Could this dizziness and vertigo be alcohol-related?

February 14, 2013 8:10 AM

Asking for a friend who is suffering from bouts of vertigo. She's wondering if it could be alcohol-related, if maybe you've experienced anything like this, or if you have any advice.

As usual, YANAD, YANHD, etc.

She's a moderate to heavy drinker, usually 2-3 drinks an evening. One day she woke up feeling vertiginous, worse when lying down but still occasionally dizzy when standing, bending over, or turning. After one full day of symptoms she decided to take a sabbatical from drinking (something she had been considering doing anyway). Symptoms persisted for several days, then tapered down during the next week or two, and basically came to an end after three weeks. She experienced a week of vertigo-free living minus one day with a very mild case early in the morning.

She visited a GP who of course recommended an ENT. The ENT described her symptoms as benign positional vertigo, couldn't nail it down much more other than to say, "Come back on one of the days you're having a strong attack and we might be able to do more tests."

After her non-dizzy week she had two consecutive nights of drinking and on the third day woke up with strong symptoms again. Of course this happened during the final weekend of Carnival when no doctors' offices are open so she couldn't visit the ENT as they requested. She has not had anything to drink since those two nights. Symptoms persist but are lessening, maybe dissipating a bit faster than during the original attack.

She says she has noticed ringing in her ears but can't confirm that it's any more frequent than the normal ringing one gets in ones ears - she thinks she's just looking for it now and notices it more. No signs of pressure or hearing loss or any of the other classic indicators of Meniere's Disease.

posted by komara to Health & Fitness (14 answers total)

Vertigo/dizziness is a well-recognized symptom of alcoholism. So is tinnitus. General article. Recent study.

Your friend needs to get some help.
posted by valkyryn at 8:46 AM on February 14, 2013 [4 favorites]

IANAD, just somebody who has struggled with vertigo for several years now in various ways. My sympathies to your friend.

Could it be alcohol? Yes, it could be. It could also be BPPV (benign positional paroxysmal vertigo), which comes on when the person changes positions (standing, bending, turning over in bed). Could also be an ear or sinus infection, or allergies. Or other things.

It helps to be as precise about the symptoms as possible:
*What is she doing when the symptoms happen? What is her body position-- lying down, standing, sitting, etc.?
* What exactly is the sensation? Is the room spinning? (Which direction? Is it always the same?) Does she feel light-headed? Does she lose her balance? Does she get nauseated? Does she vomit?
* How long do the symptoms last?
* If she is able to do this during an episode, she should ask a friend nearby (or look in a mirror) to see whether her eyes are moving back and forth (i.e., does she have nystagmus?)
* Does she have any headaches? Earaches?
* Has she recently had a cold or nasal infection?
* Does she use a neti pot?
The more accurate info she can provide, the better the hope of a good diagnosis. This kind of stuff is tricky to diagnose, and a good doctor won't just ask a couple of questions and push some pills at her.
posted by tuesdayschild at 8:51 AM on February 14, 2013 [3 favorites]

Another data point. I don't drink much (and didn't at any time near this incident). But one morning I woke up with horrendous vertigo (my first experience and I kinda freaked out and called paramedics!) Mine was an inner ear infection indicated by some redness in one ear, and I was given a prescription to help with recurring dizziness (which I did experience for a couple weeks though rarely, and nothing like the first morning).

I would like to assume the ENT people checked for an inner ear infection, but you never know.
posted by Glinn at 9:02 AM on February 14, 2013

Alcohol can and will affect the balance centers of your central nervous system (located mainly in your brainstem and cerebellum) and your peripheral nervous system--mainly messing with fluid regulation in the vestibular organs of the inner ear. This is why a lot of people get "the spins" when they've been drinking heavily. I wouldn't think two-three drinks per evening would cause that, although I guess it could, especially if she's a small person, or mildly dehydrated, drinking on an empty stomach, etc. It could also be that she's developed one of many vestibular disorders (e.g., early Meniere's, labyrinthitis, etc.) and that her vestibular system is therefore more "sensitive" to the effects of alcohol and/or all the other crappy components of alcoholic beverages (a growing number of ear specialists believe that some Meniere's syndrome is caused by autoimmune disease and/or "allergy" mediated by the inner ear, although actually nobody really knows and it's probably caused by multiple factors).

