Common causes of dizziness and how to treat it

Most people will feel dizzy at some point in their lives but frequent bouts of dizziness can be distressing and affect your quality of life. Dizziness refers to feeling off-balance or light-headed. You may feel as though the objects around you are moving or that you are moving despite standing still. 

Other symptoms of dizziness include not being able to walk in a straight line and feeling nauseous or vomiting. Depending on the underlying cause, you may also have additional symptoms, such as ringing or hissing sounds coming from inside one or both of your ears (tinnitus), hearing loss, headaches, discharge from your ear or feeling as if your ears are full. 

What causes dizziness?

Conditions affecting the inner ear

The most common causes of dizziness are due to conditions that affect ears. This is because your ears work together with your eyes and sensors throughout your body that control proprioception (your ability to sense the position and movement of your body) to regulate your balance. 

The part of your ear responsible for balance is called the labyrinth or inner ear. It contains several important structures: a spiral-shaped structure called the cochlea that allows you to hear and the vestibular apparatus, which controls your balance. The vestibular apparatus includes semicircular canals and a structure called the vestibule. 

Conditions that affect these inner ear structures can cause balance disorders that consequently result in dizziness. They include: 

• Benign Positional Paroxysmal Vertigo (BPPV) — where tiny calcium crystals (otoconia) in the vestibule become dislodged, usually due to head movements, and inappropriately stimulate balance sensors causing dizziness and vertigo
• Labyrinthitis — infection of the inner ear that causes dizziness, vertigo and nausea
• Menière’s syndrome — a build-up of fluid in the inner ear that causes dizziness, hearing loss and tinnitus; the cause is currently unknown
• Vestibular neuronitis — infection of the vestibular nerve that carries information from the vestibular apparatus to the brain causing dizziness, vertigo, nausea and hearing loss

Conditions affecting the head or brain

Head injuries, vestibular migraines (migraines where one of the main symptoms is dizziness) and in rare cases, brain tumours can all cause dizziness. 

Degenerative conditions of the brain can also cause dizziness, specifically Parkinson’s disease and multiple sclerosis, which affects the brain and spinal cord. 

Conditions affecting the heart

A wide range of heart conditions can cause dizziness by affecting how well blood is pumped around your body. 

This includes an irregular heartbeat (arrhythmia), a tear in the wall of the main artery of your heart (aortic dissection), cardiomyopathy, heart murmurs and heart palpitations. 

Heart attacks, cardiac arrest and cardiogenic shock, which are all life-threatening medical emergencies, can also cause dizziness alongside other symptoms. 

A stroke that damages areas of your brain that process information on the position and movement of your body can cause dizziness too. 

Hormonal changes

In women, hormonal changes that occur just before the start of a period, during perimenopause or menopause can cause dizziness.

Stress and anxiety can also cause dizziness due to the rush of adrenaline (a stress hormone). 

Other causes

Dehydration, heat exhaustion, low blood sugar (hypoglycaemia) caused by diabetes, iron deficiency anaemia and a drop in your blood pressure when you stand up (postural hypotension) can all cause dizziness. 

Certain medications can also cause dizziness as a side effect.

What to do during a bout of dizziness

When you feel dizzy, you should lie down until you no longer feel dizzy and then get up slowly. Avoid sudden movements (eg bending down or getting up suddenly) and any activities that could be dangerous while you’re dizzy eg driving, using heavy machinery or climbing a ladder.

To reduce the severity of any bouts of dizziness, make sure you move slowly and carefully, are well-rested and hydrated, and avoid smoking, taking recreational drugs and drinking coffee and alcohol.

When to see a doctor

If you’re concerned about your dizziness or experience persistent or frequent bouts of dizziness, it is important to see your GP to determine the underlying cause and get appropriate treatment. 

You should also see your GP if your dizziness is accompanied by increased difficulty hearing or speaking, tinnitus, numbness or weakness in your face, arms or legs, headaches, fainting, nausea, vomiting, double vision, blurred vision or other changes to your vision.

Diagnosing the cause of your dizziness

Your doctor will ask you detailed questions about your bouts of dizziness that address exactly what happens, how long it lasts, how often it occurs and any other associated symptoms.

In most cases, your ears will be carefully examined and you will be referred for a hearing test. You will also undergo a series of positional tests, where your doctor will ask you to move your head and/or body in certain directions to see if this has an effect on your dizziness.

Treating the causes of dizziness

Treatment to prevent bouts of dizziness depends on the underlying cause.

BPPV is treated with Epley’s manoeuvre, which involves a series of head movements to reposition the dislodged crystals causing your symptoms. You may need to perform these movements more than once to resolve your symptoms.

Labyrinthitis and vestibular neuritis usually get better on their own. However, your doctor may prescribe a short course of antihistamines and/or motion sickness medication to reduce your symptoms. Lying down can also help.

Meniere’s disease is usually treated with medication to ease your symptoms, hearing aids, therapies to treat tinnitus and vestibular rehabilitation to improve your balance.

Other underlying causes of dizziness will similarly be treated with specific medications, therapies or in some cases surgery.