Dizziness Demystified

Overview

Dizziness is a word people use for several different feelings. It can mean feeling lightheaded, like you might faint. It can mean feeling unsteady, as if you are walking on a boat. Or it can mean a spinning feeling, when it seems like the room or your body is turning. That spinning feeling has a medical name: vertigo (say VER-tih-go). Dizziness is not a disease in itself. It is a symptom, a signal from your body, and it has many possible causes. Most causes are not serious, and most improve with the right care.

Yes, it is extremely common. Most people feel dizzy at some point, often after standing up too quickly or when they are unwell or dehydrated. Long-lasting or repeated dizziness is also common and is a regular reason for seeing a GP.

Anyone can get dizzy, including children and healthy young adults. It becomes more common as people get older, partly because balance, hearing, vision and blood pressure control change with age, and partly because older adults often take more medicines. Inner ear problems can affect people of any age.

Symptoms

Common symptoms

• Feeling lightheaded or as though you might faint
• A spinning sensation, as if you or the room is turning (vertigo)
• Feeling unsteady on your feet or floating
• Feeling sick or being sick
• Sweating or feeling clammy
• Blurred vision or trouble focusing
• Ringing or humming in the ears, or a feeling of fullness in the ear
• Dizziness when you stand up or turn your head
• Feeling worse in busy or moving places, like supermarkets

Symptoms in children

• Young children often cannot describe dizziness, so they may seem clingy, quiet or upset instead
• Stomach pain or feeling sick without a clear reason
• Being unsteady when walking or bumping into things
• Spinning sensations after an ear infection or a cold
• Travel sickness or feeling unwell in the car
• Reluctance to join in play or sport because of feeling wobbly

Symptoms in older adults

• Unsteadiness and a fear of falling
• Dizziness when standing up, which can be caused by blood pressure dropping
• Dizziness linked to medicines, especially those for blood pressure, heart problems or mood
• Dehydration, particularly in hot weather or during illness
• Often more than one cause at once, such as ear, heart, vision and joint problems together
• Falls or near-falls, which are always worth mentioning to a doctor

Causes

Main causes

• Inner ear balance problems, such as tiny crystals moving in the ear canal (called BPPV), which cause short spells of spinning when you turn your head
• Inflammation of the balance nerve, often after a viral infection, causing sudden strong vertigo that lasts days
• Ménière's disease, which causes episodes of vertigo with ringing in the ears and hearing changes
• A drop in blood pressure when standing up, which makes you lightheaded
• Dehydration or not eating enough
• Side effects of medicines, or combinations of medicines
• Low blood sugar or anaemia (a low level of red blood cells)
• Heart rhythm problems
• Migraine, which can cause dizziness as well as headaches
• Anxiety or panic, which can cause lightheadedness and a floating feeling
• Problems with vision, neck joints or the feet, which make balance harder
• Alcohol use

Risk factors

• Getting older
• Having had dizziness or vertigo before
• Being dehydrated, unwell, or in hot weather
• Taking several medicines, or medicines for blood pressure, heart problems or mood
• Having diabetes
• Feeling very stressed or anxious
• Recent ear infection, cold or flu
• A head injury
• Pregnancy, when anaemia and low blood pressure are more common
• Standing for long periods

When to see a doctor

See a doctor urgently if:

• Dizziness with chest pain, breathlessness or a racing heartbeat
• Any fainting, or a fall with injury
• New weakness, numbness, speech trouble or vision changes
• Sudden hearing loss
• Dizziness after a head injury
• High temperature with ear pain and dizziness
• Vomiting so much that you cannot keep fluids down
• Dizziness that suddenly gets much worse

Book a routine appointment if:

• Dizziness that keeps coming back
• Spinning spells that last more than a few seconds
• Dizziness when standing, or when turning over in bed
• Dizziness with ringing in the ears or hearing changes
• Dizziness that affects work, driving or daily life
• Dizziness that started after you began a new medicine
• Unsteadiness in an older adult, even without a fall

Diagnosis

Your doctor will start by asking you to describe your dizziness in your own words, because different types of dizziness point to different causes. They will ask when it happens, how long it lasts, what brings it on, and whether you have other symptoms like hearing changes, headaches or palpitations. They will review your health conditions and every medicine you take, including ones you buy without a prescription. Then they will examine you. This may include checking your blood pressure lying down and after standing, looking in your ears, checking your eye movements, and watching how you walk and balance.

Tests that may be done

• Blood pressure checks, lying and standing
• Blood tests, such as a full blood count and blood sugar
• A heart tracing (ECG) if a heart rhythm problem is suspected
• A head-positioning test in the clinic to check for inner ear crystals
• Hearing tests
• Balance and eye-movement tests, sometimes with a specialist
• Referral to ear, heart, nerve or falls specialists if needed
• A scan of the brain is only needed in some cases, such as when other symptoms suggest a nerve problem

What to expect at your appointment

Finding the cause can take more than one visit. It often helps to keep a simple diary for a week or two: note the date and time, what you were doing, how long it lasted, and anything else you noticed. Bring a list of all your medicines, including supplements. Many people are reassured once the cause is found, because most causes can be treated or managed.

