Dizziness

What is dizziness?

Ah, that is the million dollar question. "Feeling dizzy" means different things to different people. Or even to the same person in different situations. Most commonly it is used to describe one of the following sensations:

• Vertigo, which is a feeling of spinning around.
• Feeling faint or light-headed, as if about to pass out or collapse.
• Loss of normal balance, ie being unsteady but without feeling faint or whirly.

When you go to a doctor saying you feel "dizzy", you are giving them a real challenge. Because the word "dizzy" describes several symptoms, and a vast number of conditions can cause dizziness. Your doctor should, however, be able to narrow it down, by finding out exactly what you personally mean by dizziness, and asking about other symptoms.

Why do I feel dizzy?

Well, again, it is going to depend on what you personally mean by dizziness. If you have vertigo, ie you feel as if you or the world around you is spinning or moving, then the most common causes are inner ear problems.

Other than confusing your inner ear balance system by riding on a playground roundabout or the teacups ride at the fair, or by turning a load of pirouettes, the causes include:

• Inner ear infections, such as labyrinthitis or vestibular neuritis.
• Benign paroxysmal positional vertigo (BPPV), a condition where certain movements of your head set off a spinning sensation.
• Ménière's disease.
• Migraine.

Read more about these conditions and other causes of vertigo in our separate leaflet called Vertigo.

What causes dizziness?

If, by dizziness, you mean feeling faint or light-headed, then conditions originating anywhere in your body may be the cause. For example:

• Having a high temperature (fever).
• Very hot weather.
• Side-effects of certain medicines.
• Panic attacks and anxiety.
• Problems with your heart rate - for example, your heart going too fast, too slow or not regularly.
• Low iron levels (and other causes of anaemia).
• A drop in your blood pressure when you stand up (orthostatic hypotension).
• Motion sickness.
• Low blood sugar levels.

People who feel faint often say they feel "light-headed" and feel as if they may collapse unless they sit or lie down. This is sometimes described as feeling dizzy. Most of us can remember times when we have felt like this. For example, when we have been ill with a high temperature (fever), very hungry, or very emotional. However, some people have repeated episodes of feeling faint without an obvious explanation such as a fever.

Orthostatic hypotension

This means your blood pressure drops when you sit up from lying, or when you stand up from sitting or lying. In particular, if you jump up out of bed after a night's sleep. The fall in blood pressure is just for a short time as the blood pressure quickly adjusts to your new posture. However, in some people the fainting feeling can be more severe and last for a few minutes. This problem tends to get more troublesome as you become older. It has also been associated with long COVID.

Anaemia

Symptom of anaemia include tiredness and shortness of breath. However, if you have anaemia you may not get sufficient oxygen to the brain. This can make you feel light-headed.

Arrhythmias and other heart problems

An arrhythmia is an abnormal heart rhythm. It occurs when the heart may suddenly beat too fast, too slowly, or in an abnormal way. There are various causes. One of the symptoms of an arrhythmia is to feel faint or light-headed as there may be a sudden decrease in blood supply to the brain as the arrhythmia develops. See the separate leaflet called Abnormal Heart Rhythms (Arrhythmias) for more details.

Various other heart disorders may cause a reduced flow of blood to the brain and cause you to feel faint or light-headed.

Anxiety

In particular, if you have anxiety with panic attacks you can feel light-headed. This can get worse if you over-breathe (hyperventilate) due to the anxiety or panic attack.

Medication

Feeling faint and/or light-headed is sometimes a side-effect of some medicines. It is always worth reading the information leaflet that comes in the drug packet to check if dizziness is a recognised side-effect.

And if you mean the type of dizziness where you don't feel you or the room are spinning and you don't feel faint, but you just feel unbalanced, then there are yet more possible causes.

These also can start from problems of various body organs and systems, such as your ear, your brain, your nervous system and your general state of health. Alcohol, street drugs and various medicines can also make you feel off-balance, and affect different people differently.

Should I worry about dizziness?

If you are getting recurring dizzy spells, or a constant dizziness for which there is no obvious cause, then see your doctor. If you have dizziness with other alarming symptoms (such as sudden weakness in your arms, legs or face muscles, or chest pain or feeling very breathless), then call an ambulance or consult a doctor urgently.

When do I need to see a doctor for dizziness?

It is usually best to have an explanation for dizziness. If you have a prolonged episode of dizziness, or recurring episodes of dizziness and are not sure what is causing them, then it is wise to contact a doctor. In particular, if you have other symptoms in addition to the dizziness, such as:

• Headache, especially if it is severe, or a different kind of headache to ones you usually get.
• Hearing or visual loss.
• Problems with speech.
• Weakness of arms or legs.
• Difficulty walking.
• Collapse, or periods of unconsciousness.
• Numbness in areas of your body.
• Chest pain.
• An abnormally slow or fast pulse.
• An irregular pulse.
• Any other symptom that you cannot explain.

If any of these symptoms have come on suddenly, contact a doctor immediately. Dizziness associated with a loss of consciousness that occurs during exercise needs urgent medical attention.

With this number of possibilities, it isn't all that surprising that a cause is not always found. Indeed, it is estimated that in one out of every five people complaining of dizziness who go to the doctor, a cause is never found. Fortunately even if the cause hasn't been found, the symptom of dizziness often settles in time.

How do we keep our balance?

