Dizziness is often caused by illnesses that affect the inner ear, including benign paroxysmal positional vertigo (BPPV), migraine and inflammation of the inner ear balance apparatus (called vestibular neuritis). Dizziness may also be caused by low blood pressure, some heart problems (such as cardiac arrhythmias), anxiety disorders such as panic attacks or (uncommonly) by hypoglycaemia (low blood sugar).
While some people understandably find it difficult to describe their dizziness, a description of a person’s dizziness and the circumstances in which they occur may be very helpful in reaching a diagnosis.
Symptoms of dizziness and vertigo
Descriptions of dizziness may include:
- a sensation of movement (including spinning), either of yourself or the external environment
- unsteadiness, including finding it difficult to walk in a straight line
- feeling faint.
Other symptoms that may accompany dizziness include:
- nausea and vomiting
- ringing or other sounds in the ears (tinnitus)
- difficulty hearing
- staggering gait and loss of coordination (ataxia)
- unusual eye movements, such as flitting of the eyes (nystagmus)
- finding it difficult to see clearly when moving, for example, when reading a sign while walking or driving.
The inner ear contains the organs of balance
Inside the inner ear is a series of canals filled with fluid. These canals are oriented at different angles, and as the head moves, the movement of the fluid inside these canals tells the brain how far, how fast and in what direction the head is moving.
This information is then used by the brain to move the eyes an equal and opposite amount, so that the image that is ‘seen’ by the eyes does not blur and remains clear.
Causes of dizziness and vertigo
A wide range of conditions and diseases can cause dizziness, including:
- Inner ear problems – disorders of the inner ear account for about half of all cases of persistent (ongoing) dizziness. Disorders include Meniere’s disease, benign paroxysmal positional vertigo (BPPV) and vestibular neuritis.
- Anxiety disorders – stress or anxiety may play a role in causing dizziness or, more commonly, may be a contributing factor in dizziness from other causes, such as inner ear disease.
- Brain disorders – a common cause of dizziness is migraine, even without the headache that most people associate with a migraine. Very rarely, other causes of dizziness can include stroke or other brain diseases.
- Other conditions – some cases of dizziness are due to underlying medical conditions such as low blood pressure, infection, some heart problems (such as cardiac arrhythmias) and hypoglycaemia (low blood sugar). Drugs that are used to treat conditions such as epilepsy, coronary heart disease and high blood pressure can also cause dizziness in some people.
- Unknown causes – although a cause may not be found in some people, it does not necessarily mean that these people cannot be helped by the appropriate treatment.
Diagnosis of dizziness and vertigo
In trying to work out the cause of a person’s dizziness, investigations may include:
- medical history, including careful questioning about the nature of the dizziness
- physical examination, which may include observing eye movements, positional testing and a blood pressure check
- specialised hearing or balance testing
- CT or MRI scans of the inner ear or brain
- other tests relating to specific conditions.
Treatment of dizziness and vertigo
Treatment depends on the cause of the dizziness that may be uncovered by your doctor.
Potential treatment options may include:
- canalith positioning procedures, which are a special set of exercises designed to remove inner ear ‘crystals’ in benign paroxysmal positional vertigo (BPPV)
- migraine prevention medication
- medication to dampen the sensations of dizziness
- anti-nausea medication
- balancing exercises to ‘retrain’ the nervous system, which are usually prescribed by a vestibular physiotherapist
- counselling and cognitive behaviour therapy where anxiety or stress is a factor.
Where to get help
- Your doctor
- NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
Things to remember
- Generally, most dizziness is caused by problems of the inner ear and is treatable.
- Common causes of inner ear dizziness include benign paroxysmal positional vertigo (BPPV), migraine and inflammation of the inner ear balance apparatus called vestibular neuritis.
This page has been produced in consultation with and approved by:
Royal Victorian Eye and Ear Hospital (RVEEH)
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