What is Dizziness?
Dizziness is not a disease, but rather it is a symptom of various other conditions. The state of being “dizzy” is described as feeling lightheaded, faint, weak, or unsteady in balance. It can also refer to an artificial sense of things spinning or moving. The way that dizziness manifests itself is often dependent on the particular illness that it is associated with.
Dizziness is basically classified into three different categories:
- Syncope dizziness: This type of dizziness is characterized by fainting (a brief loss of consciousness), dimmed vision, confusion, lightheadedness, a lack of coordination, or any combination of the above. It is very much like the feeling you might get if you stand up too quickly.
- Vertigo dizziness: This type feels like either you or the environment around you is spinning. It is similar to the sensation many folks experience on a spinning carnival ride.
- Nonsyncope nonvertigo dizziness: This variety of dizziness is usually linked to a feeling that the individual cannot keep their balance. Movement often makes the situation worse.
Dizziness is an extremely common complaint. It is estimated that about 42% of Americans will at some point in their lives experience dizziness that is significant enough to seek medical attention. It is thought to be responsible for over five million visits to the doctor every year, and the cost of medical care for dizziness is placed at over $1 Billion annually. The incidence of dizziness increases with age, and for those over the age of 75, dizziness is the number one reason for seeing a health care provider.
What Are the Causes of Dizziness?
Dizziness can be caused by a myriad of conditions that incorporate dizziness as one of their symptoms. But the root of all dizziness is tied to the body’s system of balance. The complex mechanism of balance involves multiple organs including the inner ear, the eyes, and the sensory nerves. The brain interprets signals from these various sources, and proper managing of all this data results in normal balance. However, if the brain cannot process the information or it receives contradictory messages, a state of imbalance will occur that often triggers dizziness. Our brains can compensate to some degree. For example, if I am standing up in the shower and close my eyes to keep the soap out, I will normally not lose my balance thanks to my inner ear and sensory nerves.
The inner ear is a very complex organ, and an improperly working inner ear (vestibular system) is responsible for most cases of dizziness, mainly due to it’s extreme sensitivity to changes in the body’s blood flow. Other medical conditions that involve the circulatory system and can contribute to dizziness are hypertension (high blood pressure) and hypoglycemia (low blood sugar).
Dizziness has many different potential causes. Some of the more common ones include:
- Vertigo is characterized by a feeling of motion or spinning, and is probably the number one condition associated with dizziness. Just like dizziness, vertigo itself is not a disease, but a symptom. Most vertigo is caused by a problem in the vestibular system of the inner ear that throws off your balance. The body is not able to properly interpret movement or changes in the position of your head. A common co-symptom of vertigo is abnormal eye movement called nystagmus. It usually appears as side-to-side movement of the eyeball. There are many conditions that can cause vertigo and its accompanying dizziness:
ü Meniere’s disease involves an excess of fluid within the inner ear. It can cause vertigo to come on suddenly and continue for 30-60 minutes or longer. It is often accompanied by tinnitus (buzzing or ringing in the ears) and intermittent hearing loss. The exact cause of Meniere’s disease is not known for certain.
ü Benign Paroxysmal Positional Vertigo (BPPV) produces vertigo when there is a change in the position of the head such as rolling over of sitting up in bed. It is caused by calcium crystals (otoconia) that are normally found in the ear. The problem is that when they lodge in the wrong part of the inner ear, they send out signals that result in vertigo and dizziness. The cause of BPPV is not known for sure, but research indicates that incidence increases with age, and that sometimes head trauma can trigger BPPV.
ü Acousitic neuroma (also known as schwannoma) involves the growth of benign tissues that attach themselves to or wrap around the acoustic nerve. This organ connects the brain and the inner ear, and acoustic neuromas can interfere with this critical means of communication. The results often include vertigo, dizziness, tinnitus, hearing loss, and balance problems.
ü Vestibular migraine: This particular type of migraine headache is very affected by motion. Vertigo and dizziness can come on from just about any movement such as riding in a car or turning your head quickly or even viewing movement on a television or movie screen. Sometimes symptoms will occur with a headache, or on occasion the patient will have the typical warning signs of a migraine, and end up with vertigo only and no headache. Associated symptoms include tinnitus, poor balance, and muffled hearing. The length of these attacks can vary greatly, from a few minutes up to several days at a time.
