Have you ever gotten out of bed and felt like you had to sit back down because you lost your balance? Or had to stop walking because everything seemed to be spinning around you for a few seconds? Dizziness can occur at the most mundane moments, even in healthy people.

It's not a diagnosis in itself, but a symptom that can be attributed to a number of explanations, including dehydration or fatigue. But when it recurs consistently, dizziness can mask more serious problems, such as neurological disorders or cardiovascular disease.

What is dizziness?

Dizziness is a term used to describe a variety of sensations such as spinning, instability, disorientation, loss of balance or even fainting and which can be perceived as weakness, confusion or uncertainty while walking.

Depending on the intensity, dizziness can range from a light-headed feeling to a false impression that everything is spinning. This impression is called vertigo and refers to the sensation that a person, or everything around them, is moving or spinning.

Dizziness itself is not a disease, but a symptom that can have multiple causes such as circulatory, metabolic, emotional disorders or even problems with the inner ear. The latter plays a major role in maintaining balance and spatial orientation, and lack of stability can signal a condition in the vestibular system.

Types of dizziness

Dizziness can manifest itself in different ways and can have a variety of causes, including neurological or musculoskeletal. Depending on how it is felt and the likely cause, several types of dizziness are distinguished.

Vertigo-like dizziness

The false sensation that everything around you is spinning or that you are spinning when you are actually standing still is called vertigo and is most often associated with disorders of the inner ear and balance system. It may be accompanied by nausea, vomiting, and difficulty maintaining stability.

Presyncope-type dizziness (lightheadedness)

Known as "lightheadedness," presyncope-type dizziness is described as a feeling of lightheadedness, weakness, or impending loss of consciousness (fainting) and is frequently associated with low blood pressure (hypotension) or dehydration.

You may experience this sensation when you stand up suddenly or after prolonged periods of standing.

Disequilibrium-type dizziness

Balance-related dizziness doesn't necessarily make you feel like everything is spinning around you, but rather it causes you to have difficulty walking or maintaining your balance. You may feel like you can't walk straight, that your steps are unsteady, or that something is pulling you to one side.

This type of dizziness is more common in patients with neurological or muscular conditions.

Dizziness with floating sensation/confusion

Dizziness with a feeling of confusion or floating occurs more frequently in the context of chronic stress, extreme fatigue, anxiety, or metabolic disorders and is a more vague form of dizziness. It does not manifest itself as the classic sensation of spinning, but rather as a state of mental fog, floating, or lack of clarity, which can affect your ability to concentrate.

Causes of dizziness

Episodes of dizziness can be temporary and short-lived, often due to trivial causes such as fatigue or dehydration. However, there are also cases in which medical evaluation is necessary, especially in the case of recurring, intense or sudden episodes. These can signal the presence of more serious health problems.

Dizziness caused by inner ear disorders

Approximately 50% of dizziness cases are caused by an inner ear condition, according to a 2022 study. The inner ear plays a central role in maintaining balance, and any imbalance at this level can cause dizziness, especially vertigo:

• Benign paroxysmal positional vertigo (BPPV): when the head position changes, small calcium crystals in the inner ear change their position and cause brief episodes of vertigo.
• Labyrinthitis or vestibular neuronitis: an inflammation of the inner ear canals or vestibular nerve, often following a viral infection, which can cause sudden and severe episodes of vertigo.
• Ménière's disease: characterized by the accumulation of fluid in the inner ear and associated with vertigo, ringing in the ears (tinnitus), and hearing impairment.

Dizziness caused by cardiovascular problems

Without adequate blood flow to the brain, dizziness, imbalance, and fainting can occur. In older people, a significant percentage of dizziness cases are caused by cardiovascular problems such as:

• Orthostatic hypotension: sudden drop in blood pressure when standing up suddenly.
• Cardiac arrhythmias: irregular heartbeats that can cause fainting due to temporary decreased cerebral blood flow.
• Cerebral circulatory insufficiency: reduced blood flow to the brain caused by narrowing or blockage of cerebral vessels.

Dizziness caused by neurological disorders

Persistent and severe episodes of dizziness may be neurological in origin, especially when associated with other symptoms such as vision, speech, or coordination problems. Neurological conditions affect the brain's ability to process information about space and balance, often leading to severe dizziness. Some of the most common causes are:

• Vestibular migraine: can cause vertigo, accompanied by headaches or visual disturbances.
• Stroke (CVA): Especially when dizziness comes on suddenly and is accompanied by weakness on one side of the body or slurred speech, it is a medical emergency.
• Conditions that require thorough investigations: such as multiple sclerosis or brain tumors.

