Dizziness: Lightheadedness and Vertigo

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	Prevention
	Preparing For Your Appointment
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Dizziness is a word that is often used to describe two different feelings. It is important to know exactly what you mean when you say "I feel dizzy" because it can help you and your doctor narrow down the list of possible problems.

• Lightheadedness is a feeling that you are about to faint or "pass out." Although you may feel dizzy, you do not feel as though you or your surroundings are moving. Lightheadedness often goes away or improves when you lie down. If lightheadedness gets worse, it can lead to a feeling of almost fainting or a fainting spell (syncope). You may sometimes feel nauseated or vomit when you are lightheaded.
• Vertigo is a feeling that you or your surroundings are moving when there is no actual movement. You may feel as though you are spinning, whirling, falling, or tilting. When you have severe vertigo, you may feel very nauseated or vomit. You may have trouble walking or standing, and you may lose your balance and fall.

Although dizziness can occur in people of any age, it is more common among older adults. A fear of dizziness can cause older adults to limit their physical and social activities. Dizziness can also lead to falls and other injuries.

Lightheadedness

It is common to feel lightheaded from time to time. Lightheadedness usually is not caused by a serious problem. It often is caused by a momentary drop in blood pressure and blood flow to your head that occurs when you get up too quickly from a seated or lying position (orthostatic hypotension).

Lightheadedness has many causes, including:

• Allergies.
• Illnesses such as the flu or colds. Home treatment of your flu and cold symptoms usually will relieve lightheadedness.
• Vomiting, diarrhea, fevers, and other illnesses that cause dehydration.
• Very deep or rapid breathing (hyperventilation).
• Anxiety and stress.
• The use of tobacco, alcohol, or illegal drugs.

A more serious cause of lightheadedness is bleeding. Most of the time, the location of the bleeding and the need to seek medical care are obvious. But sometimes bleeding is not obvious (occult bleeding). You may have small amounts of bleeding in your digestive tract over days or weeks without noticing the bleeding. When this happens, lightheadedness and fatigue may be the first noticeable symptoms that you are losing blood. Heavy menstrual bleeding also can cause this type of lightheadedness.

An uncommon cause of lightheadedness is an abnormal heart rhythm (arrhythmia), which can cause fainting spells (syncope). Unexplained fainting spells need to be evaluated by a doctor. To check your heart rate, see taking a pulse.

Many prescription and nonprescription medicines can cause lightheadedness or vertigo. The degree of lightheadedness or vertigo that a medicine causes will vary.

Vertigo

Vertigo occurs when there is conflict between the signals sent to the brain by various balance- and position-sensing systems of the body. Your brain uses input from four sensory systems to maintain your sense of balance and orientation to your surroundings.

• Vision gives you information about your position and motion in relationship to the rest of the world. This is an important part of the balance mechanism and often overrides information from the other balance-sensing systems.
• Sensory nerves in your joints allow your brain to keep track of the position of your legs, arms, and torso. Your body is then automatically able to make tiny changes in posture that help you maintain your balance (proprioception).
• Skin pressure sensation gives you information about your body's position and motion in relationship to gravity.
• A portion of the inner ear, called the labyrinth, which includes the semicircular canals, contains specialized cells that detect motion and changes in position. Injury to or diseases of the inner ear can send false signals to the brain indicating that the balance mechanism of the inner ear (labyrinth) detects motion. If these false signals conflict with signals from the other balance and positioning centers of the body, vertigo may occur.

Common causes of vertigo include:

• Inner ear disorders, such as benign paroxysmal positional vertigo (BPPV), Ménière's disease, vestibular neuritis, or labyrinthitis.
• Injury to the ear or head.
• Migraine headaches, which are painful, debilitating headaches that often occur with vertigo, nausea, vomiting, and sensitivity to light, noise, and smell.
• Decreased blood flow through the arteries that supply blood to the base of the brain (vertebrobasilar insufficiency).

Less common causes of vertigo include:

• A noncancerous growth in the space behind the eardrum (cholesteatoma).
• Brain tumors and cancer that has traveled from another part of the body (metastatic).

Immediate medical attention is needed if vertigo occurs suddenly with loss of function. Vertigo that occurs with loss of function in one area of the body can mean a problem in the brain, such as a stroke or transient ischemic attack (TIA).

Alcohol and many prescription and nonprescription medicines can cause lightheadedness or vertigo. These problems may develop from:

• Taking too much of a medicine (overmedicating).
• Alcohol and medicine interactions. This is a problem, especially for older adults, who may take many medicines at the same time.
• Misusing or abusing a medicine or alcohol.
• Drug intoxication or the effects of withdrawal.

Use the Check Your Symptoms section to decide if and when you should see a doctor.

