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Dizziness: Lightheadedness and Vertigo
Dizziness is a word that is often used to describe two different feelings. It is important to know exactly what you mean when you say “I feel dizzy,” because it can help you and your doctor narrow down the list of possible problems.
- Lightheadedness is a feeling that you are about to faint or “pass out.” Although you may feel dizzy, you do not feel as though you or your surroundings are moving. Lightheadedness often goes away or improves when you lie down. If lightheadedness gets worse, it can lead to a feeling of almost fainting or a fainting spell (syncope). You may sometimes feel nauseated or vomit when you are lightheaded.
- Vertigo is a feeling that you or your surroundings are moving when there is no actual movement. You may feel as though you are off balance, spinning, whirling, falling, or tilting. When you have severe vertigo, you may feel very nauseated or vomit. You may have trouble walking or standing, and you may lose your balance and fall.
Although dizziness can occur in people of any age, it is more common among older adults. A fear of dizziness can cause older adults to limit their physical and social activities. Dizziness can also lead to falls and other injuries.
It is common to feel lightheaded from time to time. Brief episodes of lightheadedness are not usually the result of a serious problem. Lightheadedness often is caused by a momentary drop in blood pressure and blood flow to your head that occurs when you get up too quickly from a seated or lying position (orthostatic hypotension). Ongoing lightheadedness may mean you have a more serious problem that needs to be evaluated.
Lightheadedness has many causes, including:
- Illnesses such as the flu or colds. Home treatment of your flu and cold symptoms usually will relieve lightheadedness.
- Vomiting, diarrhea, fevers, and other illnesses that cause dehydration.
- Very deep or rapid breathing (hyperventilation).
- Anxiety and stress.
- The use of tobacco, alcohol, or illegal drugs.
A more serious cause of lightheadedness is bleeding. Most of the time, the location of the bleeding and the need to seek medical care are obvious. But sometimes bleeding is not obvious (occult bleeding). You may have small amounts of bleeding in your digestive tract over days or weeks without noticing the bleeding. When this happens, lightheadedness and fatigue may be the first noticeable symptoms that you are losing blood. Heavy menstrual bleeding also can cause this type of lightheadedness.
Sometimes the cause of lightheadedness is an abnormal heart rhythm (arrhythmia), which can cause fainting spells (syncope). Unexplained fainting spells need to be evaluated by a doctor. You can check your heart rate by taking your pulse.
Many prescription and nonprescription medicines can cause lightheadedness or vertigo. The degree of lightheadedness or vertigo that a medicine causes will vary.
Vertigo occurs when there is conflict between the signals sent to the brain by various balance- and position-sensing systems of the body. Your brain uses input from four sensory systems to maintain your sense of balance and orientation to your surroundings.
- Vision gives you information about your position and motion in relationship to the rest of the world. This is an important part of the balance mechanism and often overrides information from the other balance-sensing systems.
- Sensory nerves in your joints allow your brain to keep track of the position of your legs, arms, and torso. Your body is then automatically able to make tiny changes in posture that help you maintain your balance (proprioception).
- Skin pressure sensation gives you information about your body’s position and motion in relationship to gravity.
- A portion of the inner ear, called the labyrinth, which includes the semicircular canals, contains specialized cells that detect motion and changes in position. Injury to or diseases of the inner ear can send false signals to the brain indicating that the balance mechanism of the inner ear (labyrinth) detects motion. If these false signals conflict with signals from the other balance and positioning centers of the body, vertigo may occur.
Common causes of vertigo include:
- Inner ear disorders, such as benign paroxysmal positional vertigo (BPPV), Ménière’s disease, vestibular neuritis, or labyrinthitis.
- Injury to the ear or head.
- Migraine headaches, which are painful, debilitating headaches that often occur with vertigo, nausea, vomiting, and sensitivity to light, noise, and smell.
- Decreased blood flow through the arteries that supply blood to the base of the brain (vertebrobasilar insufficiency).
Less common causes of vertigo include:
- A noncancerous growth in the space behind the eardrum (cholesteatoma).
- Brain tumors and cancer that has traveled from another part of the body (metastatic).
Immediate medical attention is needed if vertigo occurs suddenly with a change in speech or vision or other loss of function. Vertigo that occurs with loss of function in one area of the body can mean a problem in the brain, such as a stroke or transient ischemic attack (TIA).
Alcohol and many prescription and nonprescription medicines can cause lightheadedness or vertigo. These problems may develop from:
- Taking too much of a medicine (overmedicating).
- Alcohol and medicine interactions. This is a problem, especially for older adults, who may take many medicines at the same time.
- Misusing a medicine or alcohol use disorder.
- Drug intoxication or the effects of withdrawal.
Check your symptoms to decide if and when you should see a doctor.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as “male” and once as “female”). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Vertigo is the feeling that you or your surroundings are moving when there is no actual movement. It may feel like spinning, whirling, or tilting. Vertigo may make you sick to your stomach, and you may have trouble standing, walking, or keeping your balance.
Symptoms of a heart attack may include:
- Chest pain or pressure, or a strange feeling in the chest.
- Shortness of breath.
- Nausea or vomiting.
- Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
- Lightheadedness or sudden weakness.
