Dizziness; Causes, Symptoms, Diagnosis, Treatment

Dizziness is a feeling of being unsteady but can refer to different sensations including vertigo, feeling faint and problems with balance. This leaflet gives a brief overview of the causes of dizziness. There are separate, more detailed leaflets for some of the conditions listed.

Mechanism of Dizziness

Many conditions cause dizziness because multiple parts of the body are required for maintaining balance including the inner ear, eyes, muscles, skeleton, and the nervous system.

Common physiological causes of dizziness include

• inadequate blood supply to the brain due to a sudden fall in blood pressure & heart problems or artery blockages
• loss or distortion of vision or visual cues
• disorders of the inner ear
• distortion of brain/nervous function by medications such as anticonvulsants and sedatives
• the result of side effect of prescription drugs, including proton-pump inhibitor drugs (PPIs) and Coumadin (warfarin) causing dizziness/fainting

Types of Dizziness

The clinical approach to the dizzy patient depends crucially on distinguishing among these various kinds of dizziness since the differential diagnosis is peculiar to each type.

• Vertigo refers to the illusion of environmental motion, classically described as “spinning” or “whirling.” The sense of motion is usually rotatory—”like getting off a merry-go-round”—but it may be more linear—”the ground tilts up and down, like being on a boat at sea.” Disorientation in space and some sense of illusory motion are the common denominators here. Vertigo always reflects dysfunction at some level of the vestibular system, and these problems are discussed in.
• Disequilibrium represents a disturbance in balance or coordination such that confident ambulation is impaired. Symptomatically, some such patients clearly profess that “the problem is in my legs,” but others feel “dizzy in the head, too.” Common to all patients with disequilibrium is the perception that ambulation either causes the problem or clearly makes it worse. Observation of the patient’s gait and a careful neurologic examination are thus essential in evaluating this type of dizziness.
• (Pre)syncope means that the patient senses the impending loss of consciousness. When the patient has, in fact, experienced true syncope (actual loss of consciousness), considerations in apply. When the patient has not ever actually lost consciousness, the complaint “I feel like I will pass out” should be viewed skeptically, since other types of dizziness may be so described. In such circumstances, the approach to syncope in may or may not be pertinent.
• Lightheadedness is very difficult to describe without using the word “dizzy,” but this verbal imprecision is, in fact, very helpful to the clinician. Lightheadedness refers to a sensation “in the head” that is clearly not vertiginous or presyncopal, and that is not invariably related to ambulation. This vague “negative definition” emphasizes that the lightheaded patient’s description is always hazily imprecise, and even articulate patients are frustrated by the request to describe the feeling without saying “dizzy.

Causes of Dizziness

Inner ear problems that cause dizziness (vertigo)

Your sense of balance depends on the combined input from the various parts of your sensory system. These include 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

Vertigo is the false sense that your surroundings are spinning or moving. With inner ear disorders, your brain receives signals from the inner ear that aren’t consistent with what your eyes and sensory nerves are receiving. Vertigo is what results as your brain works to sort out the confusion.

• Benign paroxysmal positional vertigo (BPPV)– This condition causes an intense and brief but false sense that you’re spinning or moving. These episodes are triggered by a rapid change in head movement, such as when you turn over in bed, sit up or experience a blow to the head. BPPV is the most common cause of vertigo.
• Infection -A viral infection of the vestibular nerve – called vestibular neuritis, can cause intense, constant vertigo. If you also have a sudden hearing loss, you may have labyrinthitis.
• 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. You may also experience fluctuating hearing loss, ringing in the ear and the feeling of a plugged ear.
• A migraine – People who experience migraines may have episodes of vertigo or other types of dizziness even when they’re not having a severe headache. Such vertigo episodes can last minutes to hours and may be associated with a headache as well as light and noise sensitivity.

Circulation problems that cause dizziness

You may feel dizzy, faint or off balance if your heart isn’t pumping enough blood to your brain. Causes include

• Drop in blood pressure – A dramatic drop in your systolic blood pressure — the higher number in your blood pressure reading — may result in brief lightheadedness or a feeling of faintness. It can occur after sitting up or standing too quickly. This condition is also called orthostatic hypotension.
• Poor blood circulation-Conditions such as cardiomyopathy, heart attack, heart arrhythmia and transient ischemic attack could cause dizziness. And a decrease in blood volume may cause inadequate blood flow to your brain or inner ear.

