Feeling giddy, woozy, faint, light-headed are some of the terms people have used to describe Dizziness. The English dictionary defines Dizziness as a “sensation of instability”. Dizziness is not a disease but a symptom and can affect anybody, especially the elderly. It is not life-threatening but could be a symptom of something serious if not taken care of. It can last for a few seconds up to hours and days, in some cases. It is usually caused by an imbalance in the inner ear or dysfunction with a part of the nervous system that affects balance.
Types of Dizziness:
Dizziness can be classified into 4 categories, namely:
Vertigo:
This is described by a spinning or whirling sensation. Vertigo is the most common form of Dizziness. It can be peripheral or central. Peripheral vertigo is associated with diseases affecting balance in the inner ear e.g. Meniere’s disease, labyrinthitis, benign paroxysmal positional vertigo (BPPV), and vestibular neuritis. Central vertigo is associated with an injury or disease that affects the brain e.g. head trauma and stroke.
Disequilibrium:
This is described as a sense of imbalance e.g. the person may find walking in a straight line tasking. It can be seen in cases like Parkinson’s disease or stroke.
Presyncope:
This is described as feeling faint or almost blacking out. This feeling is common in patients with cardiovascular disorders like arrhythmias and hypotension.
Light headedness:
This is feeling of wooziness or unsteadiness. This is associated with psychiatric conditions like anxiety and depression.
Patients can hardly differentiate between these categories, so it is important to listen to their description, note physical symptoms and take a proper medical history to pinpoint the cause.
Causes of Dizziness:
Dizziness is caused by a variety of factors. The main causes are medications, diseases or disorders, and lifestyle factors.
Medications:
Dizziness is a common adverse effect of many drugs. Some of the drugs include anticoagulants, muscle relaxants, antihistamines, antihypertensives, diuretics, and benzodiazepines. The effect is usually discussed when counseling patients taking these medications so they know what to expect or how to curb it. For example: taking drugs at night might reduce the dizzy episodes compared to taking them during the day. For some drugs, the effects tend to fade as the patient’s body adapts to the drug. Medication history should be discussed with the doctor if you are presenting with Dizziness.
Diseases or Disorders:
As mentioned earlier, Dizziness is a symptom and there are many conditions that can cause it. They include; panic attacks associated with anxiety, motion sickness, hypoglycemia (low blood sugar) in diabetics, cardiovascular conditions like stroke and hypotension (low blood pressure), anaemia, inflammation of the inner ear like in labyrinthitis, ear infections such as vestibular neuritis(a disorder of the inner ear nerves) and otitis media, severe blood loss, etc.
Lifestyle Factors:
Lifestyle behaviors can also influence or contribute to the cause of Dizziness. These factors are usually easily resolved once identified. Examples are:
Alcohol intake:
Excessive alcohol intake can cause dehydration and low blood sugar levels, which can cause Dizziness. This is why people are advised to drink water in between drinks to reduce the risk of dehydration. There is also said to be a link between alcohol intake and ear imbalance which is a major cause of vertigo.
Poor ventilation:
Lack of proper ventilation means reduced access to oxygen. It can be due to having not enough windows or cooling and ventilation systems in a room or poor quality of air. One can experience fatigue, headache, nausea as well as Dizziness, and shortness of breath. There is usually an improvement if one leaves the room or the area becomes properly aerated.
Eating habits and dehydration:
Lack of proper nutrition can lead to reduced energy levels, low electrolytes, and low blood volume putting one at risk of Dizziness. Patients e.g. those with anorexia and malnutrition can feel tired, woozy, clumsy, and lightheaded.
Risk Factors Related to Dizziness:
These are conditions and attributes that put you at risk of Dizziness.
- Age : Elderly patients are at higher risk of Dizziness due to factors like poor vision, low energy levels, decreased muscle tone and capacity, poor coordination, poor nerve functioning, and hearing loss. These factors also increase their risks of falling.
- Illness: Burdened with conditions such as chronic diseases like diabetics, high blood pressure, Meniere’s disease, an ear disorder can increase risks especially if symptoms are poorly controlled or managed.
Head injuries and some medications can also put one at risk of developing Dizziness mainly vertigo.
Symptoms of Dizziness:
The symptoms of Dizziness are usually described by the sensations the person is feeling. They may feel faint, a spinning sensation, a false motion of the room or themselves, or decreased consciousness. Often, Dizziness is accompanied by other symptoms such as a headache, nausea, vomiting, tiredness, and confusion.
Diagnosis of Dizziness:
Dizziness is a common complaint made by patients to health professionals. However, it cannot be identified by simple blood work or a scan. It is totally based on patients’ descriptions of what they are experiencing and most times, it is accompanied by other symptoms. Dizziness can be predetermined, e.g. with the adverse effects of certain medications mentioned earlier, or as a result of a presenting condition, either acute or chronic. Doctors will have to take the proper medical history of the patient to help make a diagnosis. Patients may first, be required to describe their symptoms in their own words and then answer some questions to ascertain the time, triggers, and duration of the symptom. Lifestyle choices, occupational and environmental factors may also be discussed. This is necessary to determine what the patient is exposed to e.g. poisonous gas, chemicals, environmental pollution, etc.
