DIZZINESS

Dizziness
A sense of dizziness or lightheadedness can result from:

• Inner ear problems. Abnormalities of the vestibular system can lead to a sensation of floating or other false sensation of motion.
• Psychiatric disorders. Depression (major depressive disorder), anxiety and other psychiatric disorders can cause dizziness.
• Abnormally rapid breathing (hyperventilation). This condition often accompanies anxiety disorders and may cause lightheadedness.
• Medications. Lightheadedness can be a side effect of medications.

Diagnosis
Your doctor will start by reviewing your medical history and conducting a physical and neurological examination.
To determine if your symptoms are caused by problems in the balance function in your inner ear, your doctor is likely to recommend tests. They might include:

• Hearing tests. Difficulties with hearing are frequently associated with balance problems.
• Posturography test. Wearing a safety harness, you try to remain standing on a moving platform. A posturography test indicates which parts of your balance system you rely on most.
• Electronystagmography and videonystagmography. Both tests record your eye movements, which play a role in vestibular function and balance. Electronystagmography uses electrodes to record eye movements. Videonystagmography uses small cameras to record eye movements.
• Rotary chair test. Your eye movements are analyzed while you sit in a computer-controlled chair that moves slowly in a circle.
• Dix-Hallpike maneuver. Your doctor carefully turns your head in different positions while watching your eye movements to determine whether you have a false sense of motion or spinning.
• Vestibular evoked myogenic potentials test. Sensor pads attached to your neck and forehead and under your eyes measure tiny changes in muscle contractions in reaction to sounds.
• Imaging tests. MRI and CT scans can determine if underlying medical conditions might be causing your balance problems.
• Blood pressure and heart rate tests. Your blood pressure might be checked when sitting and then after standing for two to three minutes to determine if you have significant drops in blood pressure. Your heart rate might be checked when standing to help determine if a heart condition is causing your symptoms.

Treatment
Treatment depends on the cause of your balance problems. Your treatment may include:

• Balance retraining exercises (vestibular rehabilitation). Therapists trained in balance problems design a customized program of balance retraining and exercises. Therapy can help you compensate for imbalance, adapt to less balance and maintain physical activity. To prevent falls, your therapist might recommend a balance aid, such as a cane, and ways to reduce your risk of falls in your home.
• Positioning procedures. If you have BPPV, a therapist might conduct a procedure (canalith repositioning) that clears particles out of your inner ear and deposits them into a different area of your ear. The procedure involves maneuvering the position of your head.
• Diet and lifestyle changes. If you have Meniere's disease or migraines, dietary changes are often suggested that can ease symptoms. You may need to limit salt intake and avoid other dietary triggers such as caffeine, alcohol and certain ingredients. If you experience postural hypotension, you might need to drink more fluids or wear compression stockings.
• Medications. If you have severe vertigo that lasts hours or days, you might be prescribed medications that can control dizziness and vomiting.
• Surgery. If you have Meniere's disease or acoustic neuroma, your treatment team may recommend surgery. Stereotactic radiosurgery might be an option for some people with acoustic neuroma. This procedure delivers radiation precisely to your tumor and doesn't require an incision.

Dizziness

Definition
Dizziness is a term used to describe a range of sensations, such as feeling faint, woozy, weak or unsteady. Dizziness that creates the false sense that you or your surroundings are spinning or moving is called vertigo.
Description
Dizziness is one of the more common reasons adults visit their doctors. Frequent dizzy spells or constant dizziness can significantly affect your life. But dizziness rarely signals a life-threatening condition.
Treatment of dizziness depends on the cause and your symptoms. It's usually effective, but the problem may recur.
Symptoms
People experiencing dizziness may describe it as any of a number of sensations, such as:

• A false sense of motion or spinning (vertigo)
• Lightheadedness or feeling faint
• Unsteadiness or a loss of balance
• A feeling of floating, wooziness or heavy-headedness