Treatment

Treatment depends entirely on the cause. Some types of dizziness settle on their own within days or weeks. Others respond very well to specific treatment, such as a repositioning technique done in the clinic for inner ear crystals, balance exercises taught by a physiotherapist, or a review of your medicines. Your doctor will explain your options and what to expect.

Self-care at home

• Sit or lie down somewhere safe when dizziness starts, and stay still until it passes
• Stand up slowly and hold on to something solid for a moment
• Drink enough water through the day, especially in hot weather or when unwell
• Eat regular meals to keep your blood sugar steady
• Avoid sudden head movements if they trigger your symptoms
• Keep rooms well lit and use night lights
• Limit or avoid alcohol and cut back on caffeine if these seem to trigger symptoms
• Do any balance exercises your doctor or physiotherapist gives you, even when you feel well
• Do not drive or operate machinery if you feel dizzy or might faint, and check the rules with your doctor

Medical treatments

Doctors treat dizziness by targeting the underlying cause. For inner ear crystals, a trained clinician performs a gentle head and body repositioning technique that usually works within a few visits. For inflammation of the balance nerve, a short course of medicine may ease the spinning and nausea, along with rest and fluids. For Ménière's disease, treatment usually involves reducing salt in the diet and medicines prescribed by a specialist. For blood pressure that drops on standing, reviewing and adjusting medicines, plus advice on fluids and standing safely, is the main approach. Balance rehabilitation with a physiotherapist is very effective for many types of long-lasting dizziness. If anxiety plays a part, talking therapies such as cognitive behavioural therapy can help a great deal. Correcting anaemia, treating infections, checking hearing and getting the right glasses also help. Your doctor will choose what suits you and will explain the benefits and any side effects.

When is surgery considered?

Surgery is rarely needed for dizziness. It may be considered in a small number of cases when a specific inner ear problem does not respond to other treatment over time, or when a heart rhythm problem can be corrected with a procedure. Your specialist would discuss this carefully with you if it applied.

Living with this condition

Living with dizziness often means planning ahead rather than giving things up. Sit down to put on shoes and socks. Rise from bed in stages. Use a shower mat and grab rails. Reset your head position slowly. Tell the people you live and work with what to do if you feel unsteady. Pace yourself, and build in rest breaks. Over time, specific balance exercises can reduce how often dizziness bothers you.

Lifestyle tips

• Keep a regular sleep routine and go to bed and get up at similar times
• Stay well hydrated and eat regularly
• Keep rooms tidy and add night lights to reduce tripping hazards
• Have your eyesight checked and wear your glasses or hearing aids as advised
• Ask your pharmacist or doctor to review your medicines regularly
• Reduce alcohol if it triggers symptoms
• Manage stress with breathing exercises, relaxation or talking therapy if it helps you
• Avoid very crowded, busy places while you recover if these make symptoms worse

Diet and exercise

Eat regular meals, including breakfast, to keep your energy and blood sugar steady. If your doctor has advised a lower-salt diet for an inner ear condition, follow that advice. Drink water regularly through the day and more in hot weather or during exercise. Gentle regular movement is good for balance: walking, tai chi and simple balance exercises are particularly helpful. A physiotherapist can teach vestibular rehabilitation exercises, which train your brain and body to adjust. Start slowly and build up, and stop and sit down if you feel unsteady.

Mental health and emotional wellbeing

Dizziness can shake your confidence. Many people feel anxious about having an episode in public, or worry they will fall. It is common to feel low, frustrated or to avoid going out. These feelings are understandable and treatable. Tell your doctor how you are feeling, because talking therapies and graded activity can help both the anxiety and the dizziness. If you ever have thoughts of harming yourself, contact your local crisis line or emergency services straight away, and tell someone you trust.

Prevention

Not all dizziness can be prevented, but you can lower your chances of episodes and falls. Keep well hydrated, stand up slowly, eat regularly, have your medicines reviewed, treat ear infections promptly, keep your glasses and hearing aids up to date, and stay physically active to keep your balance and muscles strong.

Vaccines

No vaccine prevents dizziness itself. Staying up to date with your routine vaccinations helps you avoid infections, such as flu and some ear infections, that can sometimes trigger dizziness. Ask your doctor or pharmacist which vaccinations are right for you.

Screening programmes

There is no routine screening test for dizziness. However, regular check-ups help: blood pressure checks, blood sugar checks if you are at risk of diabetes, eye tests, hearing tests, and a review of your medicines every so often, especially if you take several. If you have had dizziness before, tell your doctor so it can be watched for.

Complications

If left untreated

• Falls and injuries, including broken bones, especially in older adults
• Losing confidence and becoming less active, which weakens balance over time
• Anxiety, low mood and avoiding social activities
• Difficulties at work or with driving
• Dehydration if vomiting continues
• In rare cases, an underlying heart or brain problem going unrecognised

Long-term outlook

The outlook is good for most people. Many types of dizziness settle within days or weeks, and others improve a lot with simple treatment such as balance exercises or a head-positioning technique. Some conditions, like Ménière's disease, can come and go over years, but they can usually be managed well with the right support. If dizziness is affecting your life, it is worth getting help. Most people do get better.

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