Persistent Nausea

[LarryG62]

My wife has had a persistent nausea  problem since about February 2008. She wakes up in the morning and feels fine...until she starts to move around. The nausea stays with her until she has some food and liquid in her stomach.  Many times, it subsides, but comes back when she moves around again.   All her tests EGD, Cat Scan, MRI, etc turn out normal.  Hida Scan showed her gall bladder to be very small and only 10% operative, so she had it removed about a month ago. Nausea subsided some for a few days, but it's back every day now, and lately she has complained of dizziness as well.  Doctors are stumped.  I hope someone will come up with a good idea of the cause of this.  Any help will be very much apprediated.

[Nancy T]

OK, this doctor you e-mailed, was he a NEUROLOGIST or an ENT? I have never heard any doctor say if it lasts more than three days it isn't an inner-ear problem--that's ridiculous!

There is a common type of inner-ear problem called vestibular neuritis which causes severe dizziness for three days or so, but there are many other things that can be wrong with the inner ear or brain.

Find another doctor if that one won't see her. If she's had negative tests for inner-ear problems, see a neurologist.

[LarryG62]

I checked with the association president and he referred me to one of his otoneuroligists here in the south.  I emailed him,gave her symptoms and asked about an appointment to see him.  He emailed me back and said if it lasted more than three days it wasnt an inner ear problem.  So, we're still at square one. She is stillnauseous....some days more than most, but I can't seem to find a circumstance that is consistent with the nasea.

[Nancy T]

Hi Larry. Be aware that a normal ENG absolutely DOES NOT rule out inner ear problems. A person can have a vestibular (inner-ear) problem that does not show up on ENG. Further tests would include rotary-chair testing and possibly others, although an ENT or neurologist specializing in dizziness would be the one to say whether further vestibular testing is warranted. A genuine balance center that has such equipment and is staffed with, or works with, a neuro-otologist (ENT specializing in the inner ear--NOT a run-of-the-mill ENT) would be able to do further testing. Lists of neuro-otologists can be found at the Web site of the American Neurotology Society.

Is she a migraineur? Even if she doesn't get headaches with the nausea and dizziness, it could very well be migraine if she has a personal or family history of it. Headache is NOT necessary for migraine.

Migraine can be associated with motion sensitivity, nausea, dizziness, and a whole bunch of other stuff. I suspect that low-level migraine activity is the cause of my dizziness problem, but I haven't had that confirmed by a doctor. There is no way to diagnose migraine except by history. A trial of migraine medication could be helpful if that is suspected.

If your wife has not seen a neurologist, that would be a possibility as well. (They are the ones who would deal with migraine, not ENTs--although even some neurologists seem extremely wishy-washy about the connection between migraine and dizziness.) Try to find one who specializes in dizziness.  This type is called an oto-neurologist and there are very few of them. See the "Otoneurologists in the USA" link at www.robbmd.com, although that list may not be completely accurate (as far as everyone on it actually calling themselves an otoneurologist) nor a complete list of neurologists interested in dizziness.

Of course, it could totally NOT be an inner-ear or brain (migraine) problem, too! I'm sure nausea has many causes.

Good luck!

Nancy T.

[LarryG62]

Yes, she has, and he said it wasn't her inner causing the problem.  The great majority of the time, she isn't dizzy, just nauseous.  I can't help thinking that something associated with balance, etc might be involved, because when she gets up and moves, the nausea returns. Not 100 % of the time, but very often. Thanks for your note.

[Nancy T]

Has she seen an ear specialist (otologist)? Had an ENG? This is ElectroNystagmoGraphy, which tests balance function and consists of watching moving lights and having warm and cold air or water run into your ears while having your eye movements recorded by either electrodes or video goggles.

It could be an inner ear problem. I too get nausea in the mornings and am motion-sensitive.

Nancy T.