Your brain constantly receives nerve messages from various parts of the body to tell you where you are and what position you are in. The three main sources of these nerve messages are:

• Your eyes - what you look at helps your brain to tell what position you are in and how you are moving.
• Nerve messages from your skin, muscles and joints help your brain to tell the positions of your arms, legs and other parts of your body.
• Your inner ears. The inner ear includes the cochlea, vestibule and semicircular canals in which there is a system of narrow fluid-filled channels called the labyrinth. The cochlea is concerned with hearing. The three semicircular canals help to control balance and posture. Head movements are sensed because when moving your head, the fluid in the labyrinth within the semicircular canals moves too. The movement of the fluid moves tiny fine hairs that are on the inside lining of the labyrinth. When the hairs move, this triggers messages to be sent to the brain via a nerve called the vestibular nerve. This gives the brain information about the movement and position of your head, even when your eyes are closed.

Cross-section of the ear

Inner ear diagram

To be free of dizziness and to have good balance, it is best to have all of these (eyes, nerve signals from the skin muscles and joints, and inner ears) working normally. However, if you shut your eyes, you will normally still have a good sense of balance and know the position of your head and other body parts. This is because of the nerve messages that are sent to your brain from your inner ears, and other parts of your body.

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What is meant by dizziness due to balance problems?

In this type of dizziness you do not have vertigo and are not light-headed or feeling faint. However, you feel unsteady on your feet and feel as if you may fall over when you walk, due to unsteadiness.

Complications of dizziness

The complications will depend on the type of dizziness and the cause, but if the dizziness causes a fall then you may also suffer an injury from that fall.

What can cause loss of balance?

This can be caused by various conditions. These include the following.

Ear problems

Some inner ear conditions can cause balance problems without the spinning sensation of vertigo - for example, an inner ear injury.

Nerve disorders

Various disorders which cause the nerves in the legs not to work properly can cause unsteadiness. For example, peripheral neuropathy, multiple sclerosis, etc.

Brain disorders

Various problems in the brain, such as a stroke, or a brain tumour, can cause balance problems. These occur if the affected part of the brain is a part that helps to control posture and balance. There will usually be other symptoms too.

General frailty

General frailty and/or being seriously ill with another illness may lead to loss of balance. You will usually have other symptoms in addition to problems with balance.

Alcohol and drugs

Your balance can be affected by drinking too much alcohol or taking some street drugs.

What tests are done for dizziness?

A doctor is likely to examine you. Sometimes the doctor can tell you the cause of the dizziness from your symptoms and the result of the examination. In some cases, various tests may be organised to find the cause of the dizziness.

Your doctor will firstly need to ask you some questions about the dizziness. Is it constant or in attacks? Is it the world-is-spinning type of dizziness or a loss of balance, or do you feel faint or light-headed?

Do you have other symptoms with it, such as being sick, hearing problems, a ringing in the ear (dizziness), headaches, palpitations, etc? Does it come on in certain situations - for example, when you move your head from one side to the other? Are you taking any medicines?

The doctor will then need to examine you. What this involves will depend on the information gleaned from the answers above, but might include:

• Taking your temperature.
• Examining your ear.
• Examining your eyes and their movements.
• Checking your pulse and blood pressure.
• Checking your balance and co-ordination.
• Looking for any weakness in the muscles of your arms, legs or face.
• Tests which look for dizziness in certain positions or position changes.

Depending on what has been established from the above, further tests might be relevant. These will differ depending on which diagnosis is suspected, but might include:

• A hearing test.
• A blood test - for example, to test you for anaemia.
• A magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan.
• Specialist tests for inner ear function and balance.
• Heart tests: a heart tracing (electrocardiogram, or ECG), a heart ultrasound scan (echocardiogram) or a heart monitor.

Dizziness treatment

The treatment depends on the cause. Your doctor will be able to advise you regarding this. It will entirely depend on the type of dizziness and what has caused it. For example:

• Labyrinthitis usually improves on its own over time.
• Benign paroxysmal positional vertigo (BPPV) can be cured by a series of manoeuvres involving tilting your head in certain ways to move debris in the semicircular canals of the inner ear. You can do these at home - an example is in the further reading section of this leaflet.
• Dizziness caused by a problem with the heart rhythm or rate is treated by putting the heart rate right - for example, by medicines, a pacemaker or a procedure done directly on the heart.
• Dizziness caused by medication is usually easily solved by reducing the dose of, changing or stopping the medicine in question.
• Dizziness due to panic attacks or anxiety is solved by treating these conditions directly with talking treatments or medicines. Examples of possible treatments include cognitive behavioural therapy, beta-blocker medicines or antidepressant medicines.

Is there anything I can take for dizziness?

Sometimes you need a medicine for the symptom of dizziness. This might be while you wait for it to get better (for example, labyrinthitis) or while you are waiting for tests to find out the cause, or because you have a condition which can't easily be cured.

For the vertigo type of dizziness, tablets called prochlorperazine or cinnarizine are often prescribed. These do not cure the underlying problem but they help you feel better until it goes away. These do not work so well for the light-headed/faint type of dizziness or for loss of balance.

Can dizziness be prevented?

Staying well hydrated and not leaving too long between meals can help prevent some types of light-headedness, but as dizziness has so many different meanings and causes, it isn't correct to say that it can always be prevented.