Dizziness, Confusion, Caffeine, and Salt
Beck (2015) reports that no two people experience dizziness the exact same way. What one patient describes as vertigo, another may describe as light-headed, woozy, dizzy, and more. Similar to tinnitus, headaches and lower back pain, one cannot disprove these sensations. However, it’s not just the variation in which words the patient uses, but the variation in the words the clinician uses, may also add to the confusion.
Beck (2015) reports that many of our “diagnostic terms” are not as exact as we might prefer as they are defined by multiple sources with different professional orientations, knowledge and agendas. For example, the terms migraine, vestibular migraine, endolymphatic hydrops and Meniere’s Disease overlap clinically—and it can be argued that each is a diagnosis of exclusion. That is, there are no objective, “gold standard” lab tests that identify the “correct” differential diagnosis. Indeed, the terms vestibular migraine, migraine associated dizziness, benign recurrent vertigo, vertiginous migraine, migraine-related vestibulopathy and others, may be somewhat (or largely) synonymous.
With regard to working up the dizzy patient, Beck notes that caffeine and salt restrictions are likely not necessary. Of course, he argues that additional salt is likely not good for anyone (i.e., blood pressure) but with regard to the impact of salt reduction for management of dizziness, he points out the absence of peer-reviewed control/experimental or RCT studies that verify the presumption that a salt free diet reduces dizziness…and he asks…if salt and caffeine reductions reduced dizziness, why are Meniere’s patients dizzy for the next 20 years?
Dr. Devin McCaslin (2013), associate professor in the Department of Hearing and Speech Sciences, Communicative Disorders, Vanderbilt Bill Wilkerson Center at Vanderbilt University, stated that:
We've gone all the way from discontinuing to maintaining all medicines. The issue is, when you tell them to discontinue their medications, they may accidentally discontinue something they should have stayed on, they may get confused, they may have a really bad day on the day of test because they didn't take medicines they were accustomed to—and one never knows the exact outcome that could happen if the patient gets confused or skips an important medicine. Bottom line…we do not tell them to discontinue their medications.” McCaslin adds “there's no study that I'm aware of that shows the patient cannot have caffeine on the morning of their test! Caffeine is fine and it's not likely to impact the test an hour or two later, but without caffeine, the patient may be very cranky and some may start to get a caffeine-withdrawal headache! So we absolutely let them have their coffee!
For More Information, References, and Recommendations
Beck DL. (2015) Dizziness, Confusion, Issues and Considerations. ENT & Audiology News. November/December 25(5):65-66.
McCaslin DL. (2013) VEMPS, Rotational Tests, and Platform Posturography: Interview with Devin L. McCaslin, PhD