What is dizziness?
Dizziness describes a variety of sensations, such as feeling weak, lightheaded, or woozy. When you’re dizzy, you may feel like you can’t hold your balance or that you might faint.
It commonly occurs when you haven’t had enough to eat or drink or when your iron intake is too low. It can happen from motion sickness, or it may be a side effect of a medication. But in rare cases, dizziness can be a sign of a serious medical condition, such as Parkinson’s disease. Dizziness is rarely a sign of a life-threatening illness.
Some studies have shown that females are 4.4 times more likely to experience vertigo. —Dr. Leila Mufdi
In some cases, your dizziness may actually be vertigo, which is a sensation that the room is spinning. Vertigo is caused by blockages or damage to the inner ear (the vestibular system).
Your inner ear plays an important role in keeping you balanced. So any inner ear problems can make you feel unsteady. People with vertigo may also experience nausea and vomiting. The condition is most noticeable when you change your position, especially moving from sitting to a standing position.
Treatment may include supplements, medications such as antihistamines and nausea medications, physical therapy, and staying hydrated.
1. Benign paroxysmal positional vertigo
- Sudden vertigo when you move your head
- Abnormal eye movements (nystagmus)
- Balance problems
While there are several types of vertigo, benign paroxysmal positional vertigo (BPPV) is the most common. About 2.5% of people will experience BPPV in their lifetime, according to a study in the Journal of Neurology, Neurosurgery, and Psychiatry. Symptoms range from mild to severe and usually last for just a few minutes. They often disappear on their own but can come back in 15% to 20% of people.
BPPV occurs when calcium carbonate crystals that are normally found in a part of your inner ear break free and travel to the nearby canals. These canals detect motion. When the crystals enter the canals, your brain may receive incorrect signals about your body’s position. This causes a spinning sensation when you move your head or change positions.
Treating benign paroxysmal positional vertigo
If you have BPPV, your doctor may recommend exercises that help reposition the crystals. You may also need to work with a physical therapist.
If your symptoms continue, antihistamines or nausea medication may help. If these don’t control your symptoms, your doctor may recommend benzodiazepines such as Valium.
2. Vestibular neuritis and labyrinthitis
- Abnormal eye movements (nystagmus)
- Unsteady gait
Vestibular neuritis and labyrinthitis are inner ear conditions caused by inflammation. Vestibular neuritis affects the vestibular nerve, while labyrinthitis affects the labyrinth, which helps control your balance. The swelling created by the inflammation can lead to vertigo.
Vestibular neuritis and labyrinthitis usually follow a viral infection such as the common cold, influenza, mumps, or measles. In rare cases, it can be caused by bacteria, though this is more common in children. Risk factors include a middle ear infection, meningitis, and autoimmune disorders.
Treating vestibular neuritis
Vestibular neuritis and labyrinthitis can be treated with antihistamines, nausea medication, and benzodiazepines.
If the infection is bacterial, you’ll be given antibiotics. Your doctor may also prescribe steroids such as prednisone to help reduce inflammation. Sometimes, physical therapy may be recommended. The swelling usually goes away over several weeks.
3. Meniere’s disease
Meniere’s disease is a chronic condition that affects the inner ear. It is thought to be caused by too much fluid in the inner ear, but it’s not clear why the fluid accumulates. Possible triggers include viral infections, improper fluid drainage, an abnormal immune response, and genetics.
Treating Meniere’s disease
Meniere’s disease can cause permanent hearing loss, so it’s important to see your doctor as soon as possible. There’s no cure, but it can be treated over the long term with medication such as diuretics. Your doctor will also recommend medications to take during an attack, such as anti-nausea medications and Valium.
4. Circulation issues
If you have poor blood flow, your brain may not get enough oxygen-rich blood. This can make you feel lightheaded or even lead to fainting. Circulation issues that can cause dizziness include blood clots, clogged arteries, heart failure, and an irregular heartbeat. Medications may also cause circulation issues.
Treating circulation problems
Your doctor may do an EKG or blood tests. In some cases, you may be referred to a cardiologist. If your symptoms are related to issues with your heart, you may need to take medications or have a procedure such as a pacemaker placement.
5. Nerve problems
- Difficulty walking
- Feeling like you might fall
Neurological problems can make you feel lightheaded and off balance. For example, peripheral neuropathy (damage to the nerves in your legs) can cause unsteadiness, along with shooting or burning nerve pain. Neuropathy has several causes, including vitamin deficiencies (such as vitamin B12), excessive alcohol intake, and diabetes.
Other neurological conditions that affect your balance include cervical spondylitis (wear and tear of the discs in your neck), stroke, and Parkinson’s disease.
Treating nerve problems
Nerve problems tend to be long-lasting and may worsen over time. Treatment varies depending on the type of nerve issue. You may need to change your diet, stop drinking, or take pain medication. You may need other medications to treat underlying conditions.
Other possible causes
There are several other types of conditions that cause dizziness. These include:
- Not eating or drinking enough
- Motion sickness
- Anxiety disorders
- Carbon monoxide poisoning
- Iron deficiency anemia
- Low blood sugar
- Heat-related illnesses
- Orthostatic hypotension (a form of low blood pressure that happens when you stand up)
Some medications can make you feel dizzy, such as:
- Blood pressure medication
- Anti-seizure medications
Because people use dizziness to describe a variety of feelings, the most important part of an evaluation is to listen to the description of the symptoms in the patient’s own words. Figuring out whether they mean by lightheadedness, spinning, or feeling off balance can help determine what type of evaluation and treatment might be effective. —Dr. Mufdi
When to call the doctor
See your doctor if you have:
- Persistent dizziness
- Dizziness that limits your ability to function
- Nausea and vomiting that you haven’t been able to control at home
- Persistent ringing in your ears
Should I go to the ER for dizziness?
Get medical attention right away if you have:
- Significant problems walking
- New weakness or numbness
- An intense headache you haven’t had in the past
- Chest pain
- Trouble breathing
- Changes in the color of your skin
- Slurred speech
- Paralysis on one side of your body
Once your doctor knows what is causing your symptoms, ask for guidance on what to expect. Will my symptoms linger? What can I do to prevent them? —Dr. Mufdi
- Drinking plenty of fluids
- Changing positions slowly
- Avoiding extreme temperatures
- Wearing compression socks to limit pooling of blood in the legs
- Exercises to reposition the calcium carbonate crystals in your ear
Other treatment options
- IV fluids
- Medications such as antihistamines, nausea medications, and benzodiazepines
- Steroids such as prednisone
- Pain medication
- Vitamin supplements
- Physical therapy
- Implanted devices such as a pacemaker
Dr. Mufdi is a board-certified emergency medicine physician. She obtained her undergraduate degree in neurobiological sciences at the University of Florida. She attended Chicago College of Osteopathic Medicine and completed an emergency medicine residency at Albert Einstein Medical Center in Philadelphia. Recognizing the value of health literacy, she is happy to have joined Buoy Health in 2021.