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Brain & Nervous System Health Center

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New Clues to Chronic Dizziness

Psychiatric, Neurological Problems May Cause Unexplained Dizziness, Study Shows

The Study

In his study, Staab and his co-author, Michael J. Ruckenstein, MD, also of the University of Pennsylvania, evaluated 345 men and women, aged 15 to 89, who had complained of chronic subjective dizziness for three months or longer and had sought help at The Balance Center from 1998 to 2004.

After evaluating their balance, Staab and Ruckenstein also asked about illness that can lead to dizziness, such as inner ear infections, migraine headaches, concussions, or other brain injuries.

They also screened them for psychiatric disorders, especially anxiety problems, which can cause dizziness.

Anxiety Disorders Common

Anxiety disorders were found to be linked to 60% of the chronic dizziness cases; central nervous system conditions such as migraine and brain injuries explained more than 38% of the cases. In less than 2%, abnormal heart rhythms were identified as the cause of the dizziness.

Two-thirds of the patients had medical problems (such as an inner ear infection) that first caused the dizziness; one-third had a psychological event, typically a panic attack, which caused the dizziness initially.

But sometimes, patients with an initial problem that was medical later developed a psychiatric problem. "The medical feeds the psychiatric," Staab says.

Medical Considerations

"The idea that dizziness is either medical or psychiatric is potentially problematic because so often it is both," Staab says. "And typically when it is both, the illness began as a medical condition."

For instance, he says, a chronically dizzy patient may tell his doctor he is afraid to drive because of dizziness, and the doctor labels it as a psychiatric problem.

But the patient may have forgotten to mention that an inner ear infection initially made him dizzy and made him anxious about driving.

Patients with chronic dizziness need to be screened for headaches, brain injuries, and other problems in addition to simply anxiety, Staab says.

Another Expert Weighs In

The new study builds on previous research, says Joseph Furman, MD, PhD, a neurologist and professor of otolaryngology at the University of Pittsburgh and a veteran researcher on the topic.

"If you take a close look at people who are dizzy without a diagnosis of disease, the two main things you are going to come up with are anxiety and migraine," he says, citing his own and others' research. "But it is complicated. People with anxiety aren't immune to vestibular [inner ear] disorders."

That points to the wisdom, he says, of including both medical and psychological assessments for chronic dizziness.

The study is published in the February issue of the Archives of Otolaryngology Head and Neck Surgery.

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