Dizziness

Dizziness, also known as lightheadedness, is a feeling of unsteadiness or loss of balance. This feeling may be with or without loss of consciousness and is a very common condition. It is common in children as well as adults. Most times, it is treatable. Rarely, the cause can be serious requiring hospitalisation. You may have vague symptoms of dizziness which disappear after some time but you should never ignore these symptoms and should visit your doctor immediately if the episodes of dizziness are frequent. Sometimes you may feel dizzy during travel (such as in a moving bus or car) and this type of dizziness is caused due to motion sickness. It can be managed by taking medicines for motion sickness as suggested by a doctor. But, at times, dizziness could be the result of an underlying health condition. Hence, consulting a doctor and undergoing proper health examination is essential to find out the cause of dizziness and to initiate proper treatment.

What Is Dizziness?

Dizziness is a feeling of losing balance when you stand up or just before you lose your consciousness. When you feel dizzy, you may feel like you are moving even if you are standing in one place.

Dizziness is a vague symptom. It can be difficult to explain to your doctor what exactly you are feeling. You may feel like:

• Losing your balance as soon as you stand up suddenly from a lying down position.
• An unsteady feeling in which you are not able to stand still.
• Feeling you are moving even when you are standing in one place.
• Having a feeling that you will faint anytime.

If you experience such symptoms then you should seek your doctor’s advice immediately.

There are many causes of dizziness, most of which can be identified and treated. So, you need to take the advice of your doctor to find out the cause of your dizziness.

Causes

Usually, the causes of dizziness are less serious such as motion sickness, dehydration, low blood sugar levels, low blood pressure, anxiety and alcohol intake. But sometimes, dizziness could be a symptom of a more serious underlying condition such as a migraine, ear infections, stroke, neurological problems and brain tumours.  

The causes of dizziness can be divided into following groups:

Neurogenic causes

These include:

• Migraine
  This is a condition in which there is a throbbing headache usually involving one side of the head. It is triggered by various factors such as noise, light or certain foods. Dizziness, nausea, and vomiting accompany the headache.
• Motion sickness
  In motion sickness, a person feels sick during travel due to the moving vehicle. Symptoms of motion sickness include nausea, headache, dizziness, and vomiting only when the vehicle is moving.
• Diseases causing vertigo
  Conditions which affect the inner ear function like Meniere’s disease where there is a defect in the unilateral hearing along with imbalance.
• Stroke
  Due to blockage in some arteries of the brain, there may be inadequate blood flow to the brain which causes a decrease in the oxygen supply to that area. This can also lead to dizziness and fainting.
• Vestibular neuritis
  Inflammation of the vestibular nerve reaching the organ that maintains balance can cause dizziness.
• Brain tumours
  Rarely, dizziness can be due to a tumour in the brain, which can obstruct the blood flow to a specific area of the brain.

Cardiogenic causes

The cardiogenic cause of dizziness is hypotension. A sudden drop in blood pressure due to a decrease in the blood volume or suddenly getting up from a lying down position can cause dizziness.

Metabolic causes

The causes include:

• Hypoglycemia
  A decrease in the blood sugar level may reduce the blood supply to the brain which can cause dizziness.
• Dehydration
  It may be due to inadequate water consumption or a continuous exposure to heat and sun.

Other causes

• Alcohol intoxication
  Excessive consumption of alcohol may affect the brain function and consciousness. You can feel dizzy, if you have consumed more than 2-3 drinks, especially, if you have consumed them very fast.
• Anxiety
  People with anxiety may experience dizziness. In such cases, the causative factor is difficult to identify.
• Drugs
  There are many drugs which can cause dizziness as a side effect such as sedatives, antihypertensive drugs and some antibiotics. Hence, if you are taking certain drugs and feeling dizzy, consult your doctor to know whether or not the drug you are taking is the causative agent of your dizziness.

Risk Factors

There are various diseases that can make a person prone to dizziness. These include:

Inner ear diseases like:

• Benign paroxysmal vertigo
  It is positional vertigo when a person has episodes of dizziness and fainting.
• Labyrinthitis
  It is the inflammation of the inner part of the ear.
• Meniere’s disease
  It is a disorder with unilateral hearing impairment, along with, vertigo episodes. Vertigo is a false sensation that the body or the environment is moving.
• Vestibular neuritis
  In this disease, there is an inflammation of the vestibular nerve reaching to the part of the ear which maintains balance, causing dizziness.
• Migraine
  In this, the person has an episodic unilateral headache, along with, some other symptoms like dizziness, nausea, and vomiting. These symptoms can be aggravated due to some factors like noise, sound.
• Diabetes
  People with diabetes who are on insulin therapy can have hypoglycemic attacks due to a sudden drop in glucose level.
• Long working hours
  Working for long hours at a high temperature or under the sun can lead to dehydration and dizziness.
• Inadequate water intake
  Less water intake can also lead to dehydration.

