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Dizziness is a very common symptom that is due to a disorder of the inner ear, which senses body positions and balance, or of the cerebellum, the part of the brain that processes information on balance. Dizziness related to disorders of the inner ear often manifests as a feeling that the world is spinning (vertigo). In brain function disorders, dizziness makes it difficult to keep your balance and stay upright and is often accompanied by other nervous system symptoms. Dizziness can also be accompanied by weakness, nausea and hearing disturbances.

Dizziness may be caused by benign paroxysmal positional vertigo (BPPV), tension headache, a transient drop in blood pressure when changing position, Ménière’s disease, ageing, heart arrhythmias, medication, ear-related reasons without a clear diagnosis, and blood circulation problems of the brain stem and the cerebellum. Dizziness can also occur in stressful situations or as a symptom of panic disorder. Dizziness that doesn’t involve other symptoms is hardly ever a sign of a serious condition. However, sudden dizziness lasting for several hours is a reason to seek medical treatment.

Vertigo often originates in the inner ear. Depending on its severity, dizziness resulting in loss of balance may be related to the spine, tension of the neck, brain function disorders, or problems with blood circulation.

Benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is caused by a transient disorder of the vestibular organ. BPPV is usually at its worst in the mornings. It often gets worse within a few seconds when the person lies down after sitting or turns in bed. Subsequent changes of position cause milder vertigo episodes. In 90% of people, the episodes disappear within three months but may recur.

Orthostatic dizziness

Dizziness related to changes of position is caused by a sudden drop in blood pressure when sitting after lying down or when standing up after sitting. It commonly occurs in teenagers during the period of rapid growth and in older people as a result of the slowing down of circulatory reactions. Dizziness quickly disappears when the position is stable. Some medicines, particularly blood pressure medicines, may cause orthostatic dizziness that is so severe that medication changes need to be discussed with a doctor. Orthostatic dizziness is a very common cause of elderly people falling down.

Self-care

BPPV usually gets better on its own, but symptoms can be alleviated faster with exercises involving precise manoeuvres to help remove the debris that has accumulated within the inner ear, in the semi-circular canal.

A disease related to the inner ear, called vestibular neuronitis, involves severe dizziness that usually resolves spontaneously within 1 to 2 weeks, although mild problems with balance may last longer.

Orthostatic dizziness can be reduced by stimulating the blood circulation. Any form of exercise can help. In fact, balance exercises help in the treatment of all types of dizziness.

When should you seek treatment?

You should see a doctor immediately if:

  • you have sudden dizziness that involves other symptoms such as disturbances with speech, hearing, vision, muscle function, or level of consciousness
  • your dizziness is so severe that you cannot stand.

If dizziness is the only symptom but lasts for several hours or involves irregular heartbeat, you should seek treatment within 24 hours.

Slowly-developed dizziness with one-sided hearing impairment, tinnitus or other nervous system symptoms is a reason to seek medical treatment within a few weeks.

If a patient experiencing dizziness is using several medicines or if the dizziness appears soon after increasing the dose, medication adjustments should be discussed with a doctor. Long-term, repeated dizziness that is not associated with changes of position is also a reason to see a doctor.

Before seeing a doctor, you should think about the following: What type is your dizziness? In what situations does it occur? Does it involve other symptoms? What medicines are you using? Depending on the occurrence and type of dizziness, the examinations will vary from simple hearing and balance tests to broader examinations.

Prevention

A stable lifestyle and exercise may help to reduce the risk of dizziness. Dizziness on standing up in the mornings can be prevented by standing more slowly and by sitting on the bed for a while.

Information sources: The Finnish Medical Society Duodecim: Terveysportti, Lääkärin tietokanta database

FSHS General Practitioner / 2nd of March 2020

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