Dear Annie: "Dizzy in New York," who suffers vertigo and ringing in the ears after eating citrus foods, may have migraine-associated vertigo and tinnitus. Such patients often have a history of headaches (which they may mistake as "sinus headaches"), but many have only inner ear symptoms. Chocolate, fermented foods (especially red wine), and other foods can be triggers, as can use and withdrawal from caffeine, hormones and headache medications. Eliminating these triggers often relieves symptoms; some patients require medications that help prevent migraine.

"Dizzy" should consider seeing a neurologist or neurotologist (an otolaryngologist who specializes in inner ear disorders) who has a special interest in treatment of vertigo and is knowledgeable about migraine-associated vertigo. — Charley C. Della Santina, Ph.D., M.D., Dept. of Otolaryngology, Head & Neck Surgery, Johns Hopkins School of Medicine

Dear Dr. Della Santina: Thank you for your expert diagnosis. Our readers really came through with suggestions and referrals. We can't promise that any of them will solve the problem, but we hope at least one will prove helpful. Read on:

From an Integrative Physician: This patient clearly has food allergies, and I also recommend that tests be run for gluten intolerance. Often, food allergies become more numerous over time. We usually develop allergies from the very foods we like the best, simply because we eat them so often. People should rotate foods so they are not eating the same ingredients frequently.

Florida: "Dizzy" should locate a physician who specializes in autoimmune diseases and ask to be checked for dysautonomia.

Brooklyn: "Dizzy" said tomato sauce also gives her vertigo. Tomatoes canned in the United States contain citric acid. She should look for tomatoes canned in Italy.

New Jersey: She may have acid reflux. I, too, get nauseated and dizzy when I eat citric acid.

California: Has she had an MRI? I had similar symptoms, and an acoustic neuroma was found. I had it removed a couple of weeks ago, and although I still have some tinnitus, the dizziness is gone, and I can eat what I want.

Arkansas: My husband's cardiologist told me to take ginger or ginger root capsules two to three times a day, and then gradually decrease it to a single capsule.

Santa Cruz: Tell "Dizzy" that she's having gall bladder problems. I endured three months of horrible vertigo, and when my acupuncturist had me cut back on oils and acids, it went away. If I have a flare-up, I use milk thistle tablets.

Wyoming: Tell her to get tested for celiac sprue (gluten intolerance). She may have to avoid foods with wheat, rye, barley, oats and other grains.

North Carolina: She should see a neurologist as soon as possible. I found out I have tri-geminal neuralgia.

Illinois: There is an inner ear problem called benign paroxysmal positional vertigo. There are exercises called Cawthorne's Head Exercises that really do help. She should see an ear, nose and throat doctor.

Oregon: A good place to find a doctor with experience in food sensitivities is through the American College for Advancement in Medicine (

Kansas: I would suggest this person contact the American Tinnitus Association (, and they may well be able to offer some recourse.

Boston: The Food Allergy and Anaphylaxis Network ( is an excellent source of information.

San Jose, Calif.: I recommend "Dizzy" contact the world-renowned House Ear Clinic in Los Angeles at

Vancouver, Wash.: There is an international organization in Portland, Ore., called the Vestibular Disorders Association at

Long Island: I found the Hearing, Balance & Speech Center in Hamden, Conn. (, and they offer a treatment called Auditory Habituation. It saved my life.

Annie's Mailbox is written by Kathy Mitchell and Marcy Sugar, longtime editors of the Ann Landers column. Please e-mail your questions to, or write to: Annie's Mailbox, P.O. Box 118190, Chicago, IL 60611. © Creators Syndicate Inc.