These feelings may be triggered or worsened by walking, standing up or moving your head. Your dizziness may be accompanied by nausea or be so sudden or severe that you need to sit or lie down. The episode may last seconds or days and may recur.
When to see a doctor
Generally, see your doctor if you experience any recurrent, sudden, severe, or prolonged and unexplained dizziness or vertigo.
Get emergency medical care if you experience new, severe dizziness or vertigo along with any of the following:

• Sudden, severe headache
• Chest pain
• Difficulty breathing
• Numbness or paralysis of arms or legs
• Fainting
• Double vision
• Rapid or irregular heartbeat
• Confusion or slurred speech
• Stumbling or difficulty walking
• Ongoing vomiting
• Seizures
• A sudden change in hearing
• Facial numbness or weakness

Causes
Dizziness has many possible causes, including inner ear disturbance, motion sickness and medication effects. Sometimes it's caused by an underlying health condition, such as poor circulation, infection or injury.
The way dizziness makes you feel and your triggers provide clues for possible causes. How long the dizziness lasts and any other symptoms you have also help pinpoint the cause.
Inner ear problems that cause dizziness (vertigo)
Your sense of balance depends on the combined input from the various parts of your sensory system. These include your:

• Eyes, which help you determine where your body is in space and how it's moving
• Sensory nerves, which send messages to your brain about body movements and positions
• Inner ear, which houses sensors that help detect gravity and back-and-forth motion

Vertigo is the false sense that your surroundings are spinning or moving. With inner ear disorders, your brain receives signals from the inner ear that aren't consistent with what your eyes and sensory nerves are receiving. Vertigo is what results as your brain works to sort out the confusion.

• Benign paroxysmal positional vertigo (BPPV). This condition causes an intense and brief but false sense that you're spinning or moving. These episodes are triggered by a rapid change in head movement, such as when you turn over in bed, sit up or experience a blow to the head. BPPV is the most common cause of vertigo.
• Infection. A viral infection of the vestibular nerve, called vestibular neuritis, can cause intense, constant vertigo. If you also have sudden hearing loss, you may have labyrinthitis.
• Meniere's disease. This disease involves the excessive buildup of fluid in your inner ear. It's characterized by sudden episodes of vertigo lasting as long as several hours. You may also experience fluctuating hearing loss, ringing in the ear and the feeling of a plugged ear.
• Migraine. People who experience migraines may have episodes of vertigo or other types of dizziness even when they're not having a severe headache. Such vertigo episodes can last minutes to hours and may be associated with headache as well as light and noise sensitivity.

Circulation problems that cause dizziness
You may feel dizzy, faint or off balance if your heart isn't pumping enough blood to your brain. Causes include:

• Drop in blood pressure. A dramatic drop in your systolic blood pressure — the higher number in your blood pressure reading — may result in brief lightheadedness or a feeling of faintness. It can occur after sitting up or standing too quickly. This condition is also called orthostatic hypotension.
• Poor blood circulation. Conditions such as cardiomyopathy, heart attack, heart arrhythmia and transient ischemic attack could cause dizziness. And a decrease in blood volume may cause inadequate blood flow to your brain or inner ear.

Other causes of dizziness

• Neurological conditions. Some neurological disorders — such as Parkinson's disease and multiple sclerosis — can lead to progressive loss of balance.
• Medications. Dizziness can be a side effect of certain medications — such as anti-seizure drugs, antidepressants, sedatives and tranquilizers. In particular, blood pressure lowering medications may cause faintness if they lower your blood pressure too much.
• Anxiety disorders. Certain anxiety disorders may cause lightheadedness or a woozy feeling often referred to as dizziness. These include panic attacks and a fear of leaving home or being in large, open spaces (agoraphobia).
• Low iron levels (anemia). Other signs and symptoms that may occur along with dizziness if you have anemia include fatigue, weakness and pale skin.
• Low blood sugar (hypoglycemia). This condition generally occurs in people with diabetes who use insulin. Dizziness (lightheadedness) may be accompanied by sweating and anxiety.
• Carbon monoxide poisoning. Symptoms of carbon monoxide poisoning are often described as "flu-like" and include headache, dizziness, weakness, upset stomach, vomiting, chest pain and confusion.
• Overheating and dehydration. If you're active in hot weather or if you don't drink enough fluids, you may feel dizzy from overheating (hyperthermia) or from dehydration. This is especially true if you take certain heart medications.