Dizziness caused by metabolic and endocrine disorders

Metabolic imbalances can directly affect the functioning of the brain and nervous system, which can sometimes cause dizziness and fatigue. The most common causes include:

• Hypoglycemia: low blood sugar,   especially in patients suffering from diabetes and people who skip meals.
• Anemia or iron deficiency : characterized by a reduced ability of the blood to carry oxygen to the brain.
• Vitamin B12 deficiency and thyroid conditions: can cause dizziness, fatigue, and difficulty concentrating.

Dizziness and heavy menstruation

Menorrhagia , or very heavy periods that require you to change your menstrual products every hour or more frequently, is characterized by significant blood and iron loss that can lead to iron deficiency and iron deficiency anemia. This can reduce oxygen levels in the brain, which can cause dizziness, weakness, and a general state of exhaustion.

Dizziness during menstruation is often accompanied by paleness, rapid pulse, difficulty concentrating, weakness, and a feeling of extreme fatigue.

If the dizziness is severe or accompanied by fainting, a gynecological consultation and blood tests (hemogram, ferritin, hormones) are recommended. Depending on the results, the doctor may recommend appropriate treatment with iron supplements, dietary changes or, if necessary, additional hormonal investigations.

Dizziness caused by external factors and lifestyle

There are also seemingly trivial factors that can cause dizziness and fatigue. Dehydration, chronic stress, anxiety and panic attacks are some of the common causes. Dizziness can also be an adverse effect of treatment with certain medications, especially antihypertensives, sedatives or antidepressants.

Symptoms associated with dizziness

Dizziness is a symptom in itself and can be easily recognized by the sensation of spinning or being off balance. However, people who experience it often also experience other conditions:

• Nausea, vomiting
• Cold sweats
• Blurred vision
• Tinnitus (ringing in the ears).
• General weakness
• Difficulty concentrating and mental fog

These symptoms can be triggered or worsened especially by sudden movements, walking, head movements, or standing up.

When dizziness becomes an alarm signal

Dizziness is among the most common reasons why patients see a doctor, and surveys show that up to 30% of the world's population is affected at some point.

An occasional, short-term episode can be attributed to dehydration or fatigue and is not a cause for concern. However, if these conditions recur, or if the episodes are severe and long-lasting (more than 3 days), it is recommended to visit a doctor to determine the exact cause.

There are also situations where emergency medical care is needed. Call an ambulance if you have an episode of sudden and intense vertigo or dizziness accompanied by:

• Pain, such as a sudden, severe pain in the chest
• Severe headaches or neck stiffness
• Fast or irregular heartbeat
• Numbness on one side or paralysis of the hands, feet, or face
• Loss of coordination
• Breathing difficulties
• Loss of consciousness or seizures
• Eye or ear problems, such as double vision or sudden changes in hearing
• Confusion or difficulty speaking
• Persistent vomiting.

Diagnosing dizziness

Because dizziness is a common symptom of many conditions, the diagnostic process involves a careful evaluation of the context in which the episodes occur and, if necessary, various additional investigations.

Medical history and physical examination for dizziness

A detailed discussion with your doctor and a physical examination (measuring your blood pressure, assessing your eye movement, reflexes, and gait) are usually the first steps in diagnosis. Your doctor will want to know the duration, intensity, and frequency of your dizziness episodes, and will try to understand triggers such as changing positions, exercise, stress, menstruation, or certain foods.

Also at this stage, a discussion will take place about the medications administered, stress level, sleep quality, and the existence of known conditions, to exclude common causes related to lifestyle or certain treatments.

ENT and vestibular tests

If the doctor suspects a condition related to the inner ear that could be causing dizziness, he or she may recommend specific ENT investigations.

Among the most commonly used tests are the Dix-Hallpike test, used to diagnose benign paroxysmal positional vertigo (BPPV), as well as audiometry or electronystagmography, which allow the evaluation of hearing and the function of the vestibular system and provide important information about balance and movement coordination.

Neurological and imaging investigations

When dizziness is severe and persistent, or when your doctor suspects a neurological cause, they may recommend an MRI or computed tomography (CT) scan. These can identify any damage, inflammation, or disorders of the central nervous system.

Balance tests and neurological evaluations help rule out conditions such as stroke, multiple sclerosis, or brain tumors.

Treatment for dizziness

Occasional, trivial episodes of dizziness often go away without treatment. Even when there is a more serious cause, the body has an incredible power to adapt within a few weeks and get rid of these conditions even without treatment.