ü Inflammation of the inner ear (acute vestibular neuronitis or labyrinthitis) can sometimes result in intense vertigo that may last for several days. In addition to dizziness, some patients experience nausea and vomiting as well. Many times the individual must remain in bed for a few days until the symptoms subside.
ü Motion sickness: Some people will get vertigo and dizziness from riding in a vehicle such as a car, bus, plane, or boat. Carnival rides such as a roller coaster or Ferris wheel can also trigger symptoms.
ü On rare occasions, vertigo can also be a sign of more critical health conditions such as a brain hemorrhage, stroke, or multiple sclerosis.
- Presyncope (feeling of faintness): In medical terms, this is a state of feeling lightheaded without losing consciousness. In addition to dizziness, symptoms of presyncope often include nausea and a pale appearance to the skin. It is usually caused by one of two factors:
ü Orthostatic hypotension is a sudden reduction of the systolic blood pressure. It can occur in some people after standing up too quickly.
ü Insufficient amount of blood from the heart: This is typically the result of clogged arteries (atherosclerosis), a bad heart muscle that can’t pump enough blood (cardiomyopathy), or an abnormal heartbeat (arrhythmia).
- Disequilibrium (poor balance): This manifestation of dizziness is tied to unsteadiness when standing or walking. It can be caused by several factors:
ü Vestibular dysfunction: The workings of the inner ear are so critical to balance. If there is a problem there, the balance is easily affected. Inner ear disorders can create illusions of false movement and make some patients feel like they are “floating.”
ü Medications: Certain drugs can cause dizziness and affect balance, especially in older folks. Common culprits include tranquilizers and some pain medications.
ü Osteoarthritis: This type of arthritis affects the joints and can cause balance difficulties when found in the legs or feet.
ü Vision problems: If a person is losing their capacity to see, as is common in seniors, dizziness and balance can be a side effect.
ü Nerve damage: Nerve troubles can also affect balance, especially a condition known as peripheral neuropathy that compromises the nerves of the legs.
- Anxiety disorders: Many anxiety disorders such as panic attacks or agoraphobia (crippling fear of leaving home) will commonly produce dizziness in patients. Some of this is due to the fact that many of these conditions also cause hyperventilation, which indirectly leads to dizziness.
What Treatments Are Available for Dizziness?
If you are experiencing dizzy spells, the first thing that must be done is to determine the type of dizziness, and to identify what the underlying problem is that is causing it. Having a thorough exam and conversation with a health care provider that knows you and your health issues well is the best way to go. You will want to consider what other symptoms you are experiencing along with dizziness, and also take into account your diet, exercise habits, and any medicine you might be taking. Your exam might also make use of a “tilt-table” that can shift you into different positions and analyze any resulting dizziness or vertigo.
Pay close attention if your dizziness accompanies any of the following signs. These may indicate a serious circulatory or neurological condition that needs to be addressed:
- Severe or chronic headaches
- Numbness or tingling
- Chest pain
- Change in heart rate (faster or slower)
- Blurred vision
- Hearing loss or muffled hearing
- Weakness in the extremities
- Falling or difficulty maintaining balance when walking
The good news about dizziness is that it can often be treated through noninvasive therapies that do not involve medications or surgery. This is truly a rarity in modern allopathic medicine. The type of treatment that is needed is dependent on the cause of the dizziness, and its associated symptoms. Here is a list of common disorders that cause dizziness, and some suggested treatments:
- BPPV: There is an excellent therapy available for BPPV that is highly successful, with positive results in up to 90% of patients. It is called canalith repositioning (also known as the “Epley Maneuver”), and it involves maneuvering the head and the use of a vibrator to manipulate the otoconia (calcium crystals) that are causing the problem so they can be reabsorbed into the fluids of the ear. It can be performed by a physical therapist of other provider, and may be repeated if needed. It works great and has no known risks or side effects!
- Inner ear problems can be treated via a therapy called vestibular rehabilitation. This involves a series of head and body exercises that you can learn that will help to correct poor balance. Once you learn them, you can do them yourself on a regular basis at home.
- Vestibular migraines and the resulting vertigo and dizziness can be dealt with by taking steps that will help reduce the incidence and severity of the migraines. These include avoiding your own personal migraine triggers such as certain foods and undue stress. Regular aerobic exercise and quality sleep can also be beneficial. In addition, vestibular rehabilitation is helpful for many patients.
- Meniere’s disease can effectively be treated through dietary changes such as a low-sodium diet. This will help reduce the retention of fluids that is the cause of Meniere’s.