Risk factors
Factors that may increase your risk of getting dizzy include:

• Age. Older adults are more likely to have medical conditions that cause dizziness, especially a sense of imbalance. They're also more likely to take medications that can cause dizziness.
• A past episode of dizziness. If you've experienced dizziness before, you're more likely to get dizzy in the future.

Complications
Dizziness can increase your risk of falling and injuring yourself. Experiencing dizziness while driving a car or operating heavy machinery can increase the likelihood of an accident. You may also experience long-term consequences if an existing health condition that may be causing your dizziness goes untreated.
Diagnosis
If your doctor suspects you are having or may have had a stroke, are older or suffered a blow to the head, he or she may immediately order an MRI or CT scan.
Most people visiting their doctor because of dizziness will first be asked about their symptoms and medications and then be given a physical examination. During this exam, your doctor will check how you walk and maintain your balance and how the major nerves of your central nervous system are working.
You may also need a hearing test and balance tests, including:

• Eye movement testing. Your doctor may watch the path of your eyes when you track a moving object. And you may be given an eye motion test in which water or air is placed in your ear canal.
• Head movement testing. If your doctor suspects your vertigo is caused by benign paroxysmal positional vertigo, he or she may do a simple head movement test called the Dix-Hallpike maneuver to verify the diagnosis.
• Posturography. This test tells your doctor which parts of the balance system you rely on the most and which parts may be giving you problems. You stand in your bare feet on a platform and try to keep your balance under various conditions.
• Rotary chair testing. During this test you sit in a computer-controlled chair that moves very slowly in a full circle. At faster speeds, it moves back and forth in a very small arc.

In addition, you may be given blood tests to check for infection and other tests to check heart and blood vessel health.

Treatment
Dizziness often gets better without treatment. Within a couple of weeks, the body usually adapts to whatever is causing it.
If you seek treatment, your doctor will base it on the cause of your condition and your symptoms. It may include medications and balance exercises. Even if no cause is found or if your dizziness persists, prescription drugs and other treatments may make your symptoms more manageable.
Medications

• Water pills. If you have Meniere's disease, your doctor may prescribe a water pill (diuretic). This along with a low-salt diet may help reduce how often you have dizziness episodes.
• Medications that relieve dizziness and nausea. Your doctor may prescribe drugs to provide immediate relief from vertigo, dizziness and nausea, including prescription antihistamines and anticholinergics. Many of these drugs cause drowsiness.
• Anti-anxiety medications. Diazepam (Valium) and alprazolam (Xanax) are in a class of drugs called benzodiazepines, which may cause addiction. They may also cause drowsiness.
• Preventive medicine for migraine. Certain medicines may help prevent migraine attacks.

Therapy

• Head position maneuvers. A technique called canalith repositioning (or Epley maneuver) usually helps resolve benign paroxysmal positional vertigo more quickly than simply waiting for your dizziness to go away. It can be done by your doctor, an audiologist or a physical therapist and involves maneuvering the position of your head. It's usually effective after one or two treatments. Before undergoing this procedure, tell your care provider if you have a neck or back condition, a detached retina, or blood vessel problems.
• Balance therapy. You may learn specific exercises to help make your balance system less sensitive to motion. This physical therapy technique is called vestibular rehabilitation. It is used for people with dizziness from inner ear conditions such as vestibular neuritis.
• Psychotherapy. This type of therapy may help people whose dizziness is caused by anxiety disorders.

Surgical or other procedures

• Injections. Your doctor may inject your inner ear with the antibiotic gentamicin to disable the balance function. The unaffected ear takes over that function.
• Removal of the inner ear sense organ. A procedure that's rarely used is called labyrinthectomy. It disables the vestibular labyrinth in the affected ear. The other ear takes over the balance function. This technique may be used if you have serious hearing loss and your dizziness hasn't responded to other treatments.

