Balance Problems

Causes

Lightheadedness occurs when your brain does not get enough blood. This may occur if:

• You have a sudden drop in blood pressure.
• Your body does not have enough water (is dehydrated) because of vomiting, diarrhea, fever, and other conditions.
• You get up too quickly after sitting or lying down (this is more common in older people).

Lightheadedness may also occur if you have the flu, low blood sugar, a cold, or allergies.

More serious conditions that can lead to light-headedness include:

• Heart problems, such as a heart attack or abnormal heart beat
• Stroke
• Bleeding inside the body
• Shock (extreme drop in blood pressure)

If any of these serious disorders are present, you will usually also have symptoms like chest pain, a feeling of a racing heart, loss of speech, change in vision, or other symptoms.

Vertigo may be due to:

• Benign positional vertigo, a spinning feeling that occurs when you move your head
• Labyrinthitis, a viral infection of the inner ear that usually follows a cold or flu
• Meniere's disease, a common inner ear problem

Other causes of lightheadedness or vertigo may include:

• Use of certain medicines
• Stroke
• Multiple sclerosis
• Seizures
• Brain tumor
• Bleeding in the brain

Home Care

If you tend to get light-headed when you stand up:

• Avoid sudden changes in posture.
• Get up from a lying position slowly, and stay seated for a few moments before standing.
• When standing, make sure you have something to hold on to.

If you have vertigo, the following tips can help prevent your symptoms from becoming worse:

• Keep still and rest when symptoms occur.
• Avoid sudden movements or position changes.
• Slowly increase activity.
• You may need a cane or other help walking when you have a loss of balance during a vertigo attack.
• Avoid bright lights, TV, and reading during vertigo attacks because they may make symptoms worse.

Avoid activities such as driving, operating heavy machinery, and climbing until 1 week after your symptoms disappear. A sudden dizzy spell during these activities can be dangerous.

When to Contact a Medical Professional

Call your local emergency number (such as 911) or go to an emergency room if you are dizzy and have:

• A head injury
• Fever over 101°F (38.3°C), headache, or very stiff neck
• Seizures
• Trouble keeping fluids down
• Chest pain
• Irregular heart rate (heart is skipping beats)
• Shortness of breath
• Weakness
• Inability to move an arm or leg
• Change in vision or speech
• Fainting and loss of alertness for more than a few minutes

Call your health care provider for an appointment if you have:

• Dizziness for the first time
• New or worsening symptoms
• Dizziness after taking medicine
• Hearing loss

What to Expect at Your Office Visit

Your provider will perform a physical exam and ask questions about your medical history and symptoms, including:

• When did your dizziness begin?
• Does your dizziness occur when you move?
• What other symptoms occur when you feel dizzy?
• Are you always dizzy or does the dizziness come and go?
• How long does the dizziness last?
• Were you sick with a cold, flu, or other illness before the dizziness began?
• Do you have a lot of stress or anxiety?

Tests that may be done include:

• Blood pressure reading
• Electrocardiogram (ECG)
• Hearing tests
• Balance testing (ENG)
• Magnetic Resonance Imaging (MRI)

Your provider may prescribe medicines to help you feel better, including:

• Antihistamines
• Sedatives
• Anti-nausea medicine

Surgery may be needed if you have Meniere's disease.

References

Baloh RW, Jen JC. Hearing and equilibrium. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 428.

Chang AK, Olshaker JS. Dizziness and vertigo. In: Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 99.

Post RE, Dickerson LM. Dizziness: a diagnostic approach. Am Fam Physician. 2010 Aug 15;82(4):361-8, 369.