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Like many of you have pointed out already, unfortunately, dizziness is a common complaint in patients who have recently had strokes. To further add insult to injury, it can be quite difficult to determine what the underlying cause is and how to better aid patients during this difficult time. 

There are a few medical theories that currently try to explain the connections of dizziness, headaches, and strokes. The first theory I'll try to explain deals with the connection between migraine headaches and stroke. Studies have found that there is a common gene that predisposes people to not only migraine headaches but also the likelihood of having strokes in the future. This gene goes by the name of MTHFR (methylenetetrahydrofolate reductase). Current theories suggest that problems with this enzyme not only predispose patients to have migraine headaches but increase the chances of developing an ischemic stroke. After strokes, this gene could be possibly over-activated and cause patients to have episodes of headaches, dizziness, and a poor general condition. 

Another gene that could have a similar influence like the MTHFR gene is called the ACE receptor. If you are taking some type of ACE inhibitor, a mutation in the gene receptor can lead to increased dizziness, headaches and potentially recurrent strokes [1]. Unfortunately, science is still trying to explain problems with our DNA that predispose us to having these symptoms but early evidence suggests that there is a significant genetic overlap between migraines, ischemic strokes and coronary artery disease [2]. This is a more promising theory because many stroke patients are prescribed some type of ACE inhibitor to control their blood pressure and too high of a dose can lead to dizziness and headaches. 

Another theory that could explain these symptoms deals with the type of material lining the arteries. Endothelial is a covering that surrounds our arteries and helps control vessel tightening (vasoconstriction) and vessel expansion (vasodilation). Patients that have had strokes in the past may have internal damage to their endothelial layer. Reduced blood flow to vessels means the tissues do not have the same fuel supply that they once had and that can mean they do not work as effectively as during a pre-stroke phase. This can lead to endothelial dysfunction meaning that vessels are unable to regulate themselves appropriately and vaso-constrict too aggressively. This physiological change can lead to inflammation, coagulation problems and problems with dizziness and pressure builds in your brain. 

What is more, studies have shown that there is a decrease in cerebral vascular activity during a migraine attack, especially in the posterior part of your brain. This is the blood supply that feeds your cerebellum and helps control things such as balance and coordination, two pillars that are altered during dizziness episodes. 

These are just a few of the many theories that could explain why you or a loved one is suffering from dizziness after a stroke. It is important to consult with your cardiologists to make sure patients are not experiencing another microinfarction. If in small vessels, CT scans will be unable to pinpoint where these micro-strokes have occurred so it is important that a stroke patient is adequately controlled on the proper medication and dietary modifications to reduce the chances of having another stroke. 

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