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Lightheadedness usually is not a cause for concern unless it is severe, does not go away, or occurs with other symptoms such as an irregular heartbeat or fainting. Lightheadedness can lead to falls and other injuries. Protect yourself from injury if you feel lightheaded:

• Lie down for a minute or two. This will allow more blood to flow to your brain. After lying down, sit up slowly and remain sitting for 1 to 2 minutes before slowly standing up.
• Rest. It is not unusual to develop lightheadedness during some viral illnesses, such as a cold or the flu. Resting will help prevent attacks of lightheadedness.
• Do not drive a motor vehicle, operate equipment, or climb on a ladder while you are dizzy.
• Do not use substances that can affect your circulation, including caffeine, tobacco, alcohol, and illegal drugs.
• Do not get dehydrated, which can cause or increase lightheadedness, when you have an illness that causes diarrhea, vomiting, or a fever. Drink more fluids, especially water. Other fluids are also helpful, such as fruit juice mixed to half-strength with water, rehydration drinks, weak tea with sugar, clear broth, and gelatin dessert. If you have another medical condition, such as kidney disease or heart disease, that limits the amount of fluids you are allowed to have, do not drink more than this amount without first talking to your doctor.

If you have vertigo:

• Do not lie flat on your back. Prop yourself up slightly to relieve the spinning sensation.
• Move slowly to avoid the risk of falling.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• Nausea or vomiting develops or increases.
• Moderate to severe dehydration develops.
• Fainting occurs.
• Your symptoms do not improve in 1 week with the use of home treatment.
• Your symptoms become more severe or frequent.

You may be able to prevent lightheadedness caused by orthostatic hypotension by taking your time.

• Get up slowly from your bed or chair.
• Sit on the edge of the bed for a few minutes before standing.
• Sit up or stand up slowly to avoid sudden changes in blood flow to your head that can make you feel lightheaded.

In most cases, vertigo cannot be prevented. But some cases of vertigo are caused by head injuries. Taking the following safety measures can help lower your risk of getting a head injury that might lead to vertigo.

• Wear your seat belt when you are traveling in a motor vehicle. Secure young children in age-appropriate child car seats.
• Do not use alcohol or other drugs before playing sports or when operating an automobile or other equipment.
• Wear a helmet and other protective clothing whenever you are biking, motorcycling, skating, kayaking, horseback riding, skiing, snowboarding, rock climbing, or participating in any high-speed or impact sport.
• Wear a hard hat if you work in a construction job or in an industrial area.
• Do not dive into shallow or unfamiliar water.
• Do not keep firearms in your home. If you must keep firearms, lock them up and store them unloaded and uncocked. Lock ammunition in a separate area.

When you are dizzy, your risk of falling increases. You can make changes in your home to reduce your risk of falls.

• Remove raised doorway thresholds, throw rugs, and clutter.
• Repair loose carpet or raised areas in the floor that may cause you to trip.
• Rearrange furniture and electrical cords to keep them out of walking paths.
• Use nonskid floor wax and wipe up spills immediately, especially on ceramic tile floors.
• Keep stairways, porches, and outside walkways well lit. Use night lights in hallways and bathrooms.
• Install sturdy handrails on stairways and grab handles and nonskid mats inside and outside your shower or tub and near the toilet.
• Use shower chairs and bath benches.
• Add extra light switches if needed or use remote switches (such as clap-on switches) or timers on lights by doors and near your bed so that you will not have to get up quickly to turn on lights or walk across the room in the dark.
• Put things within easy reach so you do not need to reach overhead for them.
• Keep a cordless phone and a flashlight with new batteries by your bed.

Preventing falls

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

• What is your major symptom, lightheadedness or vertigo?
• How long have you had your symptoms? Do they come and go, or are they always present?
• What were you doing when your symptoms started?
• How often do you experience dizziness?
• What makes your symptoms better or worse?
• Do you have other symptoms that may be related to your major symptom? Symptoms may include:
  • Changes in vision, such as blurred or double vision, halos, or spots.
  • Chest pain.
  • Confusion.
  • Fainting or falling.
  • Heart palpitations, irregular heartbeat, or an unusually slow or fast heart rate.
  • Nausea or vomiting.
  • Numbness or tingling.
  • Weakness or changes in your ability to stand or walk.
  • Ringing in the ears (tinnitus) or loss of hearing.
  • Shortness of breath or a feeling of suffocation.
• What medicines do you take? Make a list of both prescription and nonprescription medicines you use.
• Do you have any health risks?

Before seeing your doctor, it may be helpful to keep track of your symptoms. Use the questions above as a guide for what to include in your diary of symptoms(What is a PDF document?).

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