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"I have been having regular fainting spells in an otherwise healthy young adult. What could it be?"
I am a healthy 20 year old female. For the last 3 months, I have been experiencing dizzy spells. During this episodes, my vision goes black, I experience tinnitis, occasionally I fall over, and rarely (6 times in the last 3 months) I lose consciousness. I have had two loss of consciousness experiences in the last two days, which is more frequent than it had been. Along with this, I had been getting migraine headaches that lasted for 4-5 days. I am now on migraine prevention meds, which has done wonders for the head pain, but nothing for the dizziness. I also occasionally experience numbness/tingling on the right side of my head and neck (the same side as the migraine pain), as well as pain behind my right eye. I had an MRI done which came back clean. I also had an EKG which was normal. I have seen several doctors, who have diagnosed me with everything from vertigo to sleep deprivation. Any insight you might have would be fantastic!
Given that you have seen several doctors and have not been given a clear diagnosis, your condition is obviously pretty complex and not so easily discernible by history alone. For that reason, I recommend scheduling an appointment with a neurologist for a complete evaluation. Having said that, there are two diagnoses that come to mind based on your description of your symptoms. One of these is complex migraines. You seem to be suffering from migraine headaches, and oftentimes migraines can have more wide-ranging effects than just head pain. Some of these effects can include nausea, changes in tactile sensation, motor deficits, and even dizziness, tinnitus, and hearing loss. However, given that the migraine medication you are on has been effective in treating your headaches but has had no effect on your dizziness and tinnitus, there may be another condition at play. This other condition may be what is called Meniere's disease. Although the exact cause is unknown, it is thought to be due to a buildup of fluid in the inner ear, which results in intermittent hearing loss, tinnitus, and vertigo. People with Meniere's disease also experience migraines at increased frequency compared to the general population. In terms of managing this condition (if it is Meniere's), proposed treatments include maintaining a low salt diet (salt can increase fluid accumulation), avoiding caffeine, alcohol, and tobacco, and using anti-nausea medications such as meclozine or valium. Betahistine in particular may be helpful because it dilates the blood vessels in your inner ear, thus increasing resorption of the inner ear fluid. If these measures do not work, there are some surgical options, such as steroid injections in the inner ear or procedures to release the fluid accumulation. Again, it is difficult to make a diagnosis without performing a physical exam or having access to other tests, so I do advise that you see a neurologist. When you do, bring up the possibility of Meniere's disease if this has not already been discussed.
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