Dizziness: what exactly do you feel
People use the word dizziness for several different feelings, and it helps the doctor to understand which one you have. It can be spinning, where you or everything around you seems to be turning (vertigo); a faint feeling, where your vision darkens or your head swims when you stand; unsteadiness when walking; or sometimes just a foggy head. The first is more often linked to the inner ear and the balance system, the second to blood pressure, the heart, blood sugar or dehydration, and the third to the nervous system, eyesight, medicines or anxiety. Try to describe to the doctor in your own words what you feel and when.
Dizziness when turning your head or standing up
If you feel dizzy for a few seconds when you turn over in bed, bend down or tip your head back, a common cause is benign paroxysmal positional vertigo, in which tiny crystals in the inner ear are involved. It is unpleasant but usually harmless and responds well to special manoeuvres done by a doctor. If your vision darkens when you stand up, postural hypotension, a sudden fall in blood pressure, is possible: it occurs with dehydration, long bed rest and some medicines. Get up slowly and drink enough water.
Dizziness with nausea, ringing in the ear or hearing loss
Spinning attacks with nausea and vomiting (more in nausea and vomiting), especially after a cold, occur with inflammation of the inner ear or the balance nerve (labyrinthitis, vestibular neuritis). If ringing in the ear and hearing loss are added, an ear, nose and throat specialist should examine you, among other things to rule out Ménière's disease. For ear pain see ear pain.
Dizziness and headache
Dizziness can be part of a migraine, even without marked pain: so-called vestibular migraine. If it comes with a sudden severe headache, trouble speaking or seeing, weakness or numbness, it is an emergency. More in headache.
Dizziness with weakness and low blood pressure
Dizziness together with general weakness, pallor, a fast heartbeat and sweating is often linked to anaemia, low blood sugar, dehydration or overheating. More in weakness and fatigue. If dizziness comes with an irregular heartbeat, breathlessness or fainting, you need to be seen by a doctor urgently.
Dizziness in older people, in women and in pregnancy
In older people dizziness is often linked to medicines, blood pressure and the risk of falls, so do not write it off as normal for your age. In women it is often linked to anaemia, hormonal changes and periods, and in pregnancy to low blood pressure and blood sugar; tell the doctor about it. Sudden weakness and fainting in pregnancy need urgent advice.
What you can do before seeing a doctor
- If you feel dizzy, sit or lie down, close your eyes and wait for it to pass; then get up slowly.
- Do not drive, work at height or use dangerous machinery until the dizziness has gone.
- Drink enough water, do not skip meals and rest.
- Cut out caffeine, alcohol and smoking: they can make dizziness worse.
- Write down when it happens, how long it lasts, what brings it on and which medicines you take.
How a doctor looks for the cause
The doctor will ask about the nature of the dizziness, how long attacks last, other symptoms and medicines, measure blood pressure and pulse lying down and standing, and check hearing, eyesight, coordination and eye movements. If positional vertigo is suspected, special tests are done. Depending on the findings, a blood count, glucose, an ECG, a hearing test, or an MRI or CT scan of the brain may be ordered. Dizziness is looked after by a neurologist and an ear, nose and throat specialist.