We may not think of it this way, but standing on two feet is complicated business. When you’re feeling unexpectedly dizzy, off-balance or lightheaded, though, you start to appreciate the normally invisible “sixth sense” of balance. Because being in balance happens “automatically” for most of us, we don’t realize what a complex system it really is. Only when something goes wrong and our world turns upside down and spins, do we even realize there is something TO go wrong.
While “dizzy spells” can be unnerving, they’re very common: Most adults experience an occasional bout of dizziness. Vertigo, the sensation of spinning, is also surprisingly common, affecting an estimated 35 percent of people over age 40 at least once during their lifetime.
“Because vertigo is not a diagnosis, but rather a symptom of an underlying problem, the first step in helping the newly “dizzy” patient is to understand what they are experiencing. This gives us the information we need to formulate a diagnosis and treatment plan,” explains Laura Brainard, M.D., an ear, nose and throat specialist at Henry Ford Health.
This means you have to be able to describe your experience of dizziness. Some people can’t see or walk straight due to the sudden sensation of spinning and experience extreme nausea. Some people have associated ear symptoms, like ear fullness, ringing in the ear and decreased hearing. Others become light-headed, feeling like they might black out. And many feel a combination of sensations.
Some people’s symptoms last a few seconds and others’ last hours, days or weeks. Whatever the experience, it is often sudden in onset, and very upsetting, leading many people to call 911 or have family take them to the ER.
The balance system is a complex system that relies on the brain’s coordination of three main sensory inputs:
- Visual: Your eyes tell you whether you’re sinking into sand or trying to navigate an icy sidewalk.
- Vestibular: Balance sensors in your inner ear’s bony labyrinth help you maintain your equilibrium by detecting changes in head movement, the pull of gravity and whether you are moving or standing still.
- Proprioceptive: Sensors on the bottom of your feet, in your joints and muscles, and in your spine and neck tell your brain WHERE you are in space and “sense” changing positions.
As you can see, your brain relies on a complex set of inputs to keep your body upright and your visual field stable. Depending on which one of these systems is out of whack, you may experience vertigo, dizziness or imbalance.
Common Causes of Dizziness
How you feel during an episode – your experience of dizziness or vertigo – offers valuable insight about what’s causing your symptoms. Here, Dr. Brainard shares some of the most common causes of dizziness – and how to address them.
- Dehydration. Even mild dehydration can cause you to feel dizzy, lightheaded or off balance. Dehydration not only depletes your blood volume, it can also cause your blood pressure to drop, which can make you feel woozy.
- Medication. The number of drugs linked to dizziness is too long to list. Check the side effects of any medications you’re taking to see if they include dizziness, vertigo or loss of balance. And if you feel dizzy consistently, talk to your pharmacist and physician to see if it could be medication-related and if there’s an alternative.
- Blood pressure. Often related to medication changes, change in health status, or to underlying heart problems, low blood pressure can cause feelings of lightheadedness, like you are going to faint. These are often most notable when standing up after laying or sitting for a long time.
- Inner ear problems. A common cause of dizziness is something called benign paroxysmal positional vertigo, or BPPV. This kind of vertigo tends to be very short-lived, lasting seconds to minutes, and very predictable – happening in response to certain head movements. It occurs when the crystals in your inner ear get dislodged from their normal spot and float into your ear’s semicircular canals. The good news: This type of vertigo is easily corrected with physical therapy.
- Heart disease. Sometimes dizziness can indicate a heart condition. Leaking or narrow heart valves, heart arrhythmias and narrowing arteries (also known as atherosclerosis) can reduce blood flow to the brain and make you feel dizzy.
- Migraine headaches. According to the Vestibular Disorders Association (VEDA), about 40 percent of people who suffer from migraines also experience dizziness or vertigo. You might suffer from dizziness before, during or completely independent of your migraine. Food, temperature changes, hormonal fluctuations and other environmental factors can trigger both dizziness and migraine headaches.
- Stroke. Rarely, a stroke can cause vertigo. For an initial episode of severe vertigo, it is important to go to the emergency room to identify if something serious is happening.
- Meniere’s disease. This is a classic inner ear disorder caused by too much fluid in the inner ear and characterized by episodic spinning dizziness, nausea, ear pressure, decreased hearing and ringing in the ear, with episodes lasting from minutes to hours. While this kind of dizziness can be severe and temporarily disabling, doctors can offer many strategies to help patients with this disease live as normal a life as possible.
- Anemia, thyroid disease, other medical problems. Because balance is such a complex system, it can be caused by many things.
How do you know if your dizzy spells are worrisome? “While most dizziness is not suggestive of an underlying severe problem, as with any new symptom, new onset vertigo or dizziness should be thoroughly evaluated,” says Dr. Brainard.
Your doctor can help rule out health problems related to dizziness, such as heart disease, rare vestibular conditions or a stroke, and get to the bottom of why you’re feeling these symptoms.
To find a doctor at Henry Ford, visit henryford.com or call 1-800-HENRYFORD (436-7936).
Dr. Laura Brainard is an otolaryngologist (ear, nose and throat specialist) who sees patients at Henry Ford Medical Center – Fairlane and Henry Ford West Bloomfield Hospital.
The Ear, Nose & Throat team at Henry Ford Hospital was recently ranked 23rd in the nation by U.S. News & World Report on its 2018-19 Best Hospitals list.