Overview
Dizziness is an umbrella term covering several different sensations: a feeling that the room is spinning (vertigo), feeling light-headed or faint, or a general sense of unsteadiness. Most dizziness has a benign cause, but some causes require urgent assessment.
How common is it?
Dizziness is among the most common complaints in primary care, affecting about 1 in 5 people each year. It becomes more common with age.
Causes and risk factors
The most common cause of spinning vertigo is a problem with the inner ear. Light-headedness often relates to blood pressure drops or dehydration. A neurological cause is less common but important to exclude.
Common risk factors
- Benign paroxysmal positional vertigo (BPPV): tiny crystals displaced in the inner ear
- Vestibular neuritis or labyrinthitis: inner ear inflammation
- Low blood pressure on standing (orthostatic hypotension)
- Dehydration
- Ménière's disease
- Anxiety
- Medications (antihypertensives, diuretics)
- Rare: brain tumour or stroke affecting balance centres
Symptoms
- Sensation that you or the room is spinning (vertigo)
- Feeling faint or about to black out
- Unsteadiness when walking
- Nausea and vomiting with vertigo
- Hearing loss or tinnitus with inner ear causes
- Triggered by head position changes in BPPV
When to see a doctor
Go to A&E for dizziness with sudden severe headache, double vision, slurred speech, weakness or numbness, as these suggest stroke. See a doctor for unexplained persistent dizziness or repeated falls.
Diagnosis
Clinical history and Dix-Hallpike test diagnose BPPV. Blood tests check for anaemia and infection. Hearing tests assess vestibular function. MRI of the brain is done if a central cause is suspected.
Treatments
Epley manoeuvre
A series of head position changes performed by a physiotherapist or GP to reposition displaced crystals in the inner ear. Highly effective for BPPV.
Vestibular rehabilitation exercises
Exercises that train the brain to compensate for inner ear dysfunction. Effective for chronic vestibular conditions.
Medications
Prochlorperazine or antihistamines for acute vestibular symptoms. Betahistine for Ménière's disease. Treatment of underlying blood pressure or anxiety disorders.
Self-care and lifestyle
- Move slowly when changing position especially getting up from lying down
- Ensure adequate hydration especially in hot weather
- Report all new dizziness to your doctor if you drive
- Physiotherapy exercises as directed can cure BPPV completely
Prevention
Stay well hydrated, change position slowly, review medications that can lower blood pressure, and treat inner ear infections early.