Brain fog and dizziness

"Brain fog" is a poorly-defined symptom that sometimes occurs along with dizziness (from any cause) and in association with many other diagnoses. For more information please visit us at DizzinessDoctor.com/are-you-dizzy DISCLAIMER This material is intended for educational purposes only, and does not substitute evaluation by a qualified health care professional. Accessing this material is subject to the terms and conditions detailed at DizzinessDoctor.com. PURPOSE The problem: I feel “brain fog” along with my dizziness. How can this be managed? The solution: We discuss that the poorly-defined phenomenon of “brain fog” can occur in the context of many diagnoses, of which “dizziness” (from any cause) is merely one. Since there is no “test” for “brain fog,” and since its mechanism is unknown (and thus there is no proven therapy specifically targeting it), the most practical approach is to treat the other identifiable disorder — in other words, treat the underlying cause of the other symptom (whether dizziness, or anything else). WHAT IS BRAIN FOG? “Brain fog” is not (yet) a formal medical term. Nevertheless, a PubMed search for this phrase yields over 1000 hits (which is to say articles published in peer-reviewed journals), reflecting the fact that patients use this descriptor frequently. The topic of “brain fog” is difficult to study because: The literature on this topic shows that there is no widely-accepted definition. The mechanism of “brain fog” is unknown. There is no objective “test” for “brain fog.” ONE APPROACH TO CHARACTERIZATION Atik and Inel Manav (2023) categorized various symptoms reported by patients complaining of “brain fog.” To be clear, this approach is merely a suggestion by those authors, and should not by any means be interpreted as definitive or diagnostic. THAT APPROACH IS NOT DIAGNOSTICALLY VERY USEFUL Each of the individual symptoms that Atik and Inel Manav list (reported by patients in association with “brain fog”) can have a broad range of causes, so these do not go very far in narrowing down the underlying mechanism of “brain fog.” EPIDEMIOLOGY There are not yet any publications that have formally studied the epidemiology of “brain fog.” A reasonable (though very imperfect) proxy is that “brain fog” has been reported in association with many diseases, including: Neurological disorders (mild cognitive impairment, multiple sclerosis, neurosarcoidosis, traumatic brain injury) Cardiovascular disorders (dehydration, postural orthostatic tachycardia syndrome) Gastrointestinal and hepatobiliary disorders (celiac disease, cirrhosis, hepatitis C) Endocrinological disorders and hormonal states (hypothyroidism, hypoparathyroidism, menopause, pregnancy) Disorders of nutrition and metabolism (iron deficiency, sodium dysregulation, vitamin B12 deficiency) Immune-mediated diseases (allergies, chronic fatigue syndrome, fibromyalgia, rheumatoid arthritis, systemic lupus erythematosus) Infectious disorders (e.g., COVID-19) Psychiatric disorders (anxiety, autistic spectrum disorders, depression) Others (chemotherapy, kidney disease) MECHANISM OF DISEASE We have seen that: There is no consensus on the definition of “brain fog.” The descriptions of “brain fog” are quite varied. “Brain fog” occurs in association with a range of other diagnosable conditions. “Brain fog” has no objective confirmatory test. Given the above factors, it is unsurprising that the underlying mechanism of “brain fog” has remained elusive. The absence of a clear mechanism of disease has made it difficult to treat “brain fog.” TREATMENT Given those limitations, the most practical approach is that if a person with “brain fog” already carries some other formal medical diagnosis, then that other disease should be the initial therapeutic target. If a person with “brain fog” also complains of dizziness, then it is sensible to try to determine the cause of the dizziness and (if possible) treat it. It is unusual for a person to complain of “brain fog” in complete isolation of any other diseases, so if “brain fog” is the only reported “symptom,” then it is medically reasonable to undertake a search for other diagnosable conditions. This investigation is usually overseen by a patient’s primary care physician. PROGNOSIS Insofar as “brain fog” may be associated with the presence of other diagnosable medical conditions, the prognosis depends on the degree to which those other conditions can be treated.