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Persistent Dizziness
Hello Doctors, I'm 24-year-old male with persistent dizziness, lightheadedness, head heaviness, and floating sensation for 20–25 days. Symptoms started suddenly after a period of poor sleep and stress. Initially improved after rest but recurred and have persisted. Symptoms worsen with head movement, bending, standing up, walking, jumping, and visually busy environments (traffic/markets). Sitting quietly improves symptoms. No room-spinning vertigo, facial weakness, slurred speech, double vision, or loss of consciousness. ENT evaluation, PTA, VEMP, and vHIT are normal. CBC normal except ESR 47, WBC 13.66, platelets 502, slightly low serum iron; B12, Hb, and blood sugar normal. MRI Brain and MRV normal except mild sphenoid sinusitis. Betahistine gave no relief. Neurologist suspects vestibular migraine/PPPD and started Dizitac tablet and it's been 3 days, still no improvement seen,What is the most likely diagnosis and further treatment?
Based on the history provided, Persistent Postural-Perceptual Dizziness (PPPD) appears to be the most likely diagnosis, with vestibular migraine being another possibility. The onset after stress and poor sleep, worsening with standing, walking, head movements and visually busy environments, improvement with sitting quietly, along with normal MRI brain, MRV and vestibular tests (PTA, vHIT, VEMP) strongly supports a functional vestibular disorder rather than a structural brain disease.
The mildly elevated ESR, WBC and platelet count are unlikely to explain these symptoms and may represent a recent infection or nonspecific inflammatory response. Mild sphenoid sinusitis on MRI is often an incidental finding and is unlikely to be the cause of persistent dizziness.
Three days of treatment is too early to assess the response. Most medications used for PPPD or vestibular migraine require 2-6 weeks, and sometimes up to 8-12 weeks, before significant improvement is noticed. Continue the prescribed medication as advised by your neurologist
Next Steps
In addition to medication, vestibular rehabilitation therapy, regular sleep, adequate hydration, stress reduction, gradual return to physical activity, and avoidance of prolonged bed rest are important components of treatment and often improve recovery.
Continue regular follow-up with your neurologist. If symptoms persist despite adequate treatment, further evaluation for migraine prophylaxis or other less common causes may be required. Seek urgent medical attention if you develop persistent spinning vertigo, limb weakness, double vision, slurred speech, imbalance causing falls, seizures, or altered consciousness.
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