Prevention of dizziness is often difficult until a person is diagnosed with an underlying cause that leads to frequent episodes of dizziness.  Here are ways by which you can avoid recurrent attacks:

• Treating the underlying condition.
• Getting up slowly from a lying down position.
• Avoiding excessive alcohol consumption, one or two drinks per day can be taken safely.
• Avoiding playing games on mobiles or reading books during long commutes. Instead look outside or sleep to prevent dizziness due to motion sickness.

Your doctor will try and find out the underlying condition that could be causing dizziness. Here is how your doctor will find out the cause of your dizziness:

As you visit your doctor with a complaint of dizziness, your doctor will note down your complete medical history about dizziness. This may give your doctor some clue about the underlying cause and can also help to identify the triggering factor of dizziness.

Your doctor will also perform a physical examination checking your eye movements, leg movements and balancing ability.

• Romberg test
  Your doctor can ask you to walk in front of him/her to check whether you are losing your balance.
• Eye tests
  Your doctor will check your eye movements. In a condition called nystagmus, when a person is asked to move his/her eyes along the doctor’s finger, he/she fails to do so and his/her eyes get stuck at one place.
• Blood pressure measurement
  This is carried out to check for low BP in case of hypotension or high BP in case of stroke that can cause dizziness.

Some laboratory tests may be useful such as:

• Random blood sugar
  It is done to test if you have diabetes or if you are already on insulin therapy. It is also prescribed to check blood sugar control.
• Serum electrolytes
  To check for potassium levels as low potassium can lead to dizziness.
• Complete blood count
  To check for any infection or haemoglobin in case of anaemia.
• Electrocardiography (ECG)
  If cardiac disease is suspected, electrodes attached to different parts of the body can identify the infarction or block in the form of waves which the doctor can interpret. (Read more - Heart disease symptoms)
• Ear examination
  Examination of the ears and tests like audiometry are performed to rule out diseases of the inner ear.

Dizziness can get better on its own without any medication. If dizziness is due to an underlying condition, then treating the disease will improve dizziness. After thorough examination and tests, once your doctor finds the cause of dizziness, treatment will be started which will help in treating it as well. If it still persists, your doctor may prescribe some medicines and exercises.

• Dizziness due to motion sickness can be relieved by taking preventive drugs as advised by your doctor half an hour prior to the journey. In such cases, drugs like antihistamines may be helpful. 
• Dizziness due to low blood sugar can be treated by regulating blood sugar levels. Having small healthy meals at frequent intervals can help in keeping sugar levels in check.
• If dizziness is due to migraine, your doctor will prescribe you anti-migraine medicines.
• Dizziness due to low blood pressure may require hospitalisation and administration of intravenous fluids which will normalize your blood pressure and relieve the dizzy feeling.
• In case of alcohol intoxication, your doctor may advise hospitalisation and medication which can reverse the effect of alcohol.
• Your doctor may prescribe medication to treat diseases of the inner ear and may also advise surgery if required.
• If dizziness is due to the side effect of any medication, your doctor may reduce or stop the drug.

Lifestyle management

Lifestyle changes can prevent dizziness if you follow some basic changes:

• Drink plenty of water, around 3-4 litres to avoid dehydration.
• Salt restriction in case of Meniere’s disease can be helpful. Avoid sprinkling salt on fruits, salads or food.
• Follow proper timings of insulin injection as advised by your doctor and keep a source of glucose such as biscuits, or candy handy to manage hypoglycaemia.
• Avoid excessive alcohol intake. Limit it to 1-2 drinks per day for males and one drink per day for females or stop completely if possible.
• Prefer quiet environment and avoid excessive noise and bright light whenever you feel dizziness.
• Sudden change in the position should be avoided from lying down to getting up.
• Take support or sit down as soon as you feel dizzy to avoid falling.
• Always try to ask for help to avoid injury due to fainting.
• If you experience dizziness, avoid driving vehicles and operating machines.

Prognosis

The outcome depends upon the underlying cause and in most cases, it is treatable.

Complications

Complications of dizziness could be:

• Repeated episodes of dizziness if the cause is not found and treated.
• Injury due to fall.