Many different conditions can cause dizziness or sensations of being off-balance, for example, certain heart conditions, or blood disorders like anaemia. However, if you have been referred to a neurologist or an otologist, general conditions like these will usually have already been ruled out.
Dizziness is also the unwanted side effect of many different medications. You should discuss any concerns you have about medication with your GP or pharmacist.
Travelling by road, rail, air or sea can cause motion or travel sickness. The common symptoms are dizziness, nausea (feeling sick) and vomiting (being sick).
Stress or anxiety
Being stressed, anxious, tense or irritable can also provoke dizziness or a sense of imbalance. This can lead to a vicious circle effect as feeling dizzy in itself can lead to feeling stressed, anxious or depressed. Meditation has been known to help with anxiety and stress, as well as talking to a psychologist or having CBT therapy. Prioritising your own relaxation time can also relieve signs of stress. Things such as exercising, taking a walk in nature, having a relaxing bath, or listening to a calming piece of music, may help to relax you. Some people also find aromatherapy helps them relax – lavender is a popular fragrance, although this might make you sleepy. It is important to note that different people find different activities relaxing, so do what best suits you.
Low blood sugar level (hypoglycaemia)
Low blood sugar (glucose) levels can lead to dizziness – this is because your body doesn’t have the energy it needs to function properly. This is most common in people with diabetes. If someone with diabetes misses a meal, exerts themselves too much, or takes too much insulin, this may lead to low blood sugar.
Symptoms of low blood sugar are feeling hungry, trembling or feeling ‘shaky’, and sweating. In severe cases you may lose consciousness. To treat low blood sugar levels, you should eat or drink something sugary, for example some sweets or a glass of fruit juice.
Dehydration or heat exhaustion
When your body does not have as much fluid as it needs, this disturbs the balance of salts and sugars, which then affects the way it functions. Symptoms of dehydration are feeling thirsty, lightheaded (dizzy), passing dark coloured strong-smelling urine, and passing urine less frequently than normal.
If you are dehydrated, you should drink plenty of fluids, but try to avoid caffeine or fizzy drinks. Sipping small amounts regularly may be best if you are suffering from a stomach upset at the same time.
Heat exhaustion occurs when there is low blood pressure and blood volume. This can occur after being exposed to heat for a long time. Symptoms include nausea, feeling faint and sweating heavily.
If someone is suffering from heat exhaustion they should be taken to a cool place with any unnecessary clothing removed, and provided water to drink. They should feel better within approximately 30 minutes.
Postural hypotension (low blood pressure)
People with low blood pressure can be affected with dizziness after changing positions, such as standing up. This is more common in older people.
Low blood pressure occurs when the blood pressure in your arteries is unusually low. If your blood pressure drops too low, not enough blood can reach your brain and this may lead to dizziness or light-headedness, or fainting.
Some symptoms of low blood pressure are dizziness, loss of balance, fainting, blurred vision, a rapid or irregular heartbeat, confusion, nausea, and general weakness.
Low blood pressure only needs to be treated if it is showing symptoms. Very few people are given medication to treat low blood pressure. Instead, life style changes can relieve symptoms. These include; standing up slowly, avoiding standing for long periods, wearing support stockings, limiting intake of alcohol, avoiding caffeine in the evening and eating smaller, more regular meals as opposed to large meals.
Vestibular neuritis (labyrinthitis)
Vestibular neuritis is a viral infection of the inner ear (it is sometimes called labyrinthitis or viral labyrinthitis). Some specialists think that the problem is specifically with the nerve cells or neurons in the inner ear. Infections of the ear are usually viral and less commonly bacterial. Symptoms include a sudden onset of dizziness with a spinning sensation (vertigo), accompanied by nausea (feeling sick) and general unsteadiness. You may also experience problems with vision, hearing and concentration. These symptoms often develop a few days or weeks after a bad cold or influenza (the ‘flu).
The initial dizziness caused by vestibular neuritis can be intense and very distressing. For the small number of people who experience prolonged or recurrent symptoms, the dizziness is not usually as intense but might be enough of a nuisance to affect their everyday lives.
Depression, panic attacks, anxiety and derealisation (where your sense of reality seems ‘unreal’ or distorted) are also relatively common side effects of the disorder. If you are struggling with these issues, then your GP may refer you for counselling. CBT is known to help, as well as relaxation techniques and meditation.
People with vestibular neuritis often prefer to stay in bed because any movement makes the dizziness worse. You may find working difficult due a persistent feeling of ‘haziness’ or disorientation. The symptoms might last for just a few days but, in some cases, can persist for several weeks. Some people remain a little unsteady afterwards but most make a full recovery. Only a minority of people with vestibular neuritis will experience persistent, troublesome dizziness or suffer recurrences of the condition. Recurrences might be spontaneous or associated with further colds or bouts of influenza. Vestibular neuritis does not cause hearing problems. If the symptoms do not resolve completely and are still troublesome then you may be referred to an expert physiotherapist for vestibular rehabilitation.
