Dizziness
DEFINITION
Dizziness is a term used to describe everything from feeling faint or lightheaded to feeling weak or unsteady. Dizziness that creates the sense that you or your surroundings are spinning or moving is called vertigo.
Dizziness is one of the most common reasons adults visit their doctors — right up there with chest pain and fatigue. Although frequent dizzy spells or constant dizziness can keep you from doing much of anything, dizziness rarely signals a serious, life-threatening condition. Treatment of dizziness depends on the cause and your symptoms, but is usually effective.
CAUSES
The way dizziness makes you feel — such as the sensation of vertigo, a feeling of faintness or feeling as if you’ve lost your balance — provide clues for possible causes. Specific triggers, such as certain activities or positions, may give clues as to the underlying cause of your dizziness. The duration of any dizziness episodes and any additional symptoms you feel can also help pinpoint the exact cause.
Vertigo
Vertigo usually results from a sudden or temporary change in the activity of the balance structures in your inner ear (vestibular system) or in the balance structures’ connections into the brain. These connections sense movement and changes in your head position. Sitting up or moving around may make it worse. Sometimes vertigo is severe enough to cause nausea, vomiting and balance problems. But, the good news about vertigo is that it generally won’t last long. Within a couple of weeks, the body usually adapts to whatever is causing your dizziness.
Causes of vertigo may include:
- Benign paroxysmal positional vertigo (BPPV). BPPV causes intense, brief episodes of vertigo immediately following a change in the position of your head, often when you turn over in bed or sit up in the morning. BPPV is the most common cause of vertigo.
- Inflammation in the inner ear. Signs and symptoms of inflammation of your inner ear (acute vestibular neuritis) include the sudden onset of intense, constant vertigo that may persist for several days, along with nausea, vomiting and trouble with balance. These symptoms may be so severe that you have to stay in bed. When associated with sudden hearing loss, this condition is called labyrinthitis. Fortunately, vestibular neuritis generally subsides and clears up on its own. But, early medical treatment and vestibular rehabilitation therapy can be helpful in speeding recovery.
- Meniere’s disease. This disease involves the excessive buildup of fluid in your inner ear. It’s characterized by sudden episodes of vertigo lasting as long as several hours, accompanied by fluctuating hearing loss, ringing in the ear and a feeling of fullness in the affected ear.
- Vestibular migraine. Migraine is more than a headache disorder. Just as some people experience a visual “aura” with their migraines, others can get vertigo episodes and have other types of dizziness due to migraine even when they’re not having a severe headache. Such vertigo episodes can last hours to days and may be associated with headache as well as light and noise sensitivity.
- Acoustic neuroma. An acoustic neuroma (vestibular schwannoma) is a noncancerous (benign) growth on the vestibular nerve, which connects the inner ear to your brain. Symptoms of an acoustic neuroma generally include progressive hearing loss and tinnitus on one side accompanied by dizziness or imbalance.
- Other causes. Rarely, vertigo can be a symptom of a more serious neurological problem such as a stroke, brain hemorrhage or multiple sclerosis. In such cases, other neurological symptoms are usually present, such as double vision, slurred speech, facial weakness or numbness, limb coordination, or severe balance problems.
Feeling of faintness
Dizziness may make you feel faint and lightheaded without losing consciousness. Sometimes nausea, pale skin and clamminess accompany a feeling of faintness. Causes of this type of dizziness include:
- Drop in blood pressure (orthostatic hypotension). A dramatic drop in your systolic blood pressure — the higher number in your blood pressure reading — may result in lightheadedness or a feeling of faintness. It can occur after sitting up or standing too quickly.
- Inadequate output of blood from the heart. Certain conditions such as any of the various diseases of the heart muscle (cardiomyopathy), an abnormal heart rhythm (arrhythmia) or a decrease in blood volume may cause inadequate blood flow from your heart.
Loss of balance (disequilibrium)
Disequilibrium is the loss of balance or the feeling of unsteadiness when you walk. Causes may include:
- Inner ear (vestibular) problems. Abnormalities with your inner ear can cause you to feel like you are unsteady while walking, especially in the dark.
- Sensory disorders. Failing vision and nerve damage in your legs (peripheral neuropathy) are common in older adults and may result in difficulty maintaining your balance.
- Joint and muscle problems. Muscle weakness and osteoarthritis — the type of arthritis that involves wear and tear of your joints — can contribute to loss of balance when it involves your weight-bearing joints.
- Neurological conditions. Various neurological disorders can lead to progressive loss of balance, such as Parkinson’s disease and cerebellar ataxia.
- Medications. Loss of balance can be a side effect of certain medications, such as anti-seizure drugs, sedatives and tranquilizers.
Other dizzy sensations such as floating, swimming or heavy-headedness
Other “dizzy” sensations that are more difficult to describe may include feeling “spaced out” or having the sensation of spinning inside your head. Your doctor may refer to this as nonspecific dizziness. Some causes include:
- Medications. Blood pressure lowering medications may cause faintness if they lower your blood pressure too much. Many other medications can cause nonspecific feelings of dizziness that resolve when you stop the medication.
- Inner ear disorders. Some inner ear abnormalities can cause persistent, non-vertigo-type dizziness.
- Anxiety disorders. Certain anxiety disorders, such as panic attacks and a fear of leaving home or being in large, open spaces (agoraphobia), may cause dizziness. Sometimes one cause — such as a vestibular disorder — may produce symptoms, but then anxiety causes your dizziness to persist even after your inner ear problem has resolved.
- Low iron levels (anemia). Other signs and symptoms that may occur along with dizziness if you have anemia include fatigue, weakness and pale skin.
- Low blood sugar (hypoglycemia). This condition generally occurs in people with diabetes who use insulin. Dizziness may be accompanied by sweating and confusion.
- Ear infections. Sometimes, ear infections can cause dizziness. This type of dizziness will go away when the infection clears up.
- Overheating and dehydration. If you’re active in hot weather, or if you don’t drink enough fluids, you may feel dizzy from overheating (hyperthermia) or from dehydration. This is especially true if you take certain heart medications. Resting in a cool place and drinking water or a sports drink (Gatorade, Powerade, others) will usually help ease the dizzy feeling.
- Chronic subjective dizziness. This is a specific clinical syndrome characterized by persistent nonspecific dizziness that doesn’t have an obvious medical cause. Chronic subjective dizziness is associated with hypersensitivity to one’s own motion. This type of dizziness is made worse by complex visual environments (such as the grocery store), visual motion (such as a movie), visual patterns and precision visual tasks.
SYMPTOMS
Dizziness can usually be more specifically described as one of the following sensations:
- The false sense of motion or spinning (vertigo)
- Lightheadedness or the feeling of near fainting
- Loss of balance or unsteadiness (disequilibrium)
- Other sensations such as floating, swimming or heavy-headedness
A number of underlying health conditions can cause these problems. Some of these conditions disrupt or confuse the signals your brain receives from one or more of your sensory systems, including your:
- Eyes, which help you determine where your body is in space and how it’s moving
- Sensory nerves, which send messages to your brain about body movements and positions
- Inner ear, which houses sensors that help detect gravity and back-and-forth motion
When to see a doctor
See your doctor if you experience any unexplained, recurrent or severe dizziness.
Call 911 or emergency medical help or go to the emergency room if you experience new, severe dizziness or vertigo along with any of the following:
- Significant head injury
- A new, different or severe headache
- A very stiff neck
- Blurred vision
- Sudden hearing loss
- Trouble speaking
- Leg or arm weakness
- Loss of consciousness
- Falling or difficulty walking
- Chest pain or rapid slow heart rate
