Persistent Dizziness - help

[Messenger800]

For about 2.5 months i have been dealing with more or less constant (non-vertigo) dizziness.  My dizziness is more of a feeling a visual off-ness; each individual object i can see well visualy but as a scene its noisy/busy, which makes me dizzy/nauseous.  Nausea accompanies it most often when on the computer (that is where i first noticed it originally) but also in crowded, well lighted places (grocery, restaurants).   I can spend no more than half hour on computer w/o getting nauseous, and have had to lay down after.  But beyond these specific things making it worse, there is an "off" feeling (surreal, noisy depth perception, busy) constantly, even when just walking outside.  The first "bout" lasted approximately 5 weeks, and i felt a bit better for about a week.  I wasn't 100% but could do normal things, with just a slight residual dizziness (overly vague word).  I went back to work but couldn't last on computer or in meetings, and over a few days I was back to constant dizziness.  It has been 4 weeks since with little change.  

Other associated symptoms are tightness in jaw muscles (noticeable when on computer or in car), fullness/pressure in ears (most noticable after i am on computer or more dizzy), occasional photophobia, occasional headache (6 days out of last 10 weeks).   My balance is good and can't think of any other noticeable symptoms.  My basic eye test, hearing test nd MRI (w/ contrast) were normal.  

My neurologist thinks it is anxiety and has prescribed medication (and biofeedback), which has yet to work (only been a few days for former).  She doesnt feel it is migraine (unlikely to be constant & few headaches) although my mom has a history; & she doesn't seem to be worried other neuro stuff.  ENT thought it was vestibular neuritis but it came back after a ~week of relief.  I need to get back to work, but that requires computer use which i have little tolerance for.  Beyond that, i'd like to go out and do normal stuff.  

any help would be great!

[Messenger800]

Yes, I had a normal eye exam, and the MRI rules out stuff mentioned.   My hearing is fine, as is my balance.  the dizziness in not vertigo, but more of a constant mild dizziness that adds up to nausea if i walk around the street, or (more quickly) if i get on the computer or go the a store.  if i push it (ie. stay on the computer or go about a normal day), my nausea/dizziness becomes overwhelming and all i can do is lay down quietly.  Occasionally, i get mild aches behind my eyes or a mild headache.    I've now how two weeks out of twelve where the constant dizziness has subsided and i can go into stores, go on the computer for a while, etc.  then, it gradually comes back over a few days.  not sure what to do at this point, but haven't worked in two months.  i guess a second opinion by a neurologist is best.  any other thoughts would be welcome.  

[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 has many different meanings to different people.

Some people think of dizziness as a room spinning sensation. If this is the case, the causes could be either the inner ear or the brain. Inner ear causes of vertigo most commonly include benign positional vertigo (BPPV), which is due to small particle in the inner ear that moves out of place, and can be repositioned with simple head maneuvers. The symptoms often include vertigo that occurs with turning of the head, often while turning over in bed. Another cause, if your symptoms are associated with tinnitus (ear ringing) and hearing loss is called Meniere’s disease and can be treated with medications and sometimes surgery. And so on, several other causes from inner ear problems exist.

Vertigo can also be due to problems in the brain. The most common is a benign tumor called a schwanoma (also called acoustic neuroma). This is diagnosed by MRI of the brain. Multiple sclerosis can cause vertigo, but often, other symptoms are present as well. A normal MRI of the brain excludes multiple sclerosis. Thyroid problems can also lead to vertigo.

Other causes of dizziness can be a migraine variant. Basically this is marked by several hours of vertigo associated with nausea, light-sensitivity, and sometimes other symptoms. Headache may or may not be present. The treatment is different from that used to treat other migraine types; the treatment in this case is a type of medication called calcium channel blocker, such as verapamil, which is actually used to treat blood pressure but works in type of basilar migraine as well.

If light-headedness is a major symptom, causes could include low blood pressure such as due to dehydration or autonomic dysfunction, cardiac problems, and several other non-neurologic causes. Anemia can cause light-headedness as well.

Also, a person can describe dizziness in one way and with time it may change to have different dizziness symptoms (e.g., initially having room spinning sensation but chronically with sense of imbalance).

As your physicians mentioned, anxiety and inner ear disorders can be causes of dizziness. However, the causes are many. Lastly, have you had a recent eye examination? It may be worthwhile since you describe mainly visual symptoms.

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