Dizziness

Dizziness is one of the most common reasons people visit healthcare professionals, affecting approximately 20% to 30% of people at some point in their lives. While it can be alarming and disruptive to daily life, most cases of dizziness can be effectively treated once the correct cause is identified.

Table of contents

• What is dizziness?
• Common symptoms
• What causes dizziness?
• How your balance system works
• When to seek medical help
• How dizziness is diagnosed
• Treatment options
• Lifestyle habits and self-care

What is dizziness?

Dizziness is a term that people use to describe many different sensations, such as feeling faint, woozy, weak, or wobbly. Healthcare providers describe dizziness as having impaired or disturbed spatial orientation^[1][11]. The term can be so broad that it means different things to different people, which is why the first step in getting help is clearly describing what you’re experiencing.

People may experience dizziness in several distinct ways. Some feel lightheaded, as though they might pass out. Others feel unsteady on their feet, as if they have lost their sense of balance. Some describe feeling disoriented or confused, while others experience a sensation of floating or heavy-headedness^[3][11].

A specific type of dizziness called vertigo involves a false sensation of movement. People with vertigo feel as though they or their surroundings are spinning or moving, even when everything is still^[1][4]. This sensation is more precisely defined than general dizziness and typically points to problems with the inner ear or brain.

Common symptoms

When experiencing dizziness, people may describe a range of feelings and sensations. These can include a sense of motion or spinning, lightheadedness or feeling faint, a loss of balance or the sense of not feeling steady, and a feeling of floating, wooziness, or heavy-headedness^[1].

These feelings may be triggered or made worse by certain actions, such as walking, standing up, or moving your head. Dizziness may occur along with other symptoms, including nausea and vomiting, sweating, blurred vision or loss of vision, weakness, headache, or looking pale^[1][4].

The duration of dizzy spells can vary considerably. A bout may last only seconds or continue for days, and it may come back repeatedly^[1]. Up to 30 percent of older adults experience dizziness, and the percentage increases with age. Women are more commonly affected than men^[5].

Dizziness can cause serious effects on your life. It can make it difficult to perform daily activities such as bathing and dressing, and it significantly increases the risk of falling^[5].

What causes dizziness?

Dizziness has many possible causes. As people get older, they may have more health problems and take more medicines, which makes them more likely to have problems with dizziness and balance^[8]. While dizziness rarely indicates a life-threatening condition, it is important to identify the underlying cause to receive appropriate treatment^[1].

Inner ear disorders

The inner ear plays a crucial role in balance, and many common causes of dizziness originate there. Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, accounting for about 18.6% of dizziness cases^[13]. This condition occurs when tiny calcium carbonate crystals within the inner ear break down and become dislodged, sending false signals to the brain and causing brief episodes of spinning sensations when the head moves in certain ways^[21].

Other inner ear conditions that cause dizziness include labyrinthitis, which is inflammation in the labyrinth (the inner ear system responsible for hearing and balance), and vestibular neuritis, which is the most common cause of acute vertigo and affects the nerve responsible for balance signals^[11][13]. Inner ear infections from viral or bacterial sources may also interfere with the messages your inner ear sends to your brain^[11].

Other medical conditions

Dizziness can result from various health problems beyond the inner ear. Anemia, which means not having enough red blood cells, commonly causes dizziness as a symptom. Heart and blood vessel problems, such as irregular heartbeat, low blood pressure, or narrowed arteries, may also make you feel dizzy by affecting blood flow to your brain^[11].

Neurological diseases or disorders can affect your sense of balance and cause dizziness. These include migraine headaches, multiple sclerosis, and Parkinson’s disease^[11]. A concussion or head injury can damage the brain and cause dizziness among other symptoms.

Common everyday causes

Many cases of dizziness stem from everyday situations that can be addressed with simple changes. Low blood pressure, particularly when standing up quickly, is a frequent cause. Low blood sugar, dehydration, and heat exhaustion can all trigger dizziness^[3][11].

Stress and anxiety may cause dizziness, especially if you hyperventilate. Lack of sleep can contribute to feeling dizzy. Some medications, particularly blood pressure medications, often cause dizziness as a side effect^[11]. Motion sickness and alcohol consumption can also make you feel dizzy and affect your balance.

How your balance system works

Understanding how balance works helps explain why so many different things can cause dizziness. Your sense of balance is controlled by signals to the brain about body movement and your position in relation to the environment. The brain integrates this information and sends signals back to the muscles on how to maintain balance^[4].

Three sensory systems work together to manage balance. First, vision helps you see where you are in space. Second, proprioception involves movement sensors in the skin, muscle, and joints that detect your body’s position. Third, the inner ear contains the organ of balance called the vestibular system, which includes three fluid-filled loops that respond to head rotation and structures that detect gravity and back-and-forth motion^[4].

Good balance needs at least two of these three sensory systems working well. If one system is not working, the other two systems help keep you balanced. However, if the brain cannot process signals from all of these systems properly, or if the messages are not functioning correctly, you may experience a loss of balance and feel dizzy^[4].

When to seek medical help

While many episodes of dizziness are not serious, certain situations require immediate medical attention. Get emergency medical care if you have new, severe dizziness or vertigo along with any of the following: pain such as a sudden, severe headache or chest pain; rapid or irregular heartbeat; loss of feeling or movement in the arms or legs; stumbling or trouble walking; loss of feeling or weakness in the face; trouble breathing; fainting or seizures; or trouble speaking, understanding, or swallowing^[1][3].