Lifestyle and home remedies
If you tend to experience repeated episodes of dizziness, consider these tips:

• Be aware of the possibility of losing your balance, which can lead to falling and serious injury.
• Avoid moving suddenly and walk with a cane for stability, if needed.
• Fall-proof your home by removing tripping hazards such as area rugs and exposed electrical cords. Use nonslip mats on your bath and shower floors. Use good lighting.
• Sit or lie down immediately when you feel dizzy. Lie still with your eyes closed in a darkened room if you're experiencing a severe episode of vertigo.
• Avoid driving a car or operating heavy machinery if you experience frequent dizziness without warning.
• Avoid using caffeine, alcohol, salt and tobacco. Excessive use of these substances can worsen your signs and symptoms.
• Drink enough fluids, eat a healthy diet, get enough sleep and avoid stress.
• If your dizziness is caused by a medication, talk with your doctor about discontinuing it or lowering the dose.
• If your dizziness comes with nausea, try an over-the-counter (nonprescription) antihistamine, such as meclizine or dimenhydrinate (Dramamine). These may cause drowsiness. Nondrowsy antihistamines aren't as effective.
• If your dizziness is caused by overheating or dehydration, rest in a cool place and drink water or a sports drink (Gatorade, Powerade, others).

Preparing for your appointment
Your family doctor or primary care provider will probably be able to diagnose and treat the cause of your dizziness. He or she you may refer you to an ear, nose and throat (ENT) specialist or a doctor who specializes in the brain and nervous system (neurologist).
Here's some information to help you get ready for your appointment.
What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. If you're scheduled for vestibular testing, your doctor will provide instructions regarding any medications to withhold the night before and what to eat on the day of testing.
• Be prepared to describe your dizziness in specific terms. When you have an episode of dizziness, do you feel like the room is spinning, or like you are spinning in the room? Do you feel like you might pass out? Your description of these symptoms is crucial to helping your doctor make a diagnosis.
• List any other health conditions or symptoms you have, including any that may seem unrelated to your dizziness. For example, if you have felt depressed or anxious recently, this is important information for your doctor.
• List key personal information, including any major stresses or recent life changes.
• Make a list of all prescription and over-the-counter medications, vitamins or supplements that you're taking.
• List questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. For dizziness, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• Are there any other possible causes for my symptoms?
• What tests do you recommend?
• Is this problem likely temporary or long lasting?
• Is it possible my symptoms will go away without treatment?
• What treatment options might help?
• Do I need to follow any restrictions? For example, is it safe for me to drive?
• Should I see a specialist?
• Is there a generic alternative to the medicine you're prescribing?
• Do you have any brochures or other printed material that I can take home with me? What websites do you recommend?

What to expect from your doctor
Your doctor will likely ask you a number of questions about your dizziness, such as:

• Can you describe what you felt the first time you had an episode of dizziness?
• Is your dizziness continuous, or does it occur in spells or episodes?
• If your dizziness occurs in episodes, how long do these episodes last?
• How often do your dizziness episodes occur?
• When do your dizzy spells seem to happen, and what triggers them?
• Does your dizziness cause the room to spin or produce a sensation of motion?
• When you feel dizzy, do you also feel faint or lightheaded?
• Does your dizziness cause you to lose your balance?
• Are your symptoms accompanied by a ringing or fullness in your ears (tinnitus) or trouble hearing?
• Does your vision blur?
• Is your dizziness made worse by moving your head?
• What medications, vitamins or supplements are you taking?

What you can do in the meantime
If you tend to feel lightheaded when you stand up, take your time making changes in posture. If you have had episodes of dizziness while driving, arrange for alternate transportation while you're waiting to see your doctor.
If your dizziness causes you to feel like you might fall, take steps to reduce your risk. Keep your home well lighted and free of hazards that might cause you to trip. Avoid area rugs and exposed electrical cords. Place furniture where you're unlikely to bump into it, and use nonslip mats in the bathtub and on shower floors.