Dizziness: Causes, Symptoms, and Treatment

Dizziness is less severe, with a feeling of imbalance or feeling “wonky.”

Dizziness is a general term used to describe a range of sensations, such as feeling faint, light-headed, weak, or unsteady. Dizziness can create a false sense of a person’s head spinning or spinning of the surroundings or swaying. This may be associated with nausea, vomiting, sweating, headache, or difficulty walking. Vertigo differs from dizziness because vertigo is a true sensation of self-spinning or spinning of the surrounding. Dizziness on the other hand is less severe, with a feeling of imbalance or feeling “wonky.”

The common signs and symptoms of dizziness include:

• Feeling of fainting 
• Lightheadedness 
• Loss of balance 
• False sense of spinning 
• Difficulty walking
• Unsteadiness 
• Nausea and vomiting 

The causes of dizziness include the following:

Disorders of the inner ear: The inner ear maintains the body balance by sending impulses to the brain about the head, neck, and body movements. The most common inner ear disorders causing dizziness include: 

Benign paroxysmal positional vertigo (BPPV): BPPV usually has no specific trigger; it could because of trauma or sudden neck/head movements. In BPPV, canaliths (tiny calcium particles) get accumulated in canals of the inner ear.

Meniere's disease: It is an inner ear disorder in which the fluid accumulates in the inner ear and causes increased pressure. The cause may be genetic, allergies, or autoimmune. Patients typically present with vertigo, tinnitus (ringing sound in the ear), and hearing loss/aural fullness (feeling of fullness in the ear).

Labyrinthitis: It is inflammation of the nerves inside the inner ear. It can occur following viral or bacterial infections, including just a common cold.

Trauma: Trauma to the ear or skull fractures can damage the structures of the inner ear. 

Motion sickness: Vertigo can be triggered while travelling, causing motion sickness. It is also commonly associated with nausea and vomiting.

Medications: Certain medications can cause inner ear damage.

• Lesions (tumors) in the brain
• Inflammation/infection of the brain
• Stroke 
• Seizures 
• Cervical spine disorders such as cervical spondylosis 
• Multiple sclerosis 
• Parkinsonism 
• Alcohol intoxication 
• Vertigo associated with migraine (migrainous vertigo)
• Trauma to the head and neck
• Dehydration 
• Starvation
• Anemia
• Low blood pressure 
• Hypoglycemia (low blood sugar)
• Heart disease 
• Anxiety 

The following is advised during an episode of dizziness:

• Sitting or lying down immediately and resting in a cool place till the symptoms resolve. This prevents the risk of losing balance, leading to a fall and serious injury. One may use a cane or walker or handrails for support. 
• Avoiding sudden movements of the head and neck and suddenly changing positions can be helpful.
• Driving or doing any dangerous activities such as operating heavy machinery should be avoided. 
• Drinking fluids and remaining hydrated can help improve dizziness.
• Eating something sweet can help when you feel dizzy due to low blood sugar.
• Tripping hazards such as rugs on the floor, low tables, etc. should be removed in the house to lower the risk of fall in those who have frequent episodes of dizziness.
• One may take over-the-counter anti-vertigo medications such as Antivert (meclizine) or antihistamines. Painkillers may be taken if there is associated headache.

Treatment for vertigo depends on the cause. In some cases, vertigo may resolve without any treatment and never recur due to the ability of the brain to adapt. In other cases, the treatment options include:

• Vestibular rehabilitation: This is a type of physical therapy, wherein the patient is taught certain exercises to help strengthen the inner ear system.
• Canalith repositioning maneuvers: These are specific maneuvers performed by a healthcare professional, where the movements are done to dislodge the calcium deposits out of the inner ear canal.
• Medication: In some cases, medication may be prescribed to suppress the inner ear or improve blood blow in the inner ear. Medications to relieve associated symptoms such as nausea, vomiting, headache, or motion sickness may be administered. Antibiotics would be prescribed in cases of infection or inflammation. Steroids may be needed to suppress inflammation and reduce swelling. In Meniere's disease, diuretics (pills that reduce fluid in the ear) may be prescribed to reduce pressure due to fluid accumulation.
• Surgery: In severe cases, when the vertigo does not resolve with medication and other conservative measures, surgery may be required for vertigo.

The following measures may help reduce the frequency and intensity of the episodes of vertigo:

• Doing activities that improve balance, such as vestibular rehabilitation exercises, yoga, or Tai Chi
• Adequate hydration by drinking at least eight glass of water a day
• Sleeping for least seven hours and avoiding stressful situations
• Eating a healthy diet that consists of vegetables, fruits, and lean proteins 
• Reducing the salt content in food
• Taking medications as prescribed
• Managing psychological stress/anxiety