Dizziness

You might feel dizzy in different ways: a sense that the room is spinning, a lightheaded feeling like you're about to faint, or simply feeling unsteady on your feet.

What are the common causes of dizziness?

Dizziness has a wide range of possible causes, and it isn't always easy to pin down which one applies to you.

Common, everyday causes include:

• dehydration, heat exhaustion, or not having eaten for a while, which can lower your blood sugar
• standing up too quickly, causing a sudden drop in blood pressure, known as postural hypotension
• stress, anxiety or hyperventilating
• motion sickness
• a side effect of a new prescription medicine
• drinking alcohol or using recreational drugs.

Problems with your inner ear are also a common cause, since your ears play a key part in keeping your balance. These include:

• benign paroxysmal positional vertigo (BPPV), where small crystals inside the ear become dislodged and send confusing signals to the brain
• labyrinthitis or vestibular neuritis, infections that inflame the balance organs of the inner ear
• Ménière's disease, a build-up of fluid in the inner ear that also causes tinnitus and hearing loss.

Less commonly, dizziness can be linked to:

• migraine
• iron deficiency anaemia
• heart problems, such as an irregular heartbeat or low blood pressure
• conditions affecting the brain or nerves, such as stroke, Parkinson's disease or multiple sclerosis
• carbon monoxide poisoning
• Strokes, the part of your brain that controls balance can be affected.

Are there different types of dizziness?

Dizziness is usually described as one of three sensations:

• Vertigo: a false sense that you, or everything around you, is spinning or moving
• Lightheadedness: feeling faint, woozy, or like you might pass out
• Unsteadiness: a loss of balance, or a sense that you can't trust your footing, sometimes called disequilibrium.

How is dizziness diagnosed?

A GP will usually ask detailed questions about your dizziness: what it feels like, how long it lasts, how often it happens, and whether anything else is going on at the same time. They'll also ask about any medicines you're taking.

Your ears are often examined, and you may be referred for a hearing test or a series of positional tests, where you're asked to move your head or body in different directions to see if this brings on your symptoms. Depending on what they suspect, a GP may refer you to a specialist such as a neurologist, physiotherapist or ENT specialist.

How is dizziness treated?

During a bout of dizziness, it helps to:

• stop what you're doing and sit or lie down until it passes, then get up slowly
• move slowly and carefully, especially when changing position
• avoid driving, climbing ladders or using heavy machinery until the feeling has gone
• rest and drink plenty of water
• cut back on coffee, alcohol, cigarettes and avoid recreational drugs.

Beyond this, treatment depends on the underlying cause. For example:

• BPPV is often treated with the Epley manoeuvre, a series of head movements that reposition the dislodged crystals in the ear
• labyrinthitis and vestibular neuritis usually improve on their own, though a short course of antihistamines or motion sickness medicine can ease symptoms while you recover
• Ménière's disease is managed with medicines, hearing aids, and vestibular rehabilitation to support your balance
• dizziness linked to a medicine you're taking may improve if a GP adjusts the dose or switches you to something else.

If dizziness or imbalance keeps recurring, vestibular rehabilitation, a programme of exercises that retrain your balance system, can help, whatever the underlying cause.

When should I see a doctor?

See a GP if:

• your dizziness is severe, sudden, or keeps coming back
• your symptoms haven't improved after 6 weeks
• it's affecting your daily life, or you've had an unexplained fall
• you get brief dizziness, lasting less than a minute, when rolling over in bed or looking up or down
• you have new tinnitus, hearing loss, or difficulty hearing or speaking
• you have double vision, blurred vision, or other changes to your eyesight
• your face, arms or legs feel numb or weak, or you notice a sudden change in your handwriting
• you notice changes to your pulse, or episodes of fainting or collapsing.

Call 999, or go to A&E, if dizziness comes on suddenly alongside:

• chest pain, pressure or tightness, in the chest, shoulders, neck, arms, jaw or back
• a severe headache that reaches its worst within 5 minutes
• a fast or irregular heartbeat, or shortness of breath
• new weakness, numbness, or drooping on one side of your face or body
• slurred speech, or trouble understanding or swallowing
• sudden, severe hearing loss
• confusion, fainting, or loss of consciousness.

These can be signs of a heart problem, a stroke, or another condition that needs urgent care.