Other causes of dizziness

• Neurological conditions –Some neurological disorders — such as Parkinson’s disease and multiple sclerosis — can lead to progressive loss of balance.
• Medications – Dizziness can be a side effect of certain medications — such as anti-seizure drugs, antidepressants, sedatives, and tranquilizers. In particular, blood pressure lowering medications may cause faintness if they lower your blood pressure too much.
• Anxiety disorders – Certain anxiety disorders may cause lightheadedness or a woozy feeling often referred to as dizziness. These include panic attacks and a fear of leaving home or being in large, open spaces (agoraphobia).
• 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 (lightheadedness) may be accompanied by sweating and anxiety.
• 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.

People experiencing dizziness may describe it as any of a number of sensations, such as:

• A false sense of motion or spinning (vertigo)
• Lightheadedness or feeling faint
• Unsteadiness or a loss of balance
• A feeling of floating, wooziness or heavy-headedness
• Stress
• Anxiety
• Low blood sugar levels (hypoglycemia) that can affect people with diabetes, also called ‘hypos’
• Blood pressure falling when standing up called postural hypotension, that can affect older people
• Dehydration
• Heat exhaustion
• Lack of blood flow to the brain called vertebrobasilar insufficiency
• Neurological (brain) conditions, including stroke and multiple sclerosis (MS)
• Anemia
• Alcohol abuse
• Drug abuse
• Side-effects of some medication
• Irregular heartbeat
• Carbon monoxide poisoning
• Head injury
• Vision problems, adjusting to new glasses
• Sea, air or rail travel – along with travel sickness or motion sickness.

Symptom of Dizziness

Dizziness, in itself, can be a symptom of some illness and is often accompanied by other symptoms.

• A false sense of motion or spinning (vertigo)
• Lightheadedness or feeling faint
• Unsteadiness or a loss of balance
• A feeling of floating, wooziness or heavy-headedness
• Weakness
• Nausea
• Stomach ache
• A headache
• Chest congestion
• Vertigo
• Lightheadedness
• Weakness in legs

The medical conditions that often have dizziness as a symptom include

• Benign paroxysmal positional vertigo
• Meniere’s disease
• Vestibular neuronitis
• Labyrinthitis
• Otitis media
• Brain tumor
• Acoustic neuroma
• Motion sickness
• Ramsay Hunt syndrome
• A migraine
• Multiple sclerosis
• Pregnancy
• low blood pressure (hypotension)
• low blood oxygen content (hypoxemia)
• heart attack
• iron deficiency (anemia)
• low blood sugar (hypoglycemia)
• hormonal changes (e.g. thyroid disease, menstruation, pregnancy)
• panic disorder
• hyperventilation
• anxiety
• depression
• age-diminished visual, balance, and perception of spatial orientation abilities

Diagnosis of Dizziness

• Complete blood count (CBC) to screen for anemia or infection
• Electrolyte levels
• Blood sugar tests
• Kidney function tests
• Thyroid tests

X-rays, CT scans, and MRI may be indicated depending upon the patient’s needs.

• Eye movement testing– Your doctor may watch the path of your eyes when you track a moving object. And you may be given an eye motion test in which cold and warm water or air are placed in your ear canal.
• Head movement testing– If your doctor suspects your vertigo is caused by benign paroxysmal positional vertigo, he or she may do a simple head movement test called the Dix-Hallpike maneuver to verify the diagnosis.
• Posturography – This test tells your doctor which parts of the balance system you rely on the most and which parts may be giving you problems. You stand in your bare feet on a platform and try to keep your balance under various conditions.
• Rotary-chair testing- During this test you sit in a computer-controlled chair that moves very slowly in a full circle. At faster speeds, it moves back and forth in a very small arc.
• ENG (electro-nystagmography) checking eye movements while sitting down
• Caloric Test – checking balance in each ear alongside eye movements
• SVV/SVH short for subjective visual vertical or horizontal carried out in a dark room using lasers
• Posturography -to check balance test while standing on a platform
• Dix Hallpike Manoeuvre – to check for a build-up of crystals in the inner ear
• VEMP Test (vestibular evoked myogenic potential) – to check balance while moving the head.

