Dizziness is one of the most unspecific symptoms doctors hear about every day in their offices and numbers show that it is responsible for 2.5% of all ED admissions. 

A number of diseases have a dizziness and nausea as a common denominator. Some of them can be life threatening, others are benign and all of them cause a discomfort, and can significantly reduce the quality of life.

This article will provide you info about dizziness and nausea, help you understand your symptoms and point out what can you do to get rid of them. 

Note: Keep in mind that nothing can replace a medical exam and in case your symptoms are so severe that it frightens you, maybe the best decision would be to consult a health professional.

Know What You're Dealing With

Dizziness is often accompanied with nausea, but those two don’t always go together. For example, a patient with a low blood sugar can feel dizziness and nausea and another patient with the same problem can be just dizzy. They are not a disease per se, but a sign that has to be interpreted with other signs and health issues that occurred with it. 

So, the first step in understanding and explaining the underlying condition is determining what a patient means by saying: “I’m dizzy and nauseated” and is there something else that bothers him (headache, pain, stiffness of the muscles, respiratory infection, blurred vision, etc.). 

If you feel dizzy and nauseated, follow the guidelines below and think about which of the conditions described explains the way you feel. Sometimes it’s hard to define the feeling and that’s ok. The point is to figure out what sensation is dominant.

Figuring Out Your Dizziness

Dizziness refers to:

1) Vertigo

Vertigo is defined as an illusion of movement that you or your environment is spinning. How exactly you perceive this illusion has no diagnostic significance (does it looks like the body is spinning or the environment is spinning). 

The most significant criteria is the presence of spinning sensation when there is no spinning movement. Also, pay attention to the direction of spinning, since it can have a diagnostic value. If you want to find out more about vertigo causes and treatment, click here.

2) Imbalance/ Disequilibrium

Is described as:

- A difficulty to walk straight,

- A sensation of an impending fall,

- A sense of floating,

- An impression that a body is somehow tilted to the floor

We are talking about disequilibrium only in the absence of a spinning illusion (vertigo). Balance improves if there is external assistance (something to hold for).

3) Faintness/ Lightheadedness

It is a feeling of an impending loss of consciousness. Patients often refer to it as a sense of a weightless head.

4) Other

Inability to describe the dizziness is not that rare. You are aware that something is different, but the condition is not so well defined, there are no other problems.

Causes and treatment

Hopefully, you decided what do you mean by “feeling dizzy”. Now you can go through the most common causes of your condition. 

Faintness causes and treatment

Faintness occurs due to a decreased blood flow to the brain. The most common causes are:

- Postural hypotension

Postural hypotension is characterized by a prompt decrease in blood pressure within 3 minutes after standing up. 

The only way to treat this condition is to slowly get up from a sitting or lying position. Although it looks like a dramatic emergency condition, it is not life threatening. 

As soon as the body falls on the ground, the circulation and blood pressure in the brain reestablishes causing the person to wake up. Fainting can cause an injury.

- Drug side effects

Usually the anti-hypertensive medicines are the reason to blame. 

Designed to lower the blood pressure, they sometimes “push” it too low, in the “faint zone”. Examples of other medicines that can cause faintness are: antibiotics, antidepressants, pain killers, diuretics, etc. 

Correcting the dose of a medicine usually resolves the problem.

- Hypoglycemia

Sudden drop of the blood sugar level can lead to a faintness and nausea. 

The most common cause is insulin overdose and low caloric intake (aggressive diet regiments). Diabetic patients on insulin should be extra cautious about insulin doses, since extremely low blood sugar level can be deadly. 

To treat the faintness caused by insufficient food intake, it is enough to take a chocolate bar, or drink some soda.

- Cervical degenerative disc disease

Stiff muscles of the neck and changes of the cervical portion of the spine column can cause insufficient blood flow to the bran, which leads to faintness. 

This condition is usually painful and never have a sudden onset (the disease can be an explanation of faintness in patients with pre-diagnosed neck pain or stiffness).

- Vertebrobasilar insufficiency

Atherosclerosis is characterized by the thickening, loss of elasticity and plaque buildup in arteries all over the body. If those changes take place in the vertebrobasilar arterial system, the blood flow to the brain will be compromised which causes faintness. 

Vertebrobasilar arteries supply cerebellum with oxygen, the cerebellum is responsible for voluntary movements (posture, balance, coordination) and decreased oxygen supply causes compromised cerebellum function.

- Panic attacks

Hyperventilation during the panic attack causes carbon-dioxide levels to drop which leads to narrowing the arterial blood vessels, causing faintness.

- Food poisoning

It can be a cause if you had  a suspicious meal in the last 12-24hours, feeling dizzy and nauseated (usually diarrhea is present as well).

- Dehydration

Not enough water in the organism causes electrolytes disbalance in the body, low circulating volume of blood and decreased blood flow to the brain.

- Low blood pressure (Arterial hypotension)

Low BP causes insufficient blood flow to the brain.

Treatment: By laying down and lifting your legs above the head level, the faintness should subside as the blood flow to the brain increases. As soon as the circulation is established again, the nausea will resolve as well.

Disequilibrium/ Imbalance causes and treatment

- Eye problems

Eyes are surprisingly important in maintaining the postural position of the body. In the elderly population, balance centers in the Central Nervous System are affected by some degenerative changes causing their function to decline. In that case, eyesight can be the only mechanism of preserving the postural position of the body (after closing the eyes while standing up, the patient loses the balance and falls).

- Numbness in feet and legs (neuropathy)

The underlying condition is most often Diabetes. Nerve endings over time deteriorate in diabetic patients, causing the numbness and problems with the balance of the body. Patients often refer to it as dizziness combined with the numbness in feet and legs. Because of poor glycemia control, nausea is often present.

- Diseases of the nervous system (Multiple sclerosis, Parkinson’s disease, Alzheimer disease, etc.).

Treatment: Using external assistance to keep the balance. None of these conditions can be treated on your own and health professional consultation is needed.

Other- can’t really describe what’s wrong, but something is wrong

In cases like this, the dizziness and nausea are interpreted as psychogenic. 

Pay attention in which situations they occur (their onset and severity appear to correlate with psychological stress and tiredness).

Treatment: Sedatives, rest and follow up.

Important!

Dizziness and nausea can be a sign of serious health issues. Immediate and prompt reaction sometimes can save a life. Establishing the exact diagnosis requires a multidisciplinary medical approach and continuous evaluation of symptoms. ENT specialists are the first instance to look for in cases of dizziness and nausea (especially if you are having an acute severe first episode that rapidly worsens).

Post by:

Aleksandar Grbovic

MD, Aleksandar Grbovic lives in Belgrade, Serbia. Finished Faculty of Medicine, University of Belgrade (2012). Worked as a medical representative in a pharmaceutical company, General medicine physician, soon to be Radiologist in the biggest occupational medicine Institute in Serbia. Crazy about forensic medicine. Passionate about promoting evidence based medicine to the layman, bridging the gap between the doctor’s and the patient’s point of view.

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