It could really be any number of things, but your friend should go see a neurotologist/oto-neurologist if she continues to experience these symptoms--many ENTs are not equipped to properly diagnose these conditions. In the meantime, she should stop drinking to see if that helps. I currently live with a chronic vestibular disorder which started when I was in college and drinking a lot. I stopped drinking completely for many months and it made no difference in terms of my constant vertigo, but it was really helpful to go on that health kick for a while.

tuesdayschild has some great recommendations. Your friend needs to document her symptoms in a very specific manner--this really helps the doctor pinpoint the cause.
posted by bennett being thrown at 9:05 AM on February 14, 2013

Possibly. I've had BPPV and I do not drink much. A lot of times weird ear stuff co-presents [as with tinnitus and BPPV] and I find that with me sometimes stress can bring it on, maybe because of jaw-clenching or who knows. In any case cutting down on drinking is never a bad plan if you're having dizziness spells. She should go to the doc again with her concerns. There are some things that can be done for BPPV of unknown etiology but the doc should have all the information (including that your friend drinks excessively) to help them draw conclusions.
posted by jessamyn at 9:05 AM on February 14, 2013

Did the possibility of an inner ear infection come up? I've been plagued by those on and off for years, usually in the late winter/early spring. They do take some time to go away. It could be that if she drinks heavily she's depleting her body of nutrients and fluids, which has weakened her not-fully-recovered immune system yet, and that might explain the return of symptoms. (And women metabolize alcohol differently--its effect is more acute because our bodies have less water content, and therefore we get dehydrated more quickly.

Sometimes I get prescribed antibiotics, but if the cause is viral you just have to wait it out. I have found that taking a couple ibuprofen a few times a day reduces the dizziness.

She needs to cut down on the drinking, though. No more than one drink a night, and preferably less, is the NIH guideline for women. If preserving her health isn't enough of a motivation, preventing damage to her looks might be, frivolous as it sounds.
posted by tully_monster at 9:06 AM on February 14, 2013

If it helps...I have confirmed vertigo. And tinnitus to go with it.

If I drink alcohol---even three sips---I get sent into vertigo hell, so I just don't drink.
posted by TinWhistle at 9:08 AM on February 14, 2013

I had symptoms similar to what you described. I felt a little dizzy, off balance, slightly nauseated etc. And any time I got dizzy from spinning (playing spinning games with my daughter or a dog for example) I felt additional nausea for about three days. I don't drink alcohol at all. What I discovered is that I think my situation was vision-related. Specifically, I was straining my eyes to see things up close and sometimes with my eyes aimed at sharp angles (i.e., not aimed straight in front of me). When I stopped doing that, the problem went away. I don't know if your friend is doing anything like that but I felt it's worth mentioning just in case it's not caused by alcohol or other possible causes.
posted by Dansaman at 9:11 AM on February 14, 2013

Also, many people confuse the "inner ear" with the "middle ear." The middle ear is the area right behind the eardrum which frequently becomes infected, especially in children. A doctor can actually see a middle ear infection due to redness of the eardrum and evidence of fluid & swelling behind the eardrum. An infection of the middle ear can be successfully treated with antibiotics (if it's a bacterial infection), decongestants (to open up the eustachian tube which communicates with the middle ear), etc. The inner ear is encased in the temporal bone of the skull and contains the actual organs of hearing and balance (the labyrinth/cochlea). For all intents and purposes, a doctor really can't look in your ear and tell you that you have an inner ear infection. That won't prevent them from telling you you have "viral labyrinthitis," especially if you've recently had some other viral illness. But a lot of times this diagnosis is just a code for: "I can't determine what's causing your dizziness/vertigo right now, but if I tell you it's a virus, maybe that will satisfy you until we see how this thing plays out."

