Causes and symptoms

Careful attention to symptoms can help determine the underlying cause of the dizziness. Underlying problems may be benign and easily treated or they may be dangerous and in need of intensive therapy. Not all cases of dizziness can be linked to a specific cause. More than one type of dizziness can be experienced at the same time and symptoms may be mixed. Episodes of dizziness may last for a few seconds or for days. The length of an episode is related to the underlying cause.

The symptoms of syncope include dimmed vision, loss of coordination, confusion, lightheadedness, and sweating. These symptoms can lead to a brief loss of consciousness or fainting. They are related to a reduced flow of blood to the brain; they often occur when a person is standing up and can be relieved by sitting or lying down. Vertigo is characterized by a sensation of spinning or turning, accompanied by nausea, vomiting, ringing in the ears, headache, or fatigue. An individual may have trouble walking, remaining coordinated, or keeping balance. Nonsyncope nonvertigo dizziness is characterized by a feeling of being off balance that becomes worse if the individual tries moving or performing detail-intense tasks.

A person may experience dizziness for many reasons. Syncope is associated with low blood pressure, heart problems, and disorders in the autonomic nervous system, the system of involuntary functions such as breathing. Syncope may also arise from emotional distress, pain, and other reactions to outside stressors. Nonsyncope nonvertigo dizziness may be caused by rapid breathing, low blood sugar, or migraine headache, as well as by more serious medical conditions.

Vertigo is often associated with inner ear problems called vestibular disorders. A particularly intense vestibular disorder, Méniére's disease, interferes with the volume of fluid in the inner ear. This disease, which affects approximately one in every 1,000 people, causes intermittent vertigo over the course of weeks, months, or years. Méniére's disease is often accompanied by ringing or buzzing in the ear, hearing loss, and a feeling that the ear is blocked. Damage to the nerve that leads from the ear to the brain can also cause vertigo. Such damage can result from head injury or a tumor. An acoustic neuroma, for example, is a benign tumor that wraps around the nerve. Vertigo can also be caused by disorders of the central nervous system and the cirulatory system, such as hardening of the arteries (arteriosclerosis), stroke, or multiple sclerosis.

Some medications cause changes in blood pressure or blood flow. These medications can cause dizziness in some people. Prescription medications carry warnings of such side effects, but common drugs, such as caffeine or nicotine, can also cause dizziness. Certain antibiotics can damage the inner ear and cause hearing loss and dizziness.

Diet may cause dizziness. The role of diet may be direct, as through alcohol intake. It may be also be indirect, as through arteriosclerosis caused by a high-fat diet. Some people experience a slight dip in blood sugar and mild dizziness if they miss a meal, but this condition is rarely dangerous unless the person is diabetic. Food sensitivities or allergies can also be a cause of dizziness. Chronic conditions, such as heart disease, and serious acute problems, such as seizures and strokes, can cause dizziness. However, such conditions usually exhibit other characteristic symptoms.

Diagnosis

During the initial medical examination, an individual with dizziness should provide a detailed description of the type of dizziness experienced, when it occurs, and how often each episode lasts. A diary of symptoms may help track this information. Report any symptoms that accompany the dizziness, such as a ringing in the ear or nausea, any recent injury or infection, and any medication taken.

Blood pressure, pulse, respiration, and body temperature are checked, and the ear, nose, and throat are scrutinized. The sense of balance is assessed by moving the individual's head to various positions or by tilt-table testing. In tilt-table testing, the person lies on a table that can be shifted into different positions and reports any dizziness that occurs.

Further tests may be indicated by the initial examination. Hearing tests help assess ear damage. X rays, computed tomography scan (CT scan), and magnetic resonance imaging (MRI) can pinpoint evidence of nerve damage, tumor, or other structural problems. If a vestibular disorder is suspected, a technique called electronystagmography (ENG) may be used. ENG measures the electrical impulses generated by eye movements. Blood tests can determine diabetes, high cholesterol, and other diseases. In some cases, a heart evaluation may be useful. Despite thorough testing, an underlying cause cannot always be determined.

Treatment

Treatment is determined by the underlying cause. If an individual has a cold or influenza, a few days of bed rest is usually adequate to resolve dizziness. Other causes of dizziness, such as mild vestibular system damage, may resolve without medical treatment.

If dizziness continues, drug therapy may prove helpful. Because circulatory problems often cause dizziness, medication may be prescribed to control blood pressure or to treat arteriosclerosis. Sedatives may be useful to relieve the tension that can trigger or aggravate dizziness. Low blood sugar associated with diabetes sometimes causes dizziness and is treated by controlling blood sugar levels. An individual may be asked to avoid caffeine, nicotine, alcohol, and any substances that cause allergic reactions. A low-salt diet may also help some people.

When other measures have failed, surgery may be suggested to relieve pressure on the inner ear. If the dizziness is not treatable by drugs, surgery, or other means, physical therapy may be used and the patient may be taught coping mechanisms for the problem.

Alternative treatment

Because dizziness may arise from serious conditions, it is advisable to seek medical treatment. Alternative treatments can often be used alongside conventional medicine without conflict. Relaxation techniques, such as yoga and massage therapy that focus on relieving tension, are popularly recommended methods for reducing stress. Aromatherapists recommend a warm bath scented with essential oils of lavender, geranium, and sandalwood.

Homeopathic therapies can work very effectively for dizziness, and are especially applicable when no organic cause can be identified. An osteopath or chiropractor may suggest adjustments of the head, jaw, neck, and lower back to relieve pressure on the inner ear. Acupuncturists also offer some treatment options for acute and chronic cases of dizziness. Nutritionists may be able to offer advice and guidance in choosing dietary supplements, identifying foods to avoid, and balancing nutritional needs.

Prognosis

Outcome depends on the cause of dizziness. Controlling or curing the underlying factors usually relieves dizziness. In some cases, dizziness disappears without treatment. In a few cases, dizziness can become a permanent disabling condition and a person's options are limited.

Prevention

Most people learn through experience that certain activities will make them dizzy and they learn to avoid them. For example, if reading in a car produces motion sickness, an individual leaves reading materials for after the trip. Changes to the diet can also cut down on episodes of dizziness in susceptible people. Relaxation techniques can help ward off tension and anxiety that can cause dizziness.

These techniques can help minimize or even prevent dizziness for people with chronic diseases. For example, persons with Méniére's disease may avoid episodes of vertigo by leaving salt, alcohol, and caffeine out of their diets. Reducing blood cholesterol can help diminish arteriosclerosis and indirectly treat dizziness.

Some cases of dizziness cannot be prevented. Acoustic neuromas, for example, are not predictable or preventable. When the underlying cause of dizziness cannot be discovered, it may be difficult to recommend preventive measures. Alternative approaches designed to rebalance the body's energy flow, such as acupuncture and constitutional homeopathy, may be helpful in cases where the cause of dizziness cannot be pinpointed.

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