What really happens when you feel dizzy

Mar 03, 2019 Dr Zulfikar Bux, Features / Columnists

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By Dr Zulfikar Bux

Assistant Professor of Emergency Medicine
“Feeling dizzy” means different things to different people. Or even to the same person in different situations. Most commonly it is used to describe one of the following sensations:
• Vertigo, which is a feeling of spinning around.
• Feeling faint or light-headed, as if about to pass out or collapse.
• Loss of normal balance, i.e. being unsteady but without feeling faint or whirly.
When you go to a doctor saying you feel “dizzy”, you are giving them a real challenge. Because the word “dizzy” describes several symptoms, and a vast number of conditions can cause dizziness. Your doctor should, however, be able to narrow it down, by finding out exactly what you personally mean by dizziness, and asking about other symptoms.

WHY DO YOU FEEL DIZZY?
Dizziness is usually a problem of the inner ear or brain. It may be due to infection or nerve problems of the ear. Balance issues without dizziness may be due to low blood pressure, anxiety, nerve problems and heart issues. It is important to see your doctor to investigate the problem.
If you have vertigo, i.e. you feel as if you or the world around you is spinning, then the most common causes are inner ear problems. Infections, nerve problems or a dislodged stone inside the ear can cause you to feel dizzy.

WHAT ARE THE POSSIBLE CAUSES OF FEELING FAINT?
If, by dizziness, you mean feeling faint or light-headed, then conditions originating anywhere in your body may be the cause. For example:
• Having a high temperature (fever).
• Very hot weather.
• Side-effects of certain medicines.
• Panic attacks.
• Problems with your hear rate – its beating too fast or slow or irregular.
• Low iron levels causing low blood count.

SHOULD YOU WORRY ABOUT DIZZINESS?
If you are getting recurring dizzy spells, or a constant dizziness for which there is no obvious cause, then see your doctor. If you have dizziness with other alarming symptoms such as sudden weakness in your arms, legs or face muscles, or chest pain or feeling very breathless, then call an ambulance or see a doctor urgently.
It is usually best to have an explanation for dizziness. If you have a prolonged episode of dizziness, or recurring episodes of dizziness and are not sure what is causing them, then it is wise to see a doctor. In particular, if you have other symptoms in addition to the dizziness, such as:
• Headache, especially if it is severe, or a different kind to ones you usually get.
• Hearing or visual loss.
• Problems with speech.
• Weakness of arms or legs.
• Difficulty walking.
• Collapse, or periods of unconsciousness.
• Numbness in areas of your body.
• Chest pain.
• An abnormally slow, fast or irregular pulse
• Any other symptom that you cannot explain.
• If any of these symptoms have come on suddenly, see a doctor immediately.

WHAT ARE TESTS THAT CAN BE DONE FOR DIZZINESS?
Sometimes the doctor can tell you the cause of the dizziness from your symptoms and the result of the examination. After talking to you, your doctor may do the following examinations:
• Taking your temperature.
• Examining your ear.
• Examining your eyes and their movements.
• Checking your pulse and blood pressure and blood sugar
• Checking your balance and co-ordination.
• Looking for any weakness in the muscles of your arms, legs or face.
• Tests which look for dizziness in certain positions or position changes.
Depending on what has been established from the above, further tests might be relevant. These will differ depending on which diagnosis is suspected, but might include:
• A hearing test.
• A blood test – for example, to test you for anaemia (low blood count)
• An MRI or CT scan of your head.
• Heart tests: An ECG or an ultrasound of your heart

IS THERE TREATMENT FOR DIZZINESS?
The treatment depends on the cause. Your doctor will be able to advise you regarding this. It will entirely depend on the type of dizziness and what has caused it. For example:
• Labyrinthitis (inflamed ear nerves) usually improves on its own over time.
• Benign paroxysmal positional vertigo (BPPV) can be cured by a series of maneuvers tilting your head in certain ways to move debris (small stones) in the semicircular canals of the inner ear back in place.
• Dizziness caused by a problem with the heart rhythm or rate is treated by putting the heart rate right – for example, by medicines, a pacemaker or a procedure done directly on the heart.
• Dizziness caused by medication is usually easily solved by reducing the dose of, changing or stopping the medicine in question.
• Dizziness due to panic attacks or anxiety is solved by treating these conditions directly with talking treatments or medicines.
• Dizziness caused low blood sugar can be corrected by giving glucose
• Dizziness caused by low blood count can be corrected by increasing your blood count with supplements or a blood transfusion.
Sometimes when the cause is unknown, your doctor may choose to put you on medications specifically designed to help the dizziness but not the cause. As you can see, dizziness is a complex complaint with many causes. Some can be serious while most are not. Let your doctor decide which you have if you start to feel dizzy.

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