If dizziness is an ordinary life experience, it is also a common medical symptom. About 25 percent of all adults have experienced at least one bout of unprovoked dizziness; it’s particularly common above age 60, when one in three people experiences dizziness that’s severe enough to require medical attention. In the US, total cost of evaluating and treating dizziness amounts to over $1 billion a year. Now, that’s enough to set your head spinning!
Dizziness can be the symptom of a serious illness that needs prompt attention. But usually it’s not; in fact, for the great majority of people, even those who feel absolutely awful, dizziness is a mild, often self-correcting problem. To know if your dizziness is a cause for concern, you should understand the types of dizziness and the major causes of this common complaint.
•Lightheadedness. It’s the most common sensation but the least specific. People who are weak or vaguely out of sorts from fever, a virus, dehydration, fatigue, stress, hyperventilation, medication side effects, or a dozen other causes can lack mental clarity and focus. They often translate the sensation as dizziness, but doctors don’t consider it so.
• Near fainting. This sensation is usually experienced as a dimming of vision and feeling distant and out of touch; pallor, nausea and sweating are often present as well. The common denominator is decreased blood flow to the brain so it occurs most often while people are standing or when they get up quickly. Fortunately, it is usually not serious and it’s a temporary disturbance that’s quickly corrected by lying down. Even so, doctors have to take near-fainting seriously, since it can sometimes be a clue to more significant problems. Serious or not though, near-fainting, in most cases, is not true dizziness.
• Loss of equilibrium. Because people with this problem remain mentally focused, they are less likely to describe the sensation as dizziness. Still, an unsteady gait or loss of balance often accompanies actual vertigo, and people who feel unsteady when they stand or walk may mistakenly lump the conditions together. Mild imbalance is common in older people, but it can also reflect a neurologic disorder or one of the inner ear problems that cause vertigo.
• Vertigo. It’s a word with many meanings. Most often, it’s used to mean a giddy fear of heights. Shakespeare wrote, "How fearful / And dizzy ’tis to cast one’s eyes so low." And if you missed the play, check out Alfred Hitchcock’s great 1956 film, Vertigo.
But for doctors, at least, vertigo is spinning dizziness, the illusion of motion when none exists. It’s usually a turning or spinning sensation, but it can also be a tilting or rocking feeling. It can feel as if the world is turning around you or twirling in space. Having vertigo is like riding a merry-go-round when you’re stationary, like being seasick without the sea.
• Benign Paroxysmal Positional Vertigo (BPPV). The name is a mouthful but it conveys a lot of information. A mild, if very annoying condition, BPPV is truly benign. The symptoms are brief and intermittent, or paroxysmal, and they are invariably triggered by a change in head position. It is believed to be caused by tiny debris in the semicircular canals of the inner ear.
BPPV often begins abruptly and resolves on its own within two or three months. People with mild cases do not need any treatment, though they should try to move their heads slowly. But prolonged or severe cases often respond to the simple Epley maneuver, designed to move the head in a series of maneuvers so the debris floats out of the semicircular canals into a different part of the inner ear where it is harmless. This treatment, which is effective 75 percent of the time, is usually directed by a doctor or physical therapist but patients can also learn to do a simplified set of exercises themselves.
• Meniere’s disease. Like BPPV, Meniere’s disease is a common cause of vertigo, especially in the older age groups. Vertigo is the main symptom of both disorders, but in BPPV, it’s provoked by head motion, it resolves within 10-20 seconds, and it’s the only symptom.
In contrast, the vertigo of Meniere’s disease occurs spontaneously and lasts longer, often increasing to maximal intensity over 10-15 minutes, then gradually resolving over several hours. Most patients with Meniere’s disease have other symptoms as well, such as a feeling of ear fullness, a buzzing or roaring sound, and gradual hearing loss that fluctuates but may progress to deafness. In most cases, fortunately, only one ear is involved.
Although Meniere’s disease was first described in 1861, doctors are still not sure what causes it. The current thought is that an ear infection early in life produces gradual damage that leads to an excess fluid in the semicircular canals of the inner ear. As a result, doctors may recommend dietary salt restriction or prescribe diuretic medications to reduce volume of fluid; there is no evidence however, that these interventions are effective.
Medications such as meclizine (Antivert), promethazine (Phenergan), or prochlorperazine (Compazine) may help quiet down severe attacks, but they are not generally recommended for long-term use. A few patients with very severe attacks require surgical treatment, but most patients have much milder problems, and many don’t require any therapy; in fact, the episodes of vertigo usually diminish and often resolve by themselves over time.
• Vestibular Neuronitis. This condition is well named: It’s an inflammation (itis) of the vestibular nerve, the trunklike nerve that carries information from the semicircular canals of the inner ear to the brain. Because of its location, the disorder is sometimes called labyrynthitis.
The disorder begins quite abruptly; vertigo, which is often accompanied by nausea and vomiting, builds to a peak over minutes to hours. At its worst, vestibular neuronitis is truly disabling with severe imbalance and uncontrollable rapid eye movements (nystagmus) that make it difficult even to focus or read. In most cases, fortunately, the symptoms peak within the first day, then gradually subside over a few days or weeks. Mild problems can persist for three months or more, but most people recover completely, even without treatment.
People should stay quiet while they are dizzy and avoid driving, climbing and other potential hazards. As they recover, patients can resume their normal activities. During the acute phase of the illness, doctors often prescribe medications such as meclizine (Antivert), promethazine (Phenergan), or prochlorperazine (Compazine) to ease the vertigo and nausea that can be so uncomfortable. Some physicians prescribe prednisone in an attempt to reduce inflammation in the nerve but studies are needed to see if this approach has merit.
Even though vestibular neuronitis can make its victims feel absolutely terrible, it’s a self-correcting disorder; special physical therapy (vestibular PT) can help improve function during the recovery period. But persistent or severe vertigo can signal much more serious problems that need prompt medical care. And in most cases, doctors can set things straight so your world will stop twirling!