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Balance Problems

Dizziness is a term that is often used to describe 2 different symptoms: lightheadedness and vertigo.

Lightheadedness is a feeling that you might faint.

Vertigo is a feeling that you are spinning or moving, or that the world is spinning around you. See also: Vertigo-associated disorders

Alternative Names

Lightheadedness - dizzy; Loss of balance; Vertigo

Considerations

Most causes of dizziness are not serious, and they either quickly get better on their own or are easy to treat.

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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.

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