The main treatment for vestibular neuritis, in its initial stage, is antivertigo drugs. These are the same type of drugs as those used to treat motion or travel sickness.
Less common is ‘Suppurative Labyrinthitis’. This is caused by bacterial organisms infecting the labyrinth. The infection originates either in the middle ear or in the cerebrospinal fluid, as a result of bacterial meningitis.
Benign paroxysmal positional vertigo (BPPV)
People with Benign Paroxysmal Positional Vertigo (BPPV) experience intense bouts of dizziness with a revolving or spinning sensation. The dizziness is very short-lived, usually only lasting a minute or less, and is brought on by particular head movements. For example, movements like turning over in bed, or looking up to place a book on a shelf. Most people with this form of dizziness know exactly what sort of movements trigger their symptoms and can try to avoid them.
Specialists have established that the cause of BPPV is the build-up of certain particles, or crystals, within one of the tubes in the balance system called the posterior semicircular canal.
BPPV can be diagnosed by the Hallpike test. Due to the intricate connections between the balance system of the inner ear and the eye muscles, at its worst, BPPV causes a specific nystagmus (jerking movements of the eye) unique to the condition.
Recent developments in treatments have focused on clearing out the particles trapped in the posterior semicircular canal. These treatments include the Canalith repositioning procedures, or particle repositioning procedures. These effective, non-invasive treatments can be performed in your doctor’s or physiotherapist’s room and do not require the use of any specialised instruments. They are usually performed by a specialist rather than your GP who might not be familiar with them. After successful treatment with these procedures, it is quite common to suffer dizziness for up to three months afterwards.
People diagnosed with migrainous vertigo (or migraine-associated vertigo) experience vertigo as a symptom of migraine. Vertigo might be the main or only symptom of their migraine.
The most common symptoms of migraine are an intense headache, nausea (feeling sick) and vomiting (being sick). You may also have visual problems, speech problems, stiffness in your neck, and an increased sensitivity to light or noise.
Avoiding trigger factors can be an effective way of preventing migraines. These include stress, tiredness and loss of sleep, certain food and drink (for example, chocolate, cheese or alcohol), hormonal changes, weather changes (barometric-pressure variations) and smoking or smoky environments. Certain medications may also trigger migranious vertigo. There are various medications used to treat migraines, including general pain-relief drugs like aspirin and paracetamol, anti-inflammatory drugs like ibuprofen, anti-sickness medication, and special migraine pain-relief medication only available on prescription. Your GP or pharmacist will advise you of the options.
Sometimes, migraine preventative medications are prescribed which are taken daily for a period of time to try and prevent the attacks. These can include low dose anti-depressant medication, beta blockers and antiepileptic medication. Your GP can advise you of these. Always talk to your GP before starting any medication.
People with Ménière’s disease experience repeated attacks of intense dizziness with a spinning sensation. Each attack typically lasts for two to three hours, but can last up to 24 hours and often involves the affected person vomiting (being sick). This disease most commonly affects those aged 20-60 and is thought to be slightly more common in women than men.
It is common to experience noticeable changes in your hearing either before or during the vertigo attacks, including tinnitus and a loss of hearing. You may also experience sensitivity to sound or distorted sound. Commonly, you may also feel a tenderness or pressure in one of your ears immediately before or during the attacks. In the initial stages of the condition, you might maintain good balance and not experience any dizziness between attacks, but you are likely to experience varying degrees of hearing loss. This hearing loss usually fluctuates at first and improves after each dizziness attack. However, there is a tendency for hearing loss to get worse over time and it can become permanent. Less frequently, you may have symptoms in both ears.
It is important to note that the symptoms and severity of this condition can vary greatly for each person. For example, some people may experience hearing loss with regular attacks of vertigo, whereas others may experience slight vertigo with severe tinnitus.
Usually, there is no warning sign that a dizziness attack is going to happen. People are often anxious about having an attack in public places because they are concerned that on lookers will think they are drunk. The symptoms of an attack (being sick and losing balance) can be mistaken for drunkenness.
Specialists have not established the specific cause of Ménière’s disease but each attack results from a build-up of pressure in the inner ear (a condition called endolymphatic hydrops). A family history of Ménière’s disease may increase your risk of developing the condition, as well as a chemical imbalance in the fluid in your inner ear.
Current treatments can help control symptoms, but cannot not cure the condition. The main treatment for this condition is a strict low-salt diet and diuretic medication (“water tablets”) the combination of which helps to get rid of excess salt and fluid in the body and reduces the risk of a build-up of salt, fluid and pressure in the ear. This treatment can help reduce the frequency and intensity of each vertigo attack but, unfortunately, will not necessarily slow down the progression of the deafness. Balance training may also be used as a treatment, as well as relaxation techniques. In more severe cases, surgery may be required.
