Dizziness – Types, Causes and Treatment

Has it ever happened to you that you got out of bed and had to sit straight back down because you'd lost your balance? Or that you had to stop while walking because everything around you seemed to spin for a few seconds? Dizziness can strike in the most ordinary moments – even in perfectly healthy people.

Dizziness isn't a diagnosis in its own right, but a symptom that can have a range of underlying causes, including dehydration or exhaustion. If it keeps recurring, however, dizziness may also mask more serious problems, such as neurological disorders or cardiovascular disease.

What is dizziness?

Dizziness is a term that describes a wide variety of sensations: a feeling of spinning, unsteadiness, disorientation, loss of balance, or even faintness. It may be experienced as weakness, confusion, or unsteadiness when walking.

Depending on its intensity, dizziness can range from a mild light-headed feeling to the deceptive impression that everything around you is spinning. This impression is known as vertigo, and describes the sensation that the affected person themselves, or their entire surroundings, are moving or rotating.

Dizziness in itself is not an illness but a symptom with many possible causes, such as circulatory problems, metabolic disorders, emotional strain, or problems with the inner ear. The latter plays a central role in balance and spatial orientation – a lack of stability may therefore point to a disorder of the balance organ (the vestibular system).

The types of dizziness

Dizziness can manifest in different ways and have numerous causes, including neurological and musculoskeletal ones. Depending on how it is experienced and which cause is most likely, several forms of dizziness are distinguished.

Vertigo (spinning dizziness)

The deceptive sensation that everything is spinning around you, or that you yourself are rotating when in fact you are standing still, is known as vertigo. It is most commonly associated with disorders of the inner ear and the balance system. It is often accompanied by nausea, vomiting, and difficulty maintaining balance.

Pre-syncopal dizziness (light-headedness)

Known as light-headedness, pre-syncopal dizziness is described as a light feeling in the head, weakness, or an impending loss of consciousness (fainting), and is frequently linked to low blood pressure (hypotension) or dehydration.

This sensation can occur when you stand up suddenly or have been on your feet for a long time.

Dizziness as a balance disorder

This form of dizziness doesn't necessarily create the feeling that everything is spinning around you; instead, it leads to difficulty walking or keeping your balance. You may feel as though you can't walk in a straight line, that your steps are unsteady, or that you're being pulled to one side.

This type of dizziness occurs more frequently in patients with neurological or muscular conditions.

Dizziness with a floating or foggy sensation

Dizziness accompanied by a sense of confusion or floating occurs more often in connection with chronic stress, severe exhaustion, anxiety, or metabolic disorders, and is a rather non-specific form of dizziness. It doesn't present as the classic spinning sensation, but rather as mental fog, a floating feeling, or a lack of clarity, which can impair your ability to concentrate.

The causes of dizziness

Episodes of dizziness may be temporary and brief, often with mundane causes such as tiredness or dehydration. However, there are also cases that require medical assessment – particularly when episodes are recurrent, intense, or sudden in onset. These may indicate more serious health problems.

Dizziness caused by inner ear disorders

According to a 2022 study, around 50% of all cases of dizziness are caused by an inner ear disorder. The inner ear plays a central role in balance, and any disturbance at this level can trigger dizziness, particularly vertigo:

• Benign paroxysmal positional vertigo (BPPV): when the position of the head changes, tiny calcium crystals in the inner ear shift and trigger brief attacks of dizziness.
• Labyrinthitis or vestibular neuritis: inflammation of the inner ear canals or the balance nerve, often following a viral infection, which can cause sudden and severe attacks of dizziness.
• Ménière's disease: characterised by a build-up of fluid in the inner ear and associated with vertigo, ringing in the ears (tinnitus), and hearing loss.

Dizziness caused by cardiovascular problems

When the brain isn't supplied with enough blood, dizziness, balance problems, and fainting can occur. In older people, a considerable proportion of dizziness cases are attributable to cardiovascular problems, such as:

• Orthostatic hypotension: a sudden drop in blood pressure when standing up quickly.
• Cardiac arrhythmias: an irregular heartbeat that can lead to fainting through a brief reduction in blood flow to the brain.
• Cerebral circulatory insufficiency: reduced blood flow to the brain due to narrowing or blockage of the cerebral vessels.

Dizziness caused by neurological disorders

Persistent and severe episodes of dizziness may be neurological in origin, particularly when accompanied by other symptoms such as visual disturbances, speech difficulties, or problems with coordination. Neurological conditions impair the brain's ability to process information about space and balance, which often results in severe dizziness. The most common causes include:

• Vestibular migraine: can cause vertigo accompanied by headaches or visual disturbances.
• Stroke: especially when the dizziness comes on suddenly and is accompanied by one-sided weakness or slurred speech. This is a medical emergency.
• Conditions requiring thorough investigation: such as multiple sclerosis or brain tumours.

