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Causes
By Mayo Clinic staff
The key sensations that characterize your dizziness — such as vertigo, a feeling of faintness or loss of balance — provide clues for possible causes.
Vertigo
Vertigo usually results from a problem with the nerves and the structures of the balance mechanism in your inner ear (vestibular system), which sense movement and changes in your head position. Sitting up or moving around may make it worse. Sometimes vertigo is severe enough to cause nausea, vomiting and imbalance.
Causes of vertigo may include:
- Benign paroxysmal positional vertigo (BPPV). BPPV causes intense, brief episodes of vertigo immediately following a change in the position of your head, often when you turn over in bed or sit up in the morning. BPPV is the most common cause of vertigo.
- Inflammation in the inner ear. Signs and symptoms of inflammation of your inner ear (acute vestibular neuritis) include the spontaneous onset of intense, constant vertigo that may persist for several days, along with nausea, vomiting and imbalance. It can be incapacitating, requiring bed rest. When associated with sudden hearing loss, this condition is referred to as labyrinthitis. Fortunately, vestibular neuritis generally subsides and clears up on its own.
- Meniere's disease. This disease involves the excessive buildup of fluid in your inner ear. It is an uncommon condition that may affect adults at any age and is characterized by sudden episodes of vertigo lasting 30 minutes to several hours.
- Migrainous vertigo. Migraine is more than a headache disorder. Just as some people experience a visual "aura" with their migraines, others can get vertigo episodes and have other types of dizziness between migraines.
- Acoustic neuroma. An acoustic neuroma (vestibular schwannoma) is a noncancerous (benign) growth on the vestibular nerve, which connects the inner ear to your brain. Symptoms of an acoustic neuroma generally include progressive hearing loss and tinnitus on one side accompanied by dizziness or imbalance.
- Other causes. Rarely, vertigo can be a symptom of a more serious neurological problem such as a stroke, brain hemorrhage or multiple sclerosis. In such cases, other neurological symptoms are usually present, such as double vision, slurred speech, facial weakness or numbness, limb coordination, or severe balance problems.
Feeling of faintness (presyncope)
Presyncope is the medical term for feeling faint and lightheaded without losing consciousness. Sometimes nausea, pale skin and clamminess accompany a feeling of faintness. Causes of presyncope include:
- Drop in blood pressure (orthostatic hypotension). A dramatic drop in your systolic blood pressure — the higher number in your blood pressure reading — may result in lightheadedness or a feeling of faintness. It can occur after sitting up or standing too quickly.
- Inadequate output of blood from the heart. Conditions such as any of the various diseases of the heart muscle (cardiomyopathy), an abnormal heart rhythm (arrhythmia) or a decrease in blood volume may cause inadequate blood flow from your heart.
Loss of balance (disequilibrium)
Disequilibrium is the loss of balance or the feeling of unsteadiness when you walk. Causes may include:
- Inner ear (vestibular) problems. Abnormalities with your inner ear can cause you to feel like you are unsteady while walking, especially in the dark.
- Sensory disorders. Failing vision and nerve damage in your legs (peripheral neuropathy) are common in older adults and may result in difficulty maintaining your balance.
- Joint and muscle problems. Muscle weakness and osteoarthritis — the type of arthritis that involves wear and tear of your joints — can contribute to loss of balance when it involves your weight-bearing joints.
- Neurological conditions. Various neurological disorders can lead to progressive loss of balance, including Parkinson's disease, cerebellar ataxia, normal pressure hydrocephalus and spinal cord disorders.
- Medications. Loss of balance can be a side effect of certain medications, such as anti-seizure drugs, sedatives and tranquilizers.
Other dizzy sensations such as floating, swimming or heavy-headedness
Other "dizzy" sensations that are more difficult to describe may include feeling "spaced out" or having the sensation of spinning inside your head. Some causes include:
- Medications. Blood pressure lowering medications may cause faintness if they lower your blood pressure too much. Many other medications can cause nonspecific feelings of dizziness that resolve when you stop the medication.
- Inner ear disorders. Some inner ear abnormalities can cause persistent, non-vertigo-type dizziness.
- Anxiety disorders. Certain anxiety disorders, such as panic attacks and a fear of leaving home or being in large, open spaces (agoraphobia), may cause dizziness. Sometimes one cause — such as a vestibular disorder — may produce symptoms, but then anxiety causes your dizziness to persist even after your inner ear problem has resolved.
- Kerber KA, et al. Dizziness, vertigo, and hearing loss. In: Bradley WG. Neurology in Clinical Practice. 5th ed. Burlington, Mass.: Butterworth-Heinemann; 2008. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-0-7506-7525-3..50021-2--cesec5&uniq=201760123&isbn=978-0-7506-7525-3&sid=1000299571#lpState=open&lpTab=contentsTab&content=4-u1.0-B978-0-7506-7525-3..50021-2%3Bfrom%3Dtoc%3Btype%3DbookPage%3Bisbn%3D978-0-7506-7525-3. Accessed May 19, 2010.
- Tusa RJ. Dizziness. Medical Clinics of North America. 2009;93:263.
- Branch WT. Approach to the patient with dizziness. http://www.uptodate.com/home/index.html. Accessed May 19, 2010.
- Dizziness. In: Duthie EH, et al. Practice of Geriatrics. 4th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/201760123-5/1000319689/1532/147.html#4-u1.0-B978-1-4160-2261-9..50021-5--cesec23_308. Accessed May 19, 2010.
- Falls and fractures. National Institute on Aging. http://www.nia.nih.gov/HealthInformation/Publications/falls.htm. Accessed May 19, 2010.
- Barton J. Benign paroxysmal positional vertigo (BPPV). http://www.uptodate.com/home/index.html. Accessed May 19, 2010.
- Eggers SD (expert opinion). Mayo Clinic, Rochester, Minn. June 16, 2010.
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