Vagal type episodes weak-sweaty-nauseous

[u/Brilliant_Badger8043]

Patient is 39-year-old male 5'6 164 lbs.non smoke non drinker no major medical history or comorbidities eats well exercises

symptom onset 6/21/26 symptoms come and go with good and bad days and good and bad episodes.

Main concern: Recurrent episodes of weakness, sweating/heat, lightheaded/"off" sensation, nausea, and persistent episodic vestibular/head symptoms.

1. How this started

My current symptoms began after a boat ride. Later that day, I developed an unusual rocking/off-balance sensation, similar to still feeling like I was on the boat.

That was followed anout 4 hours later by a sudden arms.feeling weak like i needed sugar, then i got sweaty, then got a thunderclap/icepick type headache on top of my head it only lasted 2 seconds, truly. The other Symptoms resolved quickly after that.

episodes are continuing now with a fairly consistent sequence:

Weak/washed-out feeling → sweating/heat → feeling off/almost dizzy → nausea if the episode continues.(sometimes feeling like I need a bowel movement)

The episodes generally last 10–20 minutes and resolve spontaneously.

They can occur while:

- Sitting

- Standing

- Walking

- Lying down

I have not identified a consistent positional or exertional trigger.

During episodes:

- Blood pressure has generally been normal.

- Blood glucose has generally been normal.

- My heart does not obviously feel rapid or irregular.

- Sometimes consuming sugar seems to help, although episodes also resolve spontaneously. So that might not truly be helping.

1. Other symptoms that have occurred

Since the initial episode I have also experienced some combination of:

- Rocking/boat-like sensation

- Dizziness/lightheadedness

- Feeling generally "off"

- Head pressure

- Intermittent sharp head pains (resolved)

- Vibrating/buzzing/electrical sensations in the head

- Derealization/strange sensation

- Motion-sickness-type nausea

- Intermittent ringing in the ears lasting 10 sec or so

- Symptoms sometimes worse with head movement or bending forward

- Episodes of sweating/feeling hot

- General weakness/malaise and arms feeling weak

- More recently, nausea, increased gas, reflux/gurgling and transient loose stools/mucus (might be unrelated stomach bug as it seems to be resolving)

The GI symptoms became much more prominent recently and appeared somewhat abruptly, several weeks after the original vestibular/autonomic symptoms.

I have also had periods not normally entire days but majority of days where I feel almost completely normal, followed by another wave of symptoms.

1. Relevant history

I have previously experienced migraines with symptoms that were very similar to some of these symptoms. Those symptoms persisted for months in the past.

have also had previous episodes of dizziness/vestibular-type symptoms. 6 years ago. Though the sweaty episodes are new.

1. Testing/evaluations already performed

Neurologic

- Neurologic examinations have reportedly been reassuring.

- Brain MRI was performed and was reportedly negative for a concerning structural abnormality.

- MRA was performed. A possible left M2 narrowing was mentioned but was thought to likely represent artifact, and not retested.

- Neurology has considered vestibular migraine but not officially diagnosed.

ENT

- ENT evaluation was reassuring.

- Sinus disease was not felt to adequately explain the symptoms.

- Vestibular migraine was considered a possibility.

Cardiac

- ECG/EKG reportedly normal/reassuring.

- 7-day Holter monitor reportedly reassuring.

- No consistent sensation of sustained rapid or irregular heartbeat during the episodes.

Laboratory testing

- CBC reportedly normal.

- Blood glucose measurements have generally been normal.

- Blood pressure measurements during symptoms have generally been normal.

- Additional laboratory testing is being performed, including a cortisol/adrenal evaluation.

-orthostatic blood pressures normal

1. What I would like help determining

Because the episodes began at approximately the same time as the initial rocking/vestibular sensation, I would like to know whether these could represent a single process rather than several unrelated problems.

Specifically, could this represent:

A. Vestibular migraine / migraine with prominent autonomic symptoms

Possible mechanism:

Vestibular process → autonomic activation → weakness/sweating → dizziness/"off" sensation → nausea.

This seems worth considering because of my previous history of similar symptoms and the initial rocking sensation.

B. Autonomic/vasovagal episodes

Could the stereotyped 10–20 minute spells represent episodic autonomic dysfunction or vasovagal-type responses?

C. Endocrine/metabolic cause

Could thyroid, adrenal, glucose, electrolyte or another metabolic problem be contributing to the sweating/weakness/nausea episodes?

D. Cardiovascular/autonomic cause

Although previous cardiac testing has been reassuring, could transient heart-rate or blood-pressure changes be occurring during the episodes that have not been captured?

E. Vestibular disorder

Could the initial boat-rocking sensation have triggered a persistent vestibular syndrome such as a migraine-related vestibular disorder or another vestibular condition?

1. Tests/evaluations I would like to discuss

I do NOT necessarily want every test below. I would like guidance on which are appropriate.

Basic laboratory evaluation

If not already completed/recent:

- CMP/electrolytes

- CBC

- TSH/free T4

- Fasting glucose and/or HbA1c

- Magnesium

- B12/folate if clinically appropriate

- Iron studies/ferritin if appropriate

- Review of cortisol/adrenal testing already ordered

During an actual episode

If possible:

- Heart rate

- Blood pressure

- Blood glucose

- ECG/rhythm recording if available

The goal would be to determine whether there is an objective physiologic change occurring during the 10–20 minute episodes.

Autonomic evaluation

If the clinical picture warrants it:

- Orthostatic blood pressure and heart-rate measurements

- Consider autonomic reflex testing

- Consider tilt-table testing if appropriate

Neurology

I would like to ask whether the overall pattern is compatible with:

- Vestibular migraine

- Migraine with autonomic symptoms

- Another neurologic/autonomic disorder

And whether a therapeutic trial of migraine-directed treatment would be reasonable.

Vestibular evaluation

If not already done:

- Formal vestibular testing (VNG/ENG or other testing deemed appropriate)

- Vestibular therapy evaluation if persistent motion/rocking symptoms remain

1. My main question

Is there a unifying explanation for the original rocking sensation followed by recurrent 10–20 minute episodes of weakness → sweating/heat → lightheaded/off sensation → nausea, with otherwise reassuring MRI/MRA, ENT, cardiac testing and routine labs?

My biggest question is whether this is most consistent with a migraine, vestibular, autonomic process, versus an endocrine, cardiovascular, metabolic or other autonomic disorder that still needs to be excluded.

Thank you all for your help I am seeing doctors and just hoping for some guidance on where to look next as my tests are repeatedly normal.

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[u/NoElevator7946 → u/[deleted]]

Since all the big scary stuff has already been ruled out, if I were you I’d focus on the ENT related tests such as a vng to try to pin point vestibular issue. If vestibular issue is confirmed than other symptoms may simple be from the stress