Anti-vertigo drugs might help some people if they are taken as soon as the first symptoms of Ménière’s disease develop. Some anti-vertigo drugs can be effective in reducing the intensity of vertigo attacks.
Labyrinthine sedatives are useful if they are taken as soon as the first symptoms of Ménière’s disease develop. Several versions of these drugs can be absorbed from inside the mouth or as suppositories. They are very useful during the acute phase but have no role in the long term management and do not prevent the recurrent attacks.
Some labyrinthine vasodilators such as Serc (betahistidine) taken over a prolonged period help reduce the frequency of the attacks in many patients, but they have no benefit during the acute phase.
Some also find that the condition affects their mental health and can lead to feelings of anxiety and depression. Your GP can offer advice if you are struggling in this area. There are also a number of support groups available.
The term vascular is used to describe conditions related to the blood vessels and caused by a reduced supply of blood reaching a particular part of the body. In the case of dizziness, the areas receiving a reduced blood supply are the labyrinth (inner ear) and the lowermost part of the brain containing the balance centres. The labyrinth’s and the brain’s balance centres are supplied by the same blood vessels, so vascular dizziness can be caused by a combination of peripheral (inner ear) or central (brain) dysfunction. The symptoms can include hearing loss, visual problems (double vision, blurred vision or problems with peripheral vision), and numbness in the face or limbs.
If you suffer from vascular vertigo, it is common to have other symptoms besides dizziness. Dizziness on its own rarely has a vascular cause. Vascular causes are more likely in older people. Their symptoms are usually an indication of general vascular disease and relate to risk factors like high blood pressure, smoking, high cholesterol, diabetes, or a family history of vascular disease (high blood pressure, heart attacks, and strokes). For these people, treatment is aimed at reducing the vascular risks and most doctors will prescribe a small dose of aspirin a day to thin the blood as long as there are no reasons for someone to avoid taking it (for example, other medication, indigestion or other stomach problems).
Post-traumatic vertigo is diagnosed if you have dizziness after trauma (injury) to the head. Dizziness can occur after only minor head injuries. The actual cause of the dizziness can be a combination of inner ear or brain disorders.
Of course, after an accident involving a head injury, you may also have injuries to other parts of your body (for example, broken limbs). And, as a result of a head injury you may have health concerns more serious than dizziness problems.
Dizziness and balance problems might not become apparent until you were well enough to be up and about again. This might be some time after the accident.
Some people find that certain visual surroundings can trigger dizziness, or make existing dizziness and balance problems worse. For example, you may feel disorientated and dizzy in supermarkets when surrounded by tall stacked shelves, or in crowded train stations when surrounded by people. Or you may find that the sight of fast-moving or spinning objects can cause dizziness or make your dizziness worse. You might experience dizziness in a car when you see fast-moving scenery out of the window, or when you see fast-paced action on a TV or cinema screen.
You might also experience dizziness when you are adjusting to new prescription glasses or contact lenses.
Visual vertigo can also occur if you are experiencing problems like reduced or blurred vision. You should speak with your GP, optician or specialist if you experience problems with your vision.
Peripheral vestibular disorders
In many cases, doctors are not able to diagnose an underlying condition or disease, they are only able to diagnose that the cause of someone’s dizziness is related to the inner ear rather than the brain (a peripheral vestibular disorder).
Strictly speaking, vestibular neuritis, BPPV and Ménière’s disease are all peripheral vestibular diseases, but some people experience dizziness caused by a condition that cannot be categorised into any of these well defined groups.
For some people, abnormalities might show up in the specialised balance tests but, for others, even these special tests might not show anything. People might experience ever-present minor symptoms, or recurrent episodes of vertigo triggered by certain factors like head movements, tiredness, stress, menstrual periods, or viral infections.
You should not worry if your doctor is unable to diagnose a specific cause of your dizziness and balance problems. The majority of people in this situation experience improvements and recoveries over the longterm. Recovery can be helped by rehabilitation procedures.
Central neurological disorders
A minority of people with dizziness and balance problems have a neurological condition. The part of the brain that organises balance is the lowermost part and includes the brain stem and the cerebellum. This part of the brain is also responsible for movement, posture and speech, so these might also be affected. It is unlikely that dizziness will be the only symptom you experience if you have a neurological condition.
Strokes, demyelinating diseases of the nervous system (for example, multiple sclerosis), inflammation, or tumours can cause dizziness and balance problems. Other less common causes are bony deformities at the back of the head and the top of the spine.
These neurological causes can be identified by brain scans and a neurological examination. Your specialist will advise you.
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