see a primary care physician for the other symptoms.  

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.