Treatment of Dizziness

Medications

• Water pills –  If you have Meniere’s disease, your doctor may prescribe a water pill (diuretic). This along with a low-salt diet may help reduce how often you have dizziness episodes.
• Medications that reduce the dizziness – Antihistamines such as meclizine may offer short-term relief from vertigo. Anticholinergics help reduce dizziness. They include scopolamine skin patches.
• Anti-nausea medications – Your doctor may prescribe a drug to provide immediate relief of nausea. Some of these can cause drowsiness.
• Anti-anxiety medications – Diazepam and alprazolam are in a class of drugs called benzodiazepines, which may cause addiction. They may also cause drowsiness.
• Preventive medicine for a migraine -Certain medicines may help prevent attacks of a migraine.
• Dehydration – Drink more amounts of liquids or fluids and in cases where you are unable to drink water then intravenous administration may be preferred
• Fever or infection – Medications for fever or antibiotics to treat infections may be prescribed
• If dizziness is due to heart conditions or anxiety related disorders necessary treatment may be initiated
• Vertigo from BPPV or labyrinthitis is often treated with vestibular rehabilitation exercises, also referred to as Epley maneuvers. It involves positioning and manipulating the patients head to remove the crystals from the semicircular canals and thus reducing the inflammation.
• Medications such as diazepam and meclizine may be prescribed to reduce the inflammation within the vestibular system
• Your doctor may recommend a soft collar to restrict the range of motion of the head
• Antiviral medications such as acyclovir or valacyclovir may be prescribed for viral infections causing the labyrinthitis
• Surgery may be needed in patients with acoustic neuroma or other anatomical disorders of the ear.

Therapy of Dizziness

• Head position maneuvers – A technique called canalith repositioning (or Epley maneuver) usually helps resolve benign paroxysmal positional vertigo more quickly than simply waiting for your dizziness to go away. It can be done by your doctor, an audiologist or a physical therapist and involves maneuvering the position of your head. It’s usually effective after one or two treatments. Before undergoing this procedure, tell your care provider if you have a neck or back condition, a detached retina or blood vessel problems.
• Balance therapy –You may learn specific exercises to help make your balance system less sensitive to motion. This physical therapy technique is called vestibular rehabilitation. It is used for people with dizziness from inner ear conditions such as vestibular neuritis.
• Psychotherapy – This type of therapy may help people whose dizziness is caused by anxiety disorders.

Certain foods and nutrients may help relieve symptoms of dizziness.

Water

A common cause of dizziness is dehydration. If you feel tired and thirsty and have less frequent urination when you’re dizzy, try drinking water and staying hydrated.

Ginger

Ginger may help relieve symptoms of motion sickness. It may help also treat nausea in pregnant women. You can take ginger in many forms. Incorporate fresh or ground ginger into your diet, drink ginger tea, or take it in supplement form. However, you should always consult your doctor before taking any kind of supplement, even if it’s natural. Supplements can interfere with other medical conditions you have or medications you take.

Vitamin C

According to the Meniere’s Society, consuming vitamin C can reduce vertigo in people with Meniere’s disease. Foods rich in vitamin C include:

• oranges
• grapefruits
• strawberries
• bell peppers

Vitamin E

Vitamin E can help maintain the elasticity of blood vessels, which can help prevent circulation problems. Vitamin E can be found in:

• wheat germ
• seeds
• nuts
• kiwis
• spinach

Vitamin B-6

Foods rich in vitamin B-6 may also help treat dizziness. Some research has found that vitamin B-6 supplements helped reduce drug-induced vertigo symptoms. However, more research is needed.

Vitamin B-6 can also help prevent anemia. This vitamin can be found in foods such as:

• pistachios
• tuna
• turkey
• lean pork
• prunes
• apricots

Iron

If your doctor thinks you have anemia, they may encourage you to get more iron. Iron can be found in foods such as:

• red meat
• poultry
• beans
• dark leafy greens

References

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