Dizziness caused by metabolic and hormonal disorders

Metabolic disorders can directly affect the functioning of the brain and nervous system, sometimes causing dizziness and exhaustion. The most common causes include:

• Hypoglycaemia: a drop in blood sugar, particularly in people with diabetes and in those who skip meals.
• Anaemia or iron deficiency: characterised by a reduced ability of the blood to transport oxygen to the brain.
• Vitamin B12 deficiency and thyroid disorders: can cause dizziness, fatigue, and difficulty concentrating.

Dizziness and heavy periods

Menorrhagia – that is, very heavy bleeding where you have to change your menstrual products every hour or even more frequently – is associated with significant losses of blood and iron, which can contribute to iron deficiency and iron-deficiency anaemia. This can reduce the oxygen supply to the brain, potentially triggering dizziness, weakness, and a general state of exhaustion.

Dizziness during menstruation is often accompanied by pallor, a rapid pulse, difficulty concentrating, episodes of weakness, and marked fatigue.

If the dizziness is severe or accompanied by fainting, a gynaecological examination is advisable, along with blood tests (full blood count, ferritin, hormones). Depending on the results, your doctor may recommend appropriate treatment with iron supplements, dietary changes, or further hormonal investigations if needed.

Dizziness caused by external factors and lifestyle

There are also seemingly mundane factors that can nonetheless trigger dizziness and exhaustion. Dehydration, chronic stress, anxiety, and panic attacks are among the most common causes. Dizziness can also be a side effect of certain medications, particularly blood pressure medication, sedatives, or antidepressants.

Symptoms that accompany dizziness

Dizziness is itself a symptom and is easily recognised by the spinning or unsteady sensation. Those affected, however, often experience other complaints as well:

• Nausea, vomiting
• Cold sweats
• Blurred vision
• Tinnitus (ringing in the ears)
• A general feeling of weakness
• Difficulty concentrating and brain fog

These symptoms can be triggered or made worse, in particular, by sudden movements, walking, head movements, or standing up.

When dizziness becomes a warning sign

Dizziness is one of the most common reasons patients see a doctor. Surveys show that up to 30% of the world's population is affected by it at some point.

An occasional, brief episode may be down to dehydration or tiredness and is no cause for concern. However, if these episodes recur, or if they are severe and long-lasting (more than three days), it's advisable to see a doctor to establish the precise cause.

There are also situations where emergency medical care is required. Call the emergency services if you experience a sudden, intense attack of dizziness or vertigo accompanied by:

• Pain, for example sudden, severe chest pain
• Severe headache or a stiff neck
• A rapid or irregular heartbeat
• Numbness or paralysis on one side of the arms, legs, or face
• Loss of coordination
• Shortness of breath
• Loss of consciousness or seizures
• Problems with the eyes or ears, such as double vision or a sudden change in hearing
• Confusion or difficulty speaking
• Persistent vomiting

Diagnosing dizziness

As dizziness is a symptom of many conditions, diagnosis involves a careful assessment of the circumstances in which the episodes occur and, depending on the case, various further investigations.

Medical history and clinical examination for dizziness

A detailed conversation with your doctor and a physical examination (blood pressure measurement, assessment of eye movements, reflexes, and gait) generally form the first step in the diagnostic process. Your doctor will ask about the duration, intensity, and frequency of the episodes and will try to identify triggers such as changes in position, physical exertion, stress, menstruation, or particular foods.

This stage will also cover any medications you're taking, your stress levels, sleep quality, and known pre-existing conditions, in order to rule out common causes linked to lifestyle or certain treatments.

ENT and balance tests

If your doctor suspects an inner ear disorder is behind the dizziness, they may recommend specific ENT investigations.

The most commonly used tests include the Dix-Hallpike test for diagnosing benign paroxysmal positional vertigo (BPPV), as well as audiometry or electronystagmography, which assess hearing and the functioning of the balance system and provide important information about balance and movement coordination.

Neurological and imaging investigations

If the dizziness is severe and persistent, or if your doctor suspects a neurological cause, they may recommend an MRI or a computed tomography (CT) scan. These can detect possible lesions, inflammation, or disorders of the central nervous system.

Balance tests and neurological examinations help to rule out conditions such as stroke, multiple sclerosis, or brain tumours.

Treating dizziness

Occasional, harmless episodes of dizziness usually resolve without treatment. Even where a more serious cause is present, the body has a remarkable ability to adapt within a few weeks and overcome these states without therapy.