When the doctor recommends, however, the pursuit of a treatment, it is determined based on the symptoms and the cause identified following investigations, with the aim of improvement.

Drug treatments

Drug treatment should always be followed only on the recommendation of a doctor, as prolonged use can mask symptoms without treating the real cause.

Antivertigo medications, such as betahistine or meclizine, can keep symptoms under control by reducing the sensation of spinning.

Depending on the case, especially if the dizziness is accompanied by nausea or vomiting, antiemetics, antihistamines, or vestibular sedatives may also be prescribed.

Vestibular maneuvers and therapy

For benign positional vertigo, the Epley maneuver is one of the most effective treatments. The maneuver involves a series of controlled head and body movements, usually performed under the guidance of an ENT doctor, with the aim of repositioning particles in the inner ear and resolving the cause of the dizziness.

For other types of vestibular disorders, your doctor may recommend balance retraining exercises, known as vestibular rehabilitation. This therapy helps the brain adapt and compensate for imbalances, which leads to a decrease in the frequency and intensity of dizziness episodes.

Causal treatment of dizziness

When dizziness is a symptom of a more serious condition, the most effective long-term approach is to treat the underlying cause. Depending on the nature of the underlying cause, treatment may include controlling blood pressure and blood sugar, correcting anemia or nutritional deficiencies, or managing anxiety and stress through therapy or lifestyle changes.

Tips for managing dizziness at home

Home measures to manage dizziness are not a substitute for medical evaluation, especially if symptoms persist.

But small adjustments to your daily routine can both improve occasional or mild episodes of dizziness and help reduce the frequency and intensity of recurring episodes.

• Get up slowly from bed or a chair to avoid a sudden drop in blood pressure.
• Avoid alcohol, coffee, and smoking, which can promote dehydration.
• Hydrate yourself properly, especially during periods of high temperatures or if you have heavy menstruation.
• Get enough rest, as lack of sleep can make dizziness worse.
• Avoid driving or risky activities during episodes to prevent accidents.

How to prevent dizziness

To prevent dizziness, it is advisable to create healthy habits that support your body's optimal functioning:

• Hydrate yourself properly throughout the day.
• Avoid sudden changes in position, especially after prolonged periods of lying down or sitting.
• Adopt a balanced diet, with regular meals, to prevent hypoglycemia.
• Monitor your blood pressure, inner ear health, and hearing status through regular medical checkups.

Frequently asked questions about dizziness

Still have questions about dizziness? Below are concise answers to some of the most common questions:

What is the difference between dizziness and vertigo?

Dizziness is used as a general term to describe the sensation of unsteadiness or disorientation, while vertigo is a specific type of dizziness characterized by the false sensation of the environment or oneself spinning.

What tests are done for persistent dizziness?

Depending on the symptoms, blood tests (complete blood count, blood sugar, iron, vitamin B12), ENT tests, blood pressure measurement, vestibular or imaging investigations (MRI, CT) may be recommended.

Can dizziness be a sign of stroke?

If dizziness comes on suddenly, is severe, and is accompanied by difficulty speaking, numbness on one side of the body, or loss of coordination, it may be a sign of a stroke and is a medical emergency.

What medications help with dizziness?

Drug treatment is determined by the doctor based on the results of the investigations and may include antivertigo medications to reduce the sensation of spinning, as well as antihistamines or antiemetics if the conditions are accompanied by nausea or vomiting.

What diseases can cause dizziness?

Various inner ear conditions, cardiovascular diseases, neurological disorders, anemia, hypoglycemia, thyroid conditions, or chronic stress and anxiety can cause dizziness.

Can dizziness be caused by stress?

Yes. Chronic stress, anxiety, and panic attacks can lead to dizziness and difficulty concentrating even in the absence of other health problems.

What to do when dizziness suddenly appears?

Stop what you are doing, sit or lie down in a safe place, avoid sudden movements, and stay hydrated. If symptoms are intense or worsen, seek medical help.

Are there exercises that help with balance?

Yes, vestibular reeducation exercises and specific maneuvers, such as the Epley maneuver, have been shown to be effective for treating certain types of vertigo.

When is dizziness dangerous?

Dizziness is considered an alarm signal when it is persistent, severe, or associated with neurological symptoms, loss of consciousness, or intense headache or chest pain.

Can dizziness be caused by a lack of vitamins?

Yes, a deficiency in vitamin B12, iron, or other B-complex vitamins can manifest itself in a variety of symptoms, including dizziness, weakness, and difficulty concentrating.

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