- A fast or irregular heartbeat.
The more of these symptoms you have, the more likely it is that you’re having a heart attack. Chest pain or pressure is the most common symptom, but some people, especially women, may not notice it as much as other symptoms. You may not have chest pain at all but instead have shortness of breath, nausea, or a strange feeling in your chest or other areas.
Symptoms of serious illness may include:
- A severe headache.
- A stiff neck.
- Mental changes, such as feeling confused or much less alert.
- Extreme fatigue (to the point where it’s hard for you to function).
- Shaking chills.
Heartbeat changes can include:
- A faster or slower heartbeat than is normal for you. This would include a pulse rate of more than 120 beats per minute (when you are not exercising) or less than 50 beats per minute (unless that is normal for you).
- A heart rate that does not have a steady pattern.
- Skipped beats.
- Extra beats.
Neurological symptoms—which may be signs of a problem with the nervous system—can affect many body functions. Symptoms may include:
- Numbness, weakness, or lack of movement in your face, arm, or leg, especially on only one side of your body.
- Trouble seeing in one or both eyes.
- Trouble speaking.
- Confusion or trouble understanding simple statements.
- Problems with balance or coordination (for example, falling down or dropping things).
Many prescription and nonprescription medicines can make you feel lightheaded or affect your balance. A few examples are:
- Blood pressure medicines.
- Medicines used to treat depression or anxiety.
- Pain medicines.
- Medicines used to treat cancer (chemotherapy).
Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.
Adults and older children often have several symptoms of shock. These include:
- Passing out (losing consciousness).
- Feeling very dizzy or lightheaded, like you may pass out.
- Feeling very weak or having trouble standing.
- Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don’t have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don’t have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Call 911 Now
Based on your answers, you need emergency care.
Call911or other emergency services now.
After you call 911 , the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Call 911 Now
Based on your answers, you need emergency care.
Call911or other emergency services now.
Lightheadedness usually is not a cause for concern unless it is severe, does not go away, or occurs with other symptoms such as an irregular heartbeat or fainting. Lightheadedness can lead to falls and other injuries. Protect yourself from injury if you feel lightheaded:
- Lie down for a minute or two. This will allow more blood to flow to your brain. After lying down, sit up slowly and remain sitting for 1 to 2 minutes before slowly standing up.
- Rest. It is not unusual to develop lightheadedness during some viral illnesses, such as a cold or the flu. Resting will help prevent attacks of lightheadedness.
- Do not drive a motor vehicle, operate equipment, or climb on a ladder while you are dizzy.
- Do not use substances that can affect your circulation, including caffeine, tobacco, alcohol, and illegal drugs.
- Do not get dehydrated, which can cause or increase lightheadedness, when you have an illness that causes diarrhea, vomiting, or a fever. Drink more fluids, especially water. Other fluids are also helpful, such as fruit juice mixed to half-strength with water, rehydration drinks, weak tea with sugar, clear broth, and gelatin dessert. If you have another medical condition, such as kidney disease or heart disease, that limits the amount of fluids you are allowed to have, do not drink more than this amount without first talking to your doctor.
If you have vertigo:
- Do not lie flat on your back. Prop yourself up slightly to relieve the spinning sensation.
- Move slowly to avoid the risk of falling.
Symptoms to watch for during home treatment
Call your doctor if any of the following occur during home treatment:
- Nausea or vomiting persists or increases.
- Fainting occurs.
- Your symptoms become more severe or frequent.
You may be able to prevent lightheadedness caused by orthostatic hypotension by taking your time.
- Get up slowly from your bed or chair.
- Sit on the edge of the bed for a few minutes before standing.
- Sit up or stand up slowly to avoid sudden changes in blood flow to your head that can make you feel lightheaded.
When you are dizzy, your risk of falling increases. You can make changes in your home to reduce your risk of falls.
For more information about falls, see the topic Preventing Falls.
Preparing For Your Appointment
To prepare for your appointment, see the topicMaking the Most of Your Appointment.
You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:
- What is your major symptom, lightheadedness or vertigo?
- How long have you had your symptoms? Do they come and go, or are they always present?
- What were you doing when your symptoms started?
- How often do you experience dizziness?
- What makes your symptoms better or worse?
- Do you have other symptoms that may be related to your major symptom? Symptoms may include:
- Changes in vision, such as blurred or double vision, halos, or spots.
- Chest pain.
- Fainting or falling.
- Heart palpitations, irregular heartbeat, or an unusually slow or fast heart rate.
- Nausea or vomiting.
- Numbness or tingling.
- Weakness or changes in your ability to stand or walk.
- Ringing in the ears (tinnitus) or loss of hearing.
- Shortness of breath or a feeling of suffocation.
- What medicines do you take? Make a list of both prescription and nonprescription medicines you use.
- Do you have any health risks?
Before seeing your doctor, it may be helpful to keep track of your symptoms. Use the questions above as a guide for what to include in your diary of symptoms( What is a PDF document? ).
Current as of: June 26, 2019
Author: Healthwise Staff
Medical Review:William H. Blahd Jr. MD, FACEP – Emergency Medicine & Adam Husney MD – Family Medicine & Kathleen Romito MD – Family Medicine