Dizziness: The Different Types and What Causes Them

The different types of dizziness

Describing your dizziness precisely is the most useful thing you can do. "Dizzy" means different things to different people, and each type has a different list of causes.

Some people have more than one type at once. Doctors now also pay close attention to timing and triggers: whether dizziness is a single long attack, comes in episodes, is triggered by head position or standing, or is constant.

Vertigo: spinning dizziness

Vertigo is a false sense of motion. It usually comes from the vestibular system in the inner ear, which senses head movement.

• Benign paroxysmal positional vertigo (BPPV): the most common cause. Tiny calcium crystals drift into the wrong canal of the inner ear. Brief spinning lasting under a minute is triggered by rolling over in bed, lying down, or looking up. It is harmless and can be cured with a repositioning maneuver.
• Vestibular neuritis and labyrinthitis: inflammation of the balance nerve, often after a viral infection. Severe, constant vertigo with nausea lasts days and then slowly improves over weeks. Labyrinthitis also affects hearing.
• Meniere's disease: attacks of vertigo lasting 20 minutes to 12 hours, with ringing, fullness and fluctuating hearing loss in one ear.
• Vestibular migraine: episodes of vertigo from minutes to days, often with a migraine headache, light sensitivity or a history of migraine.
• