What are Dizziness and Vertigo?

Dizziness is the term used to describe sensations of lightheadedness, unbalanced, or “wooziness”. Vertigo is a specific type of dizziness that causes you to feel that you or the world around you is spinning or moving. Dizziness and vertigo can start or become worse when you stand up or move your head quickly, and in some cases you may also feel nauseous. Episodes of dizziness can be short and sudden, or may last for hours. Dizziness can often re-occur.

Dizziness and vertigo are symptoms, not conditions on their own. Finding the specific cause of dizziness and vertigo is difficult, and typically involves a process of elimination. Hormonal changes are thought to play a role in some cases of dizziness and vertigo, however little research has looked at this directly and for now, there is no direct causal link between hormonal fluctuations and dizziness or vertigo. [1] [2]

There are multiple causes of dizziness and vertigo including inner ear problems and circulatory problems, and dizziness and vertigo are also associated with insomnia, hot flashes, migraines, stress and anxiety. [1] [2] [3] [5]

Dizziness

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Dizziness

  • Anxiety disorders, such as panic attacks or fear of open spaces (agoraphobia) can cause dizziness and lightheadedness. 
  • Low iron levels, called anemia, can result in dizziness. Other symptoms of anemia include fatigue, a sense of weakness, and pale skin.
  • Low blood sugar (hypoglycemia), often seen in insulin-dependent diabetics, can cause dizziness, as well as sweating and anxiety.
  • Carbon monoxide poisoning, which causes dizziness, and also weakness, upset stomach, vomiting, chest pain and confusion.
  • Overheating (hyperthermia) and dehydration can both cause dizziness. [3] [5]

Vertigo

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Vertigo

Your sense of balance is based on the combination of information from your eyes (that tell you where you are), your sensory nerves (that tell your brain about your body’s position and movement), and your inner ear (that detects both gravity and back and forth motion). When you experience vertigo, the signals your brain receives from your inner ear do not match the signals it is receiving from your sensory nerves and your eyes. This causes the sensation of spinning and movement. 

Some causes of inner ear problems that result in vertigo include:

  • Benign paroxysmal positional vertigo (BPPV) happens when you rapidly change the position of your head. Sitting up too quickly are both possible causes. BPPV is the most common cause of vertigo. 
  • Infection of the vestibular nerve, which is the nerve that carries sound and balance information from your inner ear to your brain. 
  • Meniere’s disease, caused by excessive fluid buildup in your inner ear. Vertigo associated with this condition can last for hours, and you may also experience temporary hearing loss, ringing in your ears (tinnitus) and the sensation of plugged ears. 
  • Migraines and vertigo can go together, and episodes of vertigo can happen even if there is no headache present. Vertigo episodes associated with migraines can last between several minutes and several hours. [2]

Self-care for Dizziness and Vertigo

Dizziness and Vertigo are symptoms, which means that self-care may help reduce the impact or frequency of their occurrence, but these self-care options are unlikely to address the underlying issue. Recording when, how, and for how long you experience these episodes can be very helpful when you discuss your dizziness and vertigo with your healthcare provider. There are multiple possibilities about the cause of your dizziness.

 

  • Your head is not receiving enough oxygenated blood, which can make you light-headed and dizzy. This can happen from a sudden drop in blood pressure if you sit or stand up too quickly, called orthostatic hypotension. Poor blood circulation can also be a cause and can happen for many different reasons, including irregular heartbeats or cardiomyopathy, which is a condition of the heart muscle. 
  • Medications such as blood pressure lowering medications, anti-seizure drugs, antidepressants, sedatives or tranquilizers may cause faintness as a side effect. 
  • Neurological conditions, such as Parkinson’s disease and multiple sclerosis, can lead to loss of balance that progresses over time. [3] [4] 

  • Stay hydrated.
  • Maintain steady blood sugar levels by eating more frequent small meals and healthy snacks. Including complex carbohydrates, such as whole grains and vegetables is helpful as these are broken down more slowly in your body, helping to maintain balanced blood sugar instead of peaks when you eat and lows before your next meal. 
  • Follow a regular sleep schedule and go to bed and rise at the same time every day. Dizziness is associated with insomnia so good sleep hygiene can be helpful.
  • Find effective ways to manage your stress and anxiety. This can be achieved through regular exercise, meditation, or yoga. Seek counseling or therapy if you need help with severe or ongoing stress and anxiety.
  • Practice balancing exercises to help strengthen the muscles involved in supporting your balance. [4]

If you experience any recurrent, sudden, severe, or prolonged and unexplained dizziness or vertigo, inform your healthcare provider. Emergency medical care is needed if you experience new episodes of severe dizziness or vertigo along with any of the following:

  • Sudden, severe headache
  • Chest pain
  • Difficulty breathing
  • Numbness or paralysis of arms or legs
  • Fainting
  • Double vision
  • Rapid or irregular heartbeat
  • Confusion or slurred speech
  • Stumbling or difficulty walking
  • Ongoing vomiting
  • Seizures
  • A sudden change in hearing
  • Facial numbness or weakness. [3]

Therapy for Dizziness and Vertigo

At age 40 find a reliable, educated primary care provider familiar with recognizing and treating symptoms of perimenopause and menopause. The North American Menopause Society provides a list of menopause practitioners here.

Dizziness usually corrects itself without treatment, however, if you are suffering regular and/or intense episodes of dizziness you should see your healthcare provider. Seeking the cause of dizziness and vertigo is often a process of elimination. You will probably have to undergo hearing and balance tests so your healthcare provider can assess how you walk and maintain your balance. A simple head-movement test, called the Dix-Hallpike test, is the gold standard for diagnosing benign paroxysmal positional vertigo (BPPV). Posturography, where you stand on a platform in bare feet and try to keep your balance as the platform moves, gives information about how your balance system is functioning. Blood tests can indicate if there are any infections present. [3]

Medications

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Medications

Several medications may be appropriate. For Meniere’s disease you could be prescribed a diuretic to help manage the fluid buildup in your inner ear. Some medications relieve dizziness as a side-effect, including prescription antihistamines or anticholinergics (that act as a neurotransmitter blocker). Migraine medications may be helpful if you suffer from vertigo associated with migraines.

Therapies

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Therapies

There are also therapies that can be used to help. A technique called the Epley maneuver, or canalith repositioning, can help with benign paroxysmal positional vertigo (BPPV). It is a series of head position maneuvers that reposition the tiny crystals found inside the inner ear. These crystals sense gravity and when the Epley maneuver is performed properly, these crystals are restored to their normal position, stopping the vertigo episodes. It is possible to perform the Epley maneuver at home, but you should be trained by a licensed professional before attempting this, to avoid making
the vertigo worse.

Balance therapy, called vestibular rehabilitation, uses specific exercises that your healthcare provider will give you to help make your balance less sensitive to certain motions. This may help if your problems stem from inner ear conditions.

Surgical Procedures

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Surgical Procedures

There are surgical procedures, including injections into your inner ear or the complete removal of the inner ear sense organ. In these cases, the other inner ear becomes the only balance organ. These treatments are extreme and rarely used. [3]

The Science

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The body system responsible for our sense of balance and for awareness of our body position (spatial awareness or spatial orientation) is called the vestibular system. Our balance and awareness of our positioning in the world allows us to make split second adjustments to respond to internal and external forces. For example, if you miss a step or if a gust of strong wind blows against you, it is your vestibular system that corrects your position and (sometimes) allows you to keep your balance.

The vestibular system has two parts: the central system, made up of the brain and brainstem, and the peripheral system, made up of the inner ear. 

The inner ear, also known as the bony labyrinth, is located in a cavity (called the otic capsule) of the temporal bone. It is a bony structure made up of two main parts: the cochlea (which is responsible for your hearing) and the vestibular apparatus (which is responsible for maintaining balance and spatial awareness). The vestibular apparatus contains three semicircular canals that detect angular motion (like turning your head) and two sac-like structures, the utricle and saccule (together called otolith organs) , which detect straight-line or linear movements. [6] [7] 

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Each otolith organ contains hair cells with hairs that are embedded in a jelly-like material. On top of the jelly are small crystals called otoconia, much like sprinkles on top of ice cream. The otoconia, commonly called “ear rocks,” sense gravity. If the ear rocks separate from the jelly and fall into one of the semicircular canals, which can happen when the position of your head changes quickly, this sends incorrect information about gravity to your brain, causing benign paroxysmal positional vertigo (BPPV). 

The semicircular canals do not sense gravity, but they do sense movements along a straight line – up, down, and sideways. The 3 canals are oriented roughly 90 degrees to each other (in the same way that the 3 sides of a box are all oriented 90 degrees relative to each other from a corner of the box) and each canal contains multiple hair cells. When these hair cells move with straight line motion (back and forth or up and down), because of the orientation of the canal they are in, they allow your brain to identify the direction and size of any head movements. 

Inside the bony labyrinth, suspended in a fluid called perilymph, is another chamber called the membranous labyrinth and it contains a fluid called endolymph. You can visualize this as one hose filled with fluid inside another hose filled with fluid. The fluids inside both of the labyrinths contain sodium and potassium, but in different ratios. If the ratios change or become unstable for some reason (for example with a condition such as Meniere’s disease), this can result in vertigo, dizziness, nausea, plugged ears or tinnitus. [6] [7] 

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Myths & Mysteries

MYTH

Not true.  The terms vertigo and dizziness are often used interchangeably, but their symptoms and their causes are different. Typically dizziness makes you feel like your head is spinning, and vertigo makes you feel like the world is spinning around you or the floor beneath your feet is tilting. [8] 

MYTH

False. Vertigo has multiple other symptoms that usually happen at the same time as the sensation of spinning. These include nausea, vomiting, sweating, headache, changes in your hearing, tinnitus, loss of your balance and the sensation that you are being pulled sideways. [8] 

MYTH

Not true. Acrophobia is the technical name for having a fear of heights. It can happen if you are up a ladder or look out of a window in a tall building, and it can also be a debilitating disorder if you have serious acrophobia. Acrophobics may have the sensation of vertigo when they are having a stress response to being high up, but vertigo can come from many different causes.[8] 

MYTH

False. There are many different problems that can result in the feeling of vertigo. The inner ear is the most common, but other issues including medication side effects, stress, hormonal changes, or high blood pressure can also cause vertigo. [8] 

Citations

[1] https://www.hopkinsmedicine.org/health/conditions-and-diseases/allergies-and-the-immune-system

[2] https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/allergies-and-asthma

[3] https://www.mayoclinic.org/diseases-conditions/anaphylaxis/

[4] https://www.healthline.com/health/histamine-intolerance

[5] Reese I. Nutrition therapy for adverse reactions to histamine in food and beverages. Allergol Select. 2018 Sep 1;2(1):56-61. doi: 10.5414/ALX386. PMID: 31826041; PMCID: PMC6885995.

[6] https://www.healthline.com/health/histamine-intolerance#diet

[7] https://www.mayoclinic.org/diseases-conditions/allergies/diagnosis-treatment

[8] https://www.aaaai.org/Tools-for-the-Public/Conditions-Library/Allergies/Allergy-Shots-(immunotherapy)

[9] https://www.technologynetworks.com/immunology/articles/innate-vs-adaptive-immunity-335116

[10] https://www.aaaai.org/Tools-for-the-Public/Allergy,-Asthma-Immunology-Glossary/Immunoglobulin-E-(IgE)-Defined

[11] Branco, A., Yoshikawa, F., Pietrobon, A. J., & Sato, M. N. (2018). Role of Histamine in Modulating the Immune Response and Inflammation. Mediators of inflammation, 2018, 9524075. https://doi.org/10.1155/2018/95240757

[12] Benly. P (2015) Role of Histamine in Acute Inflammation Journal of Pharmaceutical Sciences and Research Vol. 7(6), 2015, 373-376

[13] Weidenhiller M, Layritz C, Hagel AF, Kuefner M, Zopf Y, Raithel M. Histaminintoleranz-Syndrom (HIS): Vielfalt der Mechanismen von physiologischer, pathophysiologischer und toxischer Wirkung und deren Unterscheidung [Histamine intolerance syndrome (HIS): plethora of physiological, pathophysiological and toxic mechanisms and their differentiation]. Z Gastroenterol. 2012 Dec;50(12):1302-9. German. doi: 10.1055/s-0032-1325487. Epub 2012 Dec 7. PMID: 23225559.

[14] https://www.webmd.com/allergies/what-are-histamines