Dizziness: When To See a Doctor?

Patients who continue to have repeated episodes of dizziness need to consult with a doctor.

Patients who continue to have repeated episodes of dizziness need to consult with a doctor. Dizziness occurring along with the following require immediate medical attention:

• Trauma to the head and neck
• Headache
• Neck pain
• High grade fever, with or without chills
• Blurring of vision
• Loss of heating
• Difficulty speaking or slurred speech
• Numbness or tingling
• Drooping of the eye or the angle of the mouth
• Loss of consciousness
• Chest pain
• Continuous vomiting
• Projectile vomiting (severe vomiting wherein the vomit is forcefully expelled several feet away from the person vomiting)

Dizziness is a general term used to describe a range of sensations, such as feeling faint, lightheaded, weak or unsteady. Dizziness can create a false sense of spinning of self or the spinning of the surroundings (swaying). This may be associated with other symptoms including nausea, vomiting, sweating, headache or difficulty walking. Vertigo differs from dizziness due to the fact that vertigo is a true sensation of self-spinning or spinning of the surrounding. Dizziness on the other hand is less severe, with a feeling of imbalance or feeling “wonky” and lightheaded.

The common signs and symptoms of dizziness include:

• Feeling of fainting 
• Lightheadedness 
• Loss of balance 
• False sense of spinning 
• Difficulty walking
• Unsteadiness 
• Nausea and vomiting
• Sweating 
• Palpitations 

The following is advised during a sudden episode of dizziness:

• Sitting or lying down immediately and resting in a cool place till the symptoms resolve. This prevents the risk of  losing balance, leading to a fall and serious injury. One may use a cane or walker or hand rails for support. 
• Avoiding sudden movements of the head and neck and sudden change positions.
• Driving or any dangerous activities like operating heavy machinery should be avoided. 
• Drinking fluids and remaining hydrated can help improve dizziness.
• Eating something sweet can help if the dizziness is caused due to low blood sugar,
• Tripping hazards such as rugs on the floor, low tables etc should be removed in the house to lower the risk of fall in those who have frequent episodes of dizziness.
• One may take over the counter anti-vertigo medications such as meclizine (Antivert) or antihistamines. Pain killers may be taken if there is associated headache.

The causes of dizziness include the following:

• Disorders of the inner ear:

The inner ear maintains balance by sending impulses to the brain about head, neck and body movements. The most common inner ear disorders of the inner ear causing dizziness include: 

BPPV: BPPV usually has no specific trigger, it could be because of trauma or sudden neck/ head movements. In BPPV tiny calcium particles (canaliths) accumulate in canals of the inner ear. 

Meniere's disease: An inner ear disorder which could be autoimmune (when the body’s immune system mistakenly attacks it’s own cells). In this condition, fluid accumulates in the inner ear and increases pressure in the ear. Patient typically present with vertigo, tinnitus (ringing sound in the ear) and hearing loss/ feeling of fullness in the ear (aural fullness) 

Labyrinthitis: Inflammation of the labyrinth in the inner ear. It can occur following viral or bacterial infections, including just a common cold.

Trauma: trauma to the ear or skull fractures can damage the structures of the inner ear. 

Motion sickness: Vertigo can be triggered while travelling causing motion sickness. It is also commonly  associated with nausea and vomiting.

Medications: certain medications can cause inner ear damage.

• Lesions (tumors) in the brain
• Inflammation/ infection of the brain
• Stroke 
• Seizures 
• Cervical spine disorders, such as cervical spondylosis 
• Multiple sclerosis 
• Parkinsonism 
• Alcohol intoxication 
• Vertigo associated with migraine (migranous vertigo)
• Trauma to the head and neck
• Dehydration 
• Starvation
• Anemia
• Low blood pressure 
• Hypoglycaemia (low blood sugar)
• Heart disease 
• Anxiety 

The following measures may help reduce the frequency and intensity of the episodes of vertigo:

• Doing activities that improve balance, such as vestibular rehabilitation exercises, yoga or Tai Chi.
• Adequate hydration by drinking at least eight glasses of water a day.
• Undisturbed sleep of at least seven hours and avoiding stressful situations. 
• Eating a healthy diet that consists of vegetables, fruits and lean proteins 
• Reducing salt content in food. 
• Taking medications as prescribed.
• Manage psychological stress/ anxiety