I should also mention that some neurotologists are proactively treating early-stage labyrinthitis and vestibular neuronitis with a course of oral steroids, which is no fun, but has been shown to reduce long-term damage to the balance system.

Also, here's a good episode of Second Opinion about dizziness, featuring one of our preeminent researchers on the human vestibular system (including mention of the use of steroids for early labyrinthitis/neuronitis).
posted by bennett being thrown at 9:20 AM on February 14, 2013

Just quit drinking.
In the long run your body will force you to do so anyway as you get older.
As an ex-cocktail hour daily drinker I can say with assurance that life is a lot simpler without booze. Plus, the irony is that the buzz doesn't last much beyond an hour or so - then you need another and another and when the drinking is over you feel worse than before you had that drink.
Its really pretty stupid. I look on drinkers now with pity.
Also, women's livers are smaller than men's so they encounter many more problems from boozing.
Is she anemic? I used to be dizzy when I stood up too fast and 'found out I had anemia.
posted by Tullyogallaghan at 9:34 AM on February 14, 2013

Response by poster: jessamyn: the doc should have all the information (including that your friend drinks excessively)

I should clarify here that she has been straightforward and truthful with every doctor she's seen with regards to how much she drinks - even specifically brought it up during discussions - and none have batted an eye or said, "You might be drinking too much" or "Well that might very well be the cause."

I'm not implying that she is or isn't drinking too much, just that all the medical people consulted have been informed and none have been concerned.
posted by komara at 9:35 AM on February 14, 2013

I'm in the process of getting the cause of my vertigo fully diagnosed, and I can tell you that a regular ENT is not going to be super-useful here. The balance system is anatomically close to your ear/nose/throat system, but functionally pretty different from the rest of it. In my case, I went to a specific balance and dizziness clinic at my local Big University.

I have also learned how important it is to be able to give as complete a history as possible. When did this start, how frequent are the attacks, what circumstances precipitate them, what makes them better, how severe are they. It's also good to know the difference between vertigo, dizziness, and disequilibrium; vertigo is when the ROOM is spinning, dizziness is when YOU are spinning, disequilibrium is when nothing is spinning but nothing is good. But yeah, she wants to see an otologist or a neuro-otologist, they will have much greater success in helping her.

Good luck to her. Vertigo is miserable and disabling.
posted by KathrynT at 9:54 AM on February 14, 2013

2-3 drinks/day is on the high side of moderate. Absent underlying liver dysfunction or a very long history of chronic drinking, alcohol is unlikely to be the underlying cause of her symptoms, though it may be exacerbating them.

Does she frequently take aspirin or other NSAIDs? Those are far more likely to cause tinnitis and vertigo than alcohol.
posted by dephlogisticated at 2:16 PM on February 14, 2013

Response by poster: Thank you, everyone, for your input. A small recap plus update:

- she developed dizziness (or more accurately, disequilibrium - thanks, KathrynT)
- she decided to stop drinking completely for four weeks, something she'd been thinking about doing anyway
- after 3 weeks or so the disequilibrium subsided
- after 4 weeks it was mostly gone aside from a mild occurrence
- when the 4 weeks were up she had 2-3 drinks two nights in a row
- disequilibrium returned on the third morning
- she's not had anything to drink since then (a few weeks now) and most of the disequilibrium has subsided
- she has, however, been keeping track of when it happens and what happens and has noticed occasional ringing in her ears and sometimes feeling like her ears are clogged or stuffy, though that feeling doesn't diminish her capacity to hear clearly

I don't yet know if she'll be repeating the "start drinking again regularly and see what happens" test but in the meantime she is trying to take notes so that when she does visit another specialist she'll have a better timeline of events.

Again, thank you all for your input.
posted by komara at 8:56 AM on February 21, 2013