You should also seek immediate medical attention if you feel dizzy and also have numbness or weakness in your face, arm, or leg; vision changes in one or both eyes; confusion; or if you become unconscious. Call emergency services immediately if you have any of these symptoms, as they may signal a stroke or other medical emergency^[3].

In general, see your healthcare professional if you have any repeated, sudden, severe, or long-lasting dizziness or vertigo with no clear cause^[1]. You should also see a doctor if your dizziness doesn’t go away, if you continue to feel unwell, if you have an unexplained fall, or if your dizziness causes you to fall and injure yourself^[3].

How dizziness is diagnosed

A careful history remains the cornerstone of diagnosing dizziness^[13]. Your healthcare professional will ask you about your symptoms and try to understand what you mean by “dizzy.” The best way to help is to describe the feeling without using the word “dizzy” and to explain the timing and triggers for your symptoms^[7][18].

Try to provide specific information about how the dizziness makes you feel as it comes on and after it has passed, what seems to trigger it, and how long it lasts. Your healthcare professional will also ask about the medicines you take and your family history^[2].

During a physical exam, your healthcare professional checks how you walk and maintain your balance. The major nerves of your central nervous system are also checked to make sure they’re working properly^[10].

You may need a hearing test and balance tests. These can include eye movement testing, where your healthcare professional watches the path of your eyes when you track a moving object or places water or air in your ear canal. Head movement testing may be done if your vertigo might be caused by BPPV. Other tests include posturography, which tells your healthcare professional which parts of the balance system you rely on most, and rotary chair testing, where you sit in a computer-controlled chair that moves in a full circle^[10].

Blood tests may be given to check for infection. You may need other tests to check your heart and blood vessel health. If your healthcare professional thinks you might be having or may have had a stroke, you may need imaging tests such as an MRI or CT scan right away^[10].

Treatment options

Treatment of dizziness depends on the cause and your symptoms. Once the correct diagnosis is made, specific and effective treatments are available for most forms of dizziness^[13]. Dizziness often gets better without treatment, but when treatment is needed, it may include medication, physiotherapy, and in rare cases, surgical procedures^[3].

Medications

For acute dizziness and vertigo, medications may be used to provide relief. These can include vestibular suppressants and antiemetic medications to control nausea. However, vestibular suppressants should only be used for a few days at most because they delay the brain’s natural compensatory mechanism for peripheral vertigo^[14].

For vestibular neuritis, the pharmacological treatment of choice is oral corticosteroids beginning as soon as possible with gradual tapering of the dose^[14]. For Ménière’s disease, high-dose, long-term betahistine may be used^[13].

Physical therapy and exercises

For BPPV, the treatment of choice is a repositioning procedure performed by a trained healthcare professional. The most common is the canalith repositioning procedure, which involves turning the patient’s head in multiple positions to help reposition the problematic crystals and return them to where they belong. This can often resolve the problem quickly, sometimes after just one session^[21].

Vestibular rehabilitation is very useful in boosting central vestibular compensation and is an important part of treatment for many balance disorders^[14][18]. Early vestibular rehabilitation is particularly important for conditions like vestibular neuronitis.

Lifestyle habits and self-care

Several daily habits and self-care strategies can help manage dizziness and support overall vestibular health. While these measures may not cure the underlying condition, many people find them helpful in reducing symptoms or preventing episodes.

Immediate relief strategies

If you experience dizziness, it may help to rest and move carefully. Remain seated and avoid abrupt movements. When you’re ready to sit up, do so slowly. It’s best to do other movements, such as turning your head, as slowly as possible until the dizziness passes^[12].

Drinking water can help if dizziness occurs due to dehydration. Staying hydrated is important for overall health and may help prevent dizziness episodes^[12][17]. Many people are not properly hydrated, and ensuring proper hydration is a daily habit that can better support the body and vestibular system. Some people find that adding electrolytes to their water helps with brain fog, dizziness, and energy, though you should talk to your doctor before adding electrolytes to your diet^[17].

Long-term lifestyle habits

Stress and mindset management is important, as stress is one of the largest contributors to migraine attacks and can worsen vestibular symptoms. Being able to have coping mechanisms to address stress, as well as tools to modify stressors that are within your control, is important for overall quality of life and vestibular management^[17].

Nutrition plays a role in managing dizziness. Sometimes dietary changes such as limiting alcohol or caffeine intake can be helpful and may also improve anxiety and sleep quality. Adding healthy fruits and vegetables and having well-balanced meals that include protein, carbohydrates, and fats is helpful for stabilizing blood sugar and can reduce afternoon crashes or morning attacks^[17].

Movement is important for the vestibular system. The body craves movement, and the vestibular system helps measure movements so the brain can make adjustments to stay safe. Movement helps strengthen the connection between the vestibular system and the brain and also helps with stress, anxiety, improved sleep, and overall health. Start small with gentle movement such as a short walk, gentle yoga, or tai chi, and gradually progress^[17].

Quality, consistent sleep helps healing and gives the brain and body the rest they need to learn, rewire, and heal. Consistent sleep-wake times, even on weekends, setting up a bedtime routine, and getting quality sleep is important for general health and long-term management of vertigo and dizziness^[17].

Avoiding known triggers for dizziness is also helpful. This includes staying hydrated, not skipping meals, getting enough sleep, and taking steps to manage anxiety^[12].