Dizziness 101 - Making Sense of Your Dizziness

"Why am I dizzy? What are the causes? How to get rid of it?" “Dizziness” is somewhat of an unprecise term, because the causes of dizziness are varied. Literally millions of people in the United States alone suffer from dizziness. Some only go through occasional dizzy spells, while others suffer from very severe forms of dizziness.

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James H. Lyons, BHSc
Pavel Kotlykov
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Dizziness can be caused by a wide variety of underlying disorders and experienced in a variety of ways. Consequently, to find out how to stop dizziness, you need to determine the cause of you  dizziness with the help of a medical professional.

Always  consult with a healthcare professional to get a confirmed diagnosis and appropriate treatment, but in the meantime you can use our guide to figure out why you feel dizziness and what you can do about it.

What is Dizziness?

Dizziness  refers to a range of different sensations and experiences, so describing your particular experience is the first step to identifying  its cause.

  • Would you describe your dizziness as a feeling of light-headedness?
  • Do you feel like you might faint?
  • Or is it more a vague sense of feeling “spaced-out”?
  • Do you feel unsteady on your feet, like you couldn't walk in a straight line?
  • Do you feel like you're spinning in place?
  • Or do you feel like you're standing still but the world is spinning around you?

All of these sensations can be labeled as dizziness, and they all have very different causes – and very different solutions. But don't be discouraged, just understand that you'll have narrow your experiences a little bit more in order to understand what's really happening.

Identify your symptoms

Sometimes  the key to unlocking why you feel dizzy is found in what else is going on at the same time.

Note any of these symptoms that you have experienced before, after, or during episodes of dizziness:

  • Nausea
  • Headache
  • Tinnitus (ringing in the ears)
  • Pressure or pain in the ear/s
  • Difficulty hearing (with or without tinnitus)
  • Vomiting
  • Fever
  • Ataxia (difficulty walking, swaying, staggering and loss of co-ordination)
  • Unusual, uncontrollable eye movements
  • Vision difficulties while in motion (e.g. difficulty reading a sign as you walk/drive by).

Dizziness Statistics

A  recent study into the occurrence of vestibular disorder – one of the  major cause of dizziness – has indicated that as many of 69 million Americans aged 40 and older have suffered from some form of vestibular disorder. Further research indicated that 8 million American experience balance problems and a further 2.4 million regularly suffer from  dizziness.

These staggering statistics highlight the importance of dealing with dizziness to first and foremost identify the underlying cause and ultimately find ways of overcoming this often highly debilitating disorder.

Check out amazing info-graphic below created by vestibular.org to better understand what your dizziness is about.

When to Seek Medical Attention

Dizziness may be the first indication of a health issue. Seek medical assistance if you experience one of the following:

  • Very severe dizziness
  • Sudden dizziness attack
  • New and unusual dizziness patterns
  • Dizziness occurring after taking medication
  • Feverishness
  • Continuous heart palpitations
  • Shortness of breath
  • Fainting
  • Slurred speech or drooping facial muscles

Call your doctor or go to the Emergency room immediately if any of these red flags are present:

  • Strong head or neck pain
  • Inability to walk straight
  • Loss of consciousness (even briefly)
  • Severe, continuous dizziness for over 1 hour

It’s not advisable to ignore dizziness. Even if the doctor later identifies a minor health issues, medical attention (and self-responsibility) must be sought.

Possible Causes

A wide variety of distinct medical conditions may produce symptoms of dizziness, including:

  • Vestibular disorders with symptoms like vertigo (disease of the balance organ in the inner ear)
  • Heart disease
  • Blood pressure disorders
  • Diabetes
  • Stroke
  • Dementia
  • Side-effects of medication
  • Anxiety
  • Low blood sugar levels
  • Dehydration
  • Metabolism disorders
  • Pregnancy
  • Severe allergies
  • PMS

If you frequently suffer from dizzy spells, seeking medical attention is of utmost importance.

There are two main reasons why dizziness happens: Issues with the vestibular system, and issues with the brain.

That doesn't necessarily mean the brain or inner ear is the problem (or, they could be). Rather, those two are processors (translators) of data you receive from both internal and external worlds. Consider them gateways which can malfunction themselves or have "strong" incoming signals

If noise is transmitted from your bodily systems, you might be alerted of this this noise with the dizzy sensation.

If constant noise is received from the outside (environment or psychological factors), you might experience dizziness as result of problems with processing (translation) of information.

So, let's look at those two main interfaces of dizziness - vestibular system and brain - one by one, starting from the former.

It's worth mentioning that chronic dizziness - and its causes and features - is something completely different from what we are discussing in this post. To learn more about chronic dizziness you read this article.

Reason for dizziness #1: Vertigo & Vestibular Conditions 101

There is an area of the inner ear called the vestibular labyrinth. This labyrinth contains a series of canals that are filled with fluid. A large nerve and an area within thebrain are also part of the vestibular network

Together, this team controls your perception of motion, balance, and proximity to other objects in space.