Dizziness with triggers can be managed by eliminating or curbing the triggers. For example; Dizziness that is medication-induced could be addressed by reducing or stopping the dose altogether, or taking a dose at night. Dizziness without triggers could be difficult to treat so further examination might be required like physical examination, blood tests, CT scans or an MRI. A referral to a specialist may also be necessary, depending on the accompanying symptoms.
Differential Diagnosis of Dizziness:
A differential diagnosis is used to distinguish between several medical conditions which share the same symptoms and features or characteristics. As already established before, Dizziness is a common complaint and is associated with several conditions and medications. A proper line of questioning can rule out minor ailments like migraines, tension headaches, or a hangover headache.
Several tests or assessments can then be carried out to narrow down the root cause. On presentation, blood pressure and blood sugar may be taken to check their patient’s baseline and rule out hypotension and hypoglycemia. An ear examination might be necessary to check for blockages or inflammation that may affect balance. Physical appearance, weight, BMI, and a history of eating habits can address issues associated with anorexia, bulimia, and malnutrition. Blood work can be done to check red blood cells counts associated with anaemia. An eye movement and balance test may also be required.
An eye movement test involves following the doctor or examiner’s finger in front of you from left to right to check for involuntary eye movements. The patient might also be required to look straight ahead, cover, and uncover each eye. The head will also be tilted from side to side while focusing on the examiner to check for rapid eye movements. These tests are part of an ocular test known as HINTS (head-impulse, nystagmus, and test of skew). It is used to check for a possible stroke. It can also determine if the cause is peripheral or central.
A proper differential diagnosis can help in knowing what to focus treatment on, what tests to do, and the appropriate referrals to make.
Treatments of Dizziness:
Dizziness can get better on its own. But as we have learned, certain conditions would require managing or alleviating the cause or trigger so proper assessment of medical history and other symptoms are necessary before considering treatment. In some cases, getting proper rest, eating, and hydrating may be enough. The patient may also be advised to keep an eye on symptoms and report back if they keep re-occurring or get worse.
- A condition like Meniere’s disease, (an ear condition that causes a spinning sensation and ringing in the ear) which can only be managed, sufferers are advised to go on a low sodium diet and given treatment such as prochlorperazine and diuretics to manage nausea and dizzy episodes.
- Migraine sufferers may be given treatment (triptans) to prevent migraine attacks.
- Patient with chronic conditions like diabetes and hypertension should be closely monitored and advised to adhere to treatment.
- Anti-depressants and anxiolytics can be given in the psychiatric conditions such as depression and anxiety.
- Ear infections like labyrinthitis and vestibular neuritis are treated with antihistamines (promethazine), corticosteroids (prednisolone) and benzodiazepines (diazepam), antibiotics and anti-viral depending on the causal agent. Intravenous fluids may also be given depending on the severity of the case.
- Dietary advice, blood supplements like B vitamins and iron or blood transfusion may be required in anaemic patients and cases of severe blood loss to increase the red blood cells count and energy levels.
MYTHs Related to Dizziness:
There are some misconceptions associated with Dizziness as with any other medical condition. These are false beliefs that most patients think to be true. Some of them include:
Myth #1: DIZZINESS WILL FADE AWAY IF YOU STAY PUT
It is true that Dizziness can worsen with movement but what is causing it should be taken into consideration. It does help to stop, take a seat, or rest when feeling dizzy especially if the trigger is known, but in some cases, it needs to be evaluated by a doctor especially if it persists or gets worse. Dizziness can be caused by the positioning of your head thus, can occur when you lie down, sit up or turn over in bed. This is common with a condition called Benign Paroxysmal Positional Vertigo, occurring mostly in the elderly. It can be idiopathic or caused by a head injury, leading to accumulation of fluid in the ear sending wrong signals to the brain. Postural hypotension can also cause Dizziness sitting or lying down.
Myth #2: DIZZINESS DOESN’T REQUIRE TREATMENT
Many people see Dizziness as a consequence of stress or malnutrition. While this may be true for some, it is important to look at each situation holistically, meaning considering other factors such as; accompanying symptoms, co-morbidities, environmental factors, lifestyle, etc., as it may be a sign of something else and treatment may be required.
Frequently Asked Questions (FAQs):
1) What Can I Do To Help My Symptoms At Home?
Ans: If your dizzy spell is not frequent, get comfortable on a bed or chair and take slow deep breaths. Stop any strenuous activity like exercise or doing house chores. If the sensation stops, rest by preferably lying down for a few more minutes before taking on any other activity.
Dehydration could be a cause so ensure to drink enough water. If you’re a diabetic experiencing low blood sugar or if you haven’t had something to eat, get something to eat, preferably a snack high in carbohydrates to boost your energy levels. Try to avoid alcohol and caffeine if possible. If you’re on blood pressure medication, check your blood pressure if you have a monitor at home and speak to your doctor if your numbers have decreased or go to a hospital.
Chewing or drinking ginger tea is also a remedy to try especially if it is associated with nausea. It is important to note what triggered the episode so as to avoid it next time. If your symptoms re-occur, make an appointment with your doctor.
2) Who Should I See?
Ans: It is important to make an appointment with your doctor first. He or she will do an initial assessment and make referrals where necessary. Depending on your doctor’s findings, you may be referred to a specialist such as an ENT specialist; a doctor disciplined in diagnosing and treating conditions affecting the ear, nose, and throat. The specialist can make referrals too depending on the situation.
