Feeling dizzy can be scary, as you worry about what’s causing your dizziness and how it might affect your life. Dr. Howard LeWine discusses likely causes.
Question: About once a week I experience a bout of extreme dizziness. It is accompanied by a physical feeling of being turned upside down, and everything looks upside down and blurred to me. It is very sudden and random. If I sit down immediately and stay still, it goes away quickly. What can cause this?
Answer: When a person uses the term “dizzy” to describe a symptom, it can reflect several different sensations. It may mean that the person is:
- Feeling lightheaded like the person might faint
- Experiencing vertigo
- Feeling detached and “out of it” — what I often refer to as cobwebs inside the head
The episodes of dizziness you describe are most consistent with vertigo.
The other possibility is that your episodes are caused by lightheadedness, either from a rapid fall in blood pressure (postural hypotension) or what’s known as a vasovagal response. But people rarely describe your types of symptoms with either of those situations.
Usually the symptoms of vertigo are not this intense. More often, people with vertigo experience a sensation that the room is spinning or that you are spinning in the room. Sometimes it is just a sense of imbalance. Vertigo may be associated with nausea, vomiting, and ringing in one or both ears (tinnitus).
When a person has recurrent episodes of vertigo, I usually suspect a disorder called benign position vertigo (BPV). In this condition, a change in head position causes sudden episodes of a spinning sensation. BPV is caused by small crystals that break loose in the canals of the inner ear and touch the sensitive nerve endings inside.
Another potential cause of episodic vertigo is Ménière’s disease. But Ménière’s does not usually cause vertigo to happen as frequently as once a week. Also, the vertigo of Ménière’s is accompanied by ringing in the ear and some hearing loss.
A much rarer cause of recurrent vertigo is intermittent interruption of blood flow to the back part of the brain.
Your next step should be to talk with your doctor about your symptoms. If this is benign positional vertigo, your doctor may advise Epley maneuvers. This involves moving the head in a sequence of positions that directs the floating crystals into a part of the inner ear with fewer nerve endings.
Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.
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