Whenever you move your head, experience inertia from gravity (like sitting up suddenly, or riding a rollercoaster), or feel vibrations from the ground, the vestibular labyrinth detects the movement and sends a signal via the nerve to the brain. Any motion within the fluid of the vestibular labyrinth is communicated by the vestibular nerve and interpreted by the brain as movement.

When something goes wrong with any part of the vestibular network, it causes a sensation of vertigo.

Vertigo is a term that is often used interchangeably with “dizziness”, but it specifically refers to a sense of motion even when you're staying still or a sense that the environment is moving around you. 

It can be accompanied by other types of dizzy feelings like light-headedness.

FACT: The feeling of dizziness that can occur when looking down from a height is called acrophobia, not vertigo!

Vertigo  can be caused by a number of conditions in the vestibular network.  Problems with the inner ear account for up to half of the cases of  dizziness, and all of them are treatable. Here's a quick overview of the  most common vestibular conditions:

Benign Paroxysmal Positional Vertigo

  • Most common cause of vestibular vertigo
  • Short episodes of vertigo when you move your head

Try  saying “benign paroxysmal position vertigo” three times fast! Benign  paroxysmal position vertigo or BPPV occurs when natural crystals within  the inner ear shift around due to head movement. These episodes of  vertigo last from seconds to minutes, and are sometimes accompanied by  vomiting.

BPPV can be caused by infections, injury to the ear,  prolonged bed rest or as an after-effect of other vestibular disorders.  However, it can also occur spontaneously from the natural degeneration  of tissue in the inner ear in older age.

→ Learn more about BPPV 

Labyrinthitis

  • Ongoing vertigo
  • Uncontrollable eye movements

As  you might guess from the name, labyrinthitis affects the vestibular  labyrinth. When an ear infection spreads to this area of the inner ear,  it causes vertigo and sometimes rapid, uncontrollable eye movements. 

Additional symptoms can include fever, hearing loss, tinnitus and ear pain.

→ Learn more about labyrinthitis  

Menier's Disease

  • Sudden attacks of vertigo that last 1 – 6 hours 
  • Pressure in the ear

Menier's disease causes attacks of vertigo dizziness that occur suddenly and usually last between 1 - 6 hours. 

There  is often pressure in the ear before and during the attack, along with  tinnitus, severe nausea and vomiting, and progressive hearing loss that  doesn't return even after the vertigo is over. No one is sure why it  occurs, and it can appear out of nowhere!

→ Learn more about Menier's disease

Vestibular Neuronitis (neuritis), or Labyrinthitis

  • Vertigo with no hearing loss or tinnitus
  • Uncontrollable eye movement towards affected ear

In case of Labyrinthitis, there's a change in hearing. You can learn about it here.

While  labyrinthitis involves inflammation of the inner ear, vestibular  neuritis is inflammation of the nerve that runs from the ear to the  brain. This causes vertigo, but no hearing loss or tinnitus. A signature  sign of vestibular neuritis is spontaneous eye movement towards the  affected ear, but it doesn't happen in every case.

It is most likely caused by a viral infection of the nerve that resolves after 7 – 10 days.

→ Learn more about Vestibular Neuritis

NO VERTIGO? See below for the second main interface responsible for experience of dizziness - the brain.

Reason for dizziness #2: Issues with the Brain

Delivery problems

The  brain requires lots of oxygen and glucose which are usually delivered in huge amounts by the blood. Anything that stops the regular delivery of O2 or blood sugar can cause a feeling of dizziness without vertigo. These conditions can cause light-headedness, fainting, and feeling “spaced-out”.

Learn more about how these common conditions can cause dizziness:

  • Low blood pressure
  • Low blood sugar
  • Anemia
  • Respiratory conditions

Chemical Clash

Medications and recreational drugs can cause many types of dizziness as a side-effect or interaction. Check with your physician or pharmacist if you are dizzy after taking any drugs – it could be an early warning sign of a dangerous reaction or just a common side-effect.

Infections & Imbalances

Herpes  zoster virus and syphilis infections can cause ongoing dizziness, as can disruption to thyroid hormones, reproductive hormones, or adrenal hormones. This includes hypothyroid conditions, chronic stress, and pregnancy!

Rare Conditions

Although they are rare, tumors, hemorrhages and trauma within the brain can cause dizziness.

Psychological Cause of Dizziness

Dizziness can present as a symptom of many common psychological disorders including anxiety disorders, depression, panic disorders, and hyperventilation conditions (we'll discuss this one later in the post).

While most cases of chronic dizziness result from a physical disorder, psychiatric issues can be a cause -- or a  consequence -- of chronic dizziness, according to research published The Journal of the American Osteopathic Association.

The researchers reviewed published studies on the relationship between psychiatric disorders and dizziness, finding psychiatric disorders -- often related to anxiety -- may be present in up to 15  percent of patients presenting with dizziness.

