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February 11, 2014 at 8:00 AMComments: 0 Faves: 0

Dizziness Vs Vertigo: When to See A Doctor

By Jeffrey VanWingen M.D. More Blogs by This Author

I've heard it explained many different ways over the years - woozy, light-headed, giddy, featherbrained, silly, spinning, whirly, drunk, air-headed - regardless of the word choice though, it's important to get down to the core issue behind the sensation.

Some causes are self-limited and will go away on their own. Some are more serious. The first step is to determine if the problem is actually dizziness or vertigo. 

Where dizziness is an uneasy or unsteady sensation, vertigo is more of a spinning sensation which most would consider to be more intense.Vertigo can be so intense in fact, it may even cause nausea and vomiting.

Dizziness and Vertigo Causes

While the causes of dizziness are numerous, the causes of vertigo are relatively few. 

  • Standing Up Too Quickly: Anything that steals supportive blood pressure to the brain can cause dizziness. We experience this briefly if we stand up to quickly, though our body usually accommodates quite quickly to this sudden loss of pressure.
  • Anemia or Dehydration: Dehydration, anemia, blood loss or pregnancy can cause dizziness via the same mechanism of lost volume.
  • Old Age: In the elderly, pressure sensors in the carotid arteries of the neck become lax causing more exaggerated dizziness with position changes.
  • Arrhythmia: Pressure to the brain is supported by our heart which acts as a pump. If this pump fails through a disturbance in rhythm (arrhythmia), dizziness can ensue.
  • Respiratory Issues: Occasionally abnormalities in the oxygen/carbon dioxide balance can cause dizziness as with hyperventilation or conditions reducing oxygen saturation of the blood (smoking, pneumonia, blood clot in the lung). 
  • Stroke: Within the brain, stroke can cause dizziness.
  • Certain Medications: Dizziness can also be a side effect of certain medications. 
  • Panic Attack: Finally, dizziness can be a symptom of a panic attack.
  • Inner Ear Dysfunction: With vertigo, the cause usually lies in the brain or the ear quite near to the brain. Dysfunction in the inner ear (the cochlea) is the most common cause of vertigo. The inner ear consists of coils filled with fluid and specialized cells that sense position. Sway in these hair-like cells gives us the perception of position. When this system goes haywire, vertigo ensues. 
  • Ear Infection: Viral infection, inner ear debris, congestion and increased pressure are common causes of inner-ear vertigo. Occasionally the position sense becomes problematic as with the condition of benign positional vertigo. 
  • Meniere Disease: And lastly, vertigo can be seen in a syndrome with hearing loss called Meniere disease.

Dizziness and Vertigo Treatment

Treatment of dizziness involves identification and correction of the underlying problem. If the cause of dizziness is not apparent, medical attention should be sought to determine the cause. 

  • Stabilization Devices: When the condition is more chronic as with the elderly, accommodations should be made to prevent falls (hand railings and assistance devices such as canes or walkers).
  • Treatment of Underlying Heart Condition: The most urgent association with dizziness is the feeling of palpitations or a heart rhythm disturbance.  Disorders of heart rhythm, though mostly harmless, can have the potential to be life threatening and medical attention should be sought immediately.  
  • Antihistamine: For vertigo, a trial of an antihistamine such as diphenhydramine (Benadryl) is reasonable.
  • The Epley Maneuver: If the condition is more chronic, a trial of the Epley maneuver is worthwhile. This maneuver is a series of twists and turns of the head aimed at clearing out the tubes of the inner ear. Having a helper in navigating this regimen is helpful. Here's an excellent demonstrations of the Epley maneuver:

Ask Your Doctor

Dizziness and vertigo are both common, unpleasant symptoms, so determining which is causing your problems is first place to start. Beyond this, sorting through other associated symptoms can lead to the most effective treatment ideas. The most dangerous associations with these symptoms are heart palpitations, shortness of breath and their presence in the elderly at risk for fall.  If symptoms persist and cause is not clear and identifiable, please seek medical care.

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