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What conditions and diseases can cause dizziness?

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.

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.

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).

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.

People with vestibular neuritis usually experience a sudden onset of dizziness with a spinning sensation (vertigo), accompanied by nausea (feeling sick) and general unsteadiness. These symptoms often develop a few days or weeks after a bad cold or influenza (the ‘flu).

People with vestibular neuritis often prefer to stay in bed because any movement makes their dizziness worse. The symptoms might last for just a few days but, in some cases, can persist for two or three 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.

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.

The main treatment for vestibular neuritis, in its initial stage, is anti-vertigo drugs. These are the same type of drugs as those used to treat motion or travel sickness.

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 only be diagnosed by the Hallpike or positional 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 focussed on clearing out the particles trapped in the posterior semicircular canal.

These treatments include the Canalith repositioning procedures (CRP), 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.

Migrainous vertigo

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).

People might also have

  • visual problems,
  • speech problems,
  • stiffness in their neck, and
  • an increased sensitivity to light.

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), and
  • smoking or smoky environments.

There are various medications used to treat migraines, including

  • general pain-relief drugs like aspirin and paracetamol,
  • antiinflammatory drugs like ibuprofen, anti-sickness medication, and
  • special migraine pain-relief medication only available on prescription.

Your GP or pharmacist will advise you on the options.

Ménière’s disease

People with Ménière’s disease experience repeated attacks of intense dizziness with a spinning sensation. Each attack can last from two to 24 hours and often involves the affected person vomiting (being sick).

People with Ménière’s disease usually experience noticeable changes in their hearing either before or during their vertigo attacks, including tinnitus and a loss of hearing. Commonly, they also feel a tenderness or pressure in one of their ears immediately before or during the attacks.

In the initial stages of the condition, people might maintain good balance and not experience any dizziness between attacks, but they 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. Around a third of people with Ménière’s disease have symptoms in both their ears.

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).

The main treatment for Ménière’s disease 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.

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 are available in varieties that can be absorbed from the inside of the mouth, or as suppositories, and can be effective in reducing the intensity of vertigo attacks.

Vascular vertigo

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.

People with vascular vertigo usually 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

People diagnosed with post-traumatic vertigo 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, people might also have injuries to other parts of their body (for example, broken limbs). And, as a result of their head injury, they might have health concerns more serious than dizziness problems.

Dizziness and balance problems might not become apparent until the person is well enough to be up and about again. This might be some time after their accident.

Visual vertigo

Some people find that certain visual surroundings can trigger dizziness, or make existing dizziness and balance problems worse. For example, some people feel disorientated and dizzy in supermarkets when they are surrounded by tall stacked shelves, or in crowded train stations when they are surrounded by people.

Others find that the sight of fast-moving or spinning objects can cause dizziness or make their dizziness worse. People might experience dizziness in a car when they see fast-moving scenery out of the window, or when they see fast-paced action on a TV or cinema screen.

People might also experience dizziness when they are adjusting to new prescription glasses or contact lenses.

Visual vertigo can also occur if people 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 long-term. 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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