After vestibular diseases, which affect parts of the inner ear and brain responsible for controlling balance, psychiatric disorders appear to be the second most  common cause of chronic dizziness. Here's a great study for your own review. Study authors note that a whole-person approach, taking into account  the patient's mental and emotional health as well as their physical health, can help physicians get to the root cause faster.

The relationship between dizziness and psychiatric disorders is complex and dynamic. It is sometimes difficult to distinguish which one is causing the other or whether the interplay is reciprocal. Researchers have attempted to better understand this relationship by introducing the term chronic subjective dizziness  (CSD).

Patients with CSD experience dizziness most days for more than three months. They often describe feeling heavy headed, light headed or imbalanced. Some feel as if the floor is moving, while others feel disassociated or far away from their environment. Many patients report  their symptoms worsen with complex stimuli, like being in crowded  spaces.

According to one study, one-third of patients with CSD had a primary  anxiety disorder and no history of vestibular disorder or another  disease that could cause dizziness. Another one-third had no history of a psychiatric disorder but had a vestibular disease that triggered an  onset of anxiety. The final one-third had a history of an anxiety or other psychiatric disorder, then developed a medical condition that triggered dizziness. In those cases, the preexisting psychiatric disorder worsened and resulted in chronic dizziness.

"I think asking the patient about their stress levels and whether they've experienced anxiety can make the conversation more approachable for both parties." says Dr.  Kelm.

Dizziness tests

The  doctor will examine you thoroughly and send you for a MRI or CT scan if  she/he suspects you are having a heart attack or stroke or have  suffered a severe blow to your head. Initially, doctor will ask you about your medical history, symptoms, and current prescribed medication. 

Subsequently,  the doctor will examine your balance and the function of your central  nervous system by having you undergo a series of tests, including:

  • Eye Movement Test: The doctor will examine the motion of your eyes. She/he may also put cold or warm water into your ears during this test.
  • Head Movement Test: If the doctor suspects that you are suffering from a vestibular disorder or vertigo, she/he will do the Dix-Hallpike test with you. In essence, your head movement will be examined to confirm, or contradict the suspected diagnosis. Also, you can check out this video that demonstrates positive Head Impulse Test (HIT) in women with vestibular neuritis.
  • Rotary Chair Test: During this test, you will be sitting on a rotating office chair. At lower speeds, the chair will rotate 360° and at faster speed only back and forth a fraction of a full circle.
  • Electronystagmography (ENG): During these test, electrodes are placed to monitor eye movements or examine the inner ear in an effort to diagnose or rule out vestibular disorders or vertigo.

These are some of the tests set to determine the  causes of dizziness, there are several other types of examinations the  doctor may carry out. If she/he suspects that your dizziness is cause by anxiety, she/he may look give you a psychological assessment. It is likely that doctor would do some blood tests and check your heart the blood vessels.

Conventional dizziness treatment

In  some instance, the doctor may feel that the underlying issue causing  the dizziness will resolve itself and alleviate any symptoms. If,  however, the cause of the dizziness has been identified to be a  specific medical issue, the treatment will depend on the underlying  cause.

When dizziness is caused by dehydration, the doctor may put you on an intravenous drip to restore hydration levels. Patients  who have contracted a virus causing dizziness may be prescribed  anti-viral drugs, while those whose dizziness stems from blood pressure  disorders will receive suitable medication. If you are suffering  from a vestibular disorder or vertigo, the doctor is likely to prescribe  specific medication for this condition.

The doctor will  treat the underlying cause, whatever it may be, and she/he may also  prescribe medication to alleviate dizziness symptoms. Because some people may feel nauseous during dizzy spells, they may also be given anti-nausea medication.

A number of non-medication, non-surgical treatments are also quite common, including:

  • Head Position Exercises: Some doctors treat dizziness by repositioning the head during one or two treatments.
  • Balance Exercises: People diagnosed with vestibular disorders may also benefit from balance therapy.
  • Psychotherapy: Psychotherapy is prescribed if the underlying causes are of a psychological nature.
  • Antibiotic Injection: The doctor may administer an antibiotic injection to the affected ear to treat vestibular disorders.
  • Surgery: On rare occasions the doctor may advise surgery on the inner ear if no other treatment has been effective.

Home treatment

Check out our post about Natural Cures for dizziness

Once you have sought medical advice, you may still need to cope with dizzy spells.

Experts recommend the following:

  • Move more slowly, particularly when standing up and sitting down
  • Sit or lie down if you are feeling dizzy
  • Drink plenty of water to stay hydrated
  • Don’t drive or operate machinery when feeling dizzy
  • Trip or fall proof your environment
  • If experiencing nausea along with dizziness, take over-the-counter anti-nausea tablets
  • Avoid salt, nicotine, caffeine, and alcohol

In  many instances, dizziness can be overcome quite easily and is only temporary.

However, sometimes the sensation becomes chronic or very frequent.

Symptoms:

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