If your doctor does recommend treatment, it will be tailored to your symptoms and the cause identified during investigations, with the aim of relieving your discomfort.

Medication-based treatments

Drug therapy should only ever be undertaken on a doctor's recommendation, as prolonged use can mask symptoms without treating the underlying cause.

Anti-vertigo medicines such as betahistine or meclizine can keep symptoms under control by reducing the spinning sensation.

Depending on the case – especially where dizziness is accompanied by nausea or vomiting – antiemetics, antihistamines, or vestibular sedatives may also be prescribed.

Manoeuvres and vestibular therapy

For benign positional vertigo, the Epley manoeuvre is one of the most effective treatment methods. The manoeuvre involves a series of controlled head and body movements, usually carried out under the guidance of an ENT specialist, to reposition the particles in the inner ear and resolve the cause of the dizziness.

For other forms of balance disorder, your doctor may recommend exercises to help restore balance, known as vestibular rehabilitation. This therapy helps the brain adapt and compensate for balance disturbances, reducing the frequency and intensity of dizzy episodes.

Treating the underlying cause of dizziness

If the dizziness is a symptom of a more serious condition, the most effective long-term approach is to treat the underlying illness. Depending on the cause, treatment may involve controlling blood pressure and blood sugar, correcting anaemia or nutritional deficiencies, or managing anxiety and stress through psychotherapy or lifestyle changes.

Tips for managing dizziness at home

Measures for managing dizziness at home are no substitute for medical assessment, particularly if symptoms persist.

Small adjustments to your daily routine can, however, both ease occasional or mild episodes of dizziness and help reduce the frequency and intensity of recurrent episodes.

• Get up slowly from bed or a chair to avoid a sudden drop in blood pressure.
• Avoid alcohol, coffee, and smoking, as they can contribute to dehydration.
• Drink plenty of fluids, especially in hot weather or during a heavy period.
• Make sure you get enough rest, as lack of sleep can worsen dizziness.
• During an episode, avoid driving or risky activities to prevent accidents.

How to prevent dizziness

To prevent dizziness, it's worth developing healthy habits that support your body in functioning at its best:

• Drink plenty of fluids throughout the day.
• Avoid sudden changes in position, particularly after lying down or sitting for a long time.
• Eat a balanced diet with regular meals to prevent low blood sugar.
• Keep an eye on your blood pressure, inner ear health, and hearing through regular medical check-ups.

Frequently asked questions about dizziness

Still have questions about dizziness? Here are brief answers to some of the most common ones:

What's the difference between dizziness and vertigo?

Dizziness is used as a general term for a feeling of unsteadiness or disorientation, while vertigo is a specific form of dizziness characterised by the deceptive sensation that your surroundings, or you yourself, are spinning.

Which tests are carried out for persistent dizziness?

Depending on the symptoms, blood tests (full blood count, blood sugar, iron, vitamin B12), ENT tests, blood pressure measurements, vestibular tests, or imaging investigations (MRI, CT) may be recommended.

Can dizziness be a sign of a stroke?

If the dizziness comes on suddenly, is severe, and is accompanied by difficulty speaking, numbness on one side, or loss of coordination, it may be a sign of a stroke and constitutes a medical emergency.

Which medications help with dizziness?

Your doctor will decide on medication based on the results of your investigations. Treatment may include anti-vertigo medicines to reduce the spinning sensation, as well as antihistamines or antiemetics if nausea or vomiting is also present.

Which conditions can cause dizziness?

Various inner ear disorders, cardiovascular disease, neurological conditions, anaemia, hypoglycaemia, thyroid disorders, as well as chronic stress and anxiety can all trigger dizziness.

Can dizziness be caused by stress?

Yes. Chronic stress, anxiety, and panic attacks can cause feelings of dizziness and difficulty concentrating, even in the absence of other health problems.

What should you do if dizziness comes on suddenly?

Stop what you're doing, sit or lie down somewhere safe, avoid sudden movements, and have a drink. If the symptoms are severe or getting worse, seek medical help.

Are there exercises that help with balance?

Yes, vestibular rehabilitation exercises and specific manoeuvres such as the Epley manoeuvre have proved effective in treating certain forms of dizziness.

When is dizziness dangerous?

Dizziness is considered a warning sign when it is persistent or severe, or when it is accompanied by neurological symptoms, loss of consciousness, or intense head or chest pain.

Can dizziness be caused by a vitamin deficiency?

Yes, a deficiency in vitamin B12, iron, or other B-complex vitamins can present with a range of symptoms, including dizziness, weakness, and difficulty concentrating.

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