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Seeing stars again? Dizziness is a sensation most people know and experience during their lifetime.
However, if you experience more than the occasional unsteadiness from standing up or turning around too fast, there might be a cause — and solution — for your symptoms.
What is dizziness?
Dizziness is a feeling of spatial disorientation without motion. Doctors who see patients experiencing dizziness first try to determine if the sensation seems more like lightheadedness, unsteadiness and feeling faint, or what’s called vertigo. Vertigo is the sensation that you might feel like you are spinning, whirling or tilting even when you’re standing still. Other important factors doctors consider in diagnosis are any triggers for dizziness and how long the symptoms last.
Dizziness can relate to broader medical conditions, including neurologic disorders, vision loss, muscle weakness or arthritis, heart disease, diabetes, migraine, anxiety or cognitive changes. This is why tracking your symptoms is essential.
Dizziness can have many causes, including low blood pressure, dehydration and medications. Vertigo, however, tends to involve a disorder of our vestibular system, most often in the inner or middle ear, but can also affect the areas of the brain involved in balance.
After you discover the best way to describe the type of dizziness you feel, it can be easier to understand the cause of the dizziness, says Dr. Clifford Hume, associate professor of Head and Neck Surgery at the UW School of Medicine and an otolaryngologist (ENT) at VA Puget Sound and Otolaryngology-Head and Neck Surgery Center at UW Medical Center – Montlake.
Other, more specific definitions of dizziness include:
- Vertigo: self-motion or distorted sense of motion of self or environment.
- Unsteadiness: feeling unstable or imbalanced when seated, standing or during movement.
- Presyncope: the impending loss of consciousness or near fainting.
- Syncope (faint): transient loss of consciousness, loss of control, falling.
Other types of dizziness can be harder to describe, such as the common “brain fog” or feeling spacey.
5 causes of dizzy spells
Hume says that about 15% of primary care visits include symptoms of dizziness. But what could cause the unsteady feeling? When you chat with your doctor about how you’re feeling, they might suggest one of these potential reasons.
Vestibular (inner ear)
An inner ear condition could trigger your dizziness. Hume outlines three kinds of vestibular conditions that may cause your symptoms: benign paroxysmal vertigo (BPPV), vestibular neuronitis/labyrinthitis, and Ménière’s disease.
While these are all inner ear conditions, the causes and outcomes vary. Middle ear infections can also cause dizziness, but these are typically associated with decreased hearing and/or pain or drainage from the ear.
In the event of a BPPV diagnosis, you’ll experience brief symptoms of vertigo.
“This common condition is caused by inner ear crystals or otoliths that dislodge into balance canals,” says Hume.
This condition is a short-lasting (seconds to a minute) episode of vertigo, typically triggered by rolling over in bed or bending over. Although vertigo attacks are short, they can repeatedly recur with triggers.
Usually, in between attacks, someone with these symptoms will typically feel pretty normal. With repositioning maneuvers, BPPV can be treated by helping the otoliths dislodge from the balance canals. If these symptoms persist, it may be best to see a physical therapist specializing in balance problems for treatment.
Hume describes vestibular neuronitis/labyrinthitis as a viral inflammation of the inner ear or the balance nerve. This condition can cause debilitating dizziness for an intermediate length of time, ranging from minutes to days, or can last longer in more chronic cases. Symptoms usually improve within a few days but can linger over weeks with occasional flare-ups.
Finally, Ménière’s disease is a condition in which inner ear fluid is imbalanced, which can cause vertigo attacks combined with ringing in the ear and hearing loss.
“This can cause fluctuating, progressive hearing loss and tinnitus in some,” says Hume.
Less than 1% of the population is diagnosed with this condition, and its symptoms can last anywhere from 20 minutes to 12 hours. Repeat Ménière’s attacks can occur over the span of years but gradually wane. Treatment is usually initiated by an otolaryngologist and starts with trigger and diet counseling and sometimes diuretics. Many migraine symptoms overlap with Ménière’s, and there may be a similar underlying biologic origin.
In some cases, vestibular testing with an otolaryngologist can assess the degree of damage, if any, to your balance pathways with any of these conditions. Vestibular therapy (specialized physical therapy) is often helpful if symptoms persist.
Cardiovascular
Heart-related issues can also cause dizziness — and there might be a variety of reasons for this.
“Hypotension (low blood pressure) can lead to changes in blood flow to the brain, causing dizziness, lightheadedness or vertigo,” says Hume. Orthostatic (or postural) hypotension is when these symptoms are triggered by standing up from a sitting or lying down position.
Additionally, hypertension (high blood pressure) or fluctuating blood pressure can cause symptoms of dizziness. The pressure at which blood is driven to the brain, known as cerebrovascular perfusion pressure, can be affected by vascular disease, lack of normal responsiveness to posture changes (think: blood pressure medication side effects), dehydration or age-related changes in the elasticity of blood vessels.
“Testing that is sometimes useful in evaluating the role of cerebrovascular perfusion in dizziness includes orthostatic blood pressure testing, tilt table autonomic testing, an ultrasound of the neck with carotid doppler or transcranial doppler, sometimes with a head turning during test.”
Neurologic
Your doctor might find that your brain is the culprit for your dizziness. Conditions such as migraines, strokes, multiple sclerosis (MS) or other neurological conditions can present dizziness as a noticeable symptom.
“Migraines are a very common cause of dizziness,” says Hume. “It’s the most common cause of persistent vertigo lasting hours in the younger population. The frequency increases again in perimenopause.” The dizziness of a migraine does not need to coincide with a headache.
Psychogenic
Many people with anxiety have found dizziness to coexist with their anxiety symptoms.
Other conditions include persistent postural perceptual dizziness (PPPD), which acute medical illnesses can trigger, and environmental or social stimuli, like large crowds. PPPD does not typically present as symptoms of vertigo.
No clear diagnosis
Sometimes, there’s no apparent reason or diagnosis for dizziness. That can be frustrating. However, by working with your doctor, you can find treatment options. It’s always a good idea to review any possible interactions between medications that can cause dizziness. When the potentially concerning causes are eliminated, there could be medications to help alleviate your symptoms so you start feeling more stable.
Who does dizziness affect?
Dizziness can affect anyone but tends to vary according to age.
“Dizziness is more common with aging,” says Hume. “In younger individuals, migraines, PPD and BPPV are the most common causes of dizziness. In older individuals, neurologic conditions, cardiovascular conditions and BPPV are common causes of dizziness.”
Some people are more likely to experience dizziness than others, and sometimes, persistent feelings of dizziness should raise some red flags.
“With persistent vertigo, especially with other neurological symptoms, it’s important to have a full evaluation in the emergency room (ER) to exclude a potential stroke. This may or may not include the need for brain imaging,” says Hume.
The American Associate of Neurologic Surgeons lists symptoms such as dizziness, facial drooping, weakness and numbness in the face, arm or leg, nausea, vomiting, severe headache, confusion, disorientation, memory loss, slurred speech, loss of vision, loss of balance and more as some of these important-to-notice symptoms of a stroke.
How to treat dizziness
In most cases, a focused physical exam and detailed history can often lead to a diagnosis, help you assess the risks and create a treatment plan.
For quick, short-term treatment, try decreasing your movement and limiting visual and other sensory stimulation, and if your symptoms are mild, sitting or lying down when the dizzy spells hit could help. Avoid sudden changes in position and bright lights, and drink water if you’re feeling thirsty. If you have other symptoms of a middle ear infection, see your doctor to start treatment, which could include oral antibiotics or ear drops.
If it’s your first time experiencing dizziness, your dizziness feels different than usual, or your dizziness doesn’t go away quickly, it’s important to reach out to your doctor to let them know how you’re feeling. And for more severe cases, such as the presence of a fast heartbeat, shortness of breath, chest pain or slurred speech, calling 911 might be necessary.
“For most causes other than BPPV, vestibular suppressants can help, but should be tapered as soon as possible to allow recovery,” says Hume.
For longer-term solutions, there are medications your doctor can prescribe to help with your symptoms, depending on the cause of your dizziness.
Overall, it’s possible to manage your dizziness with some help from your doctor. Start recording your symptoms so you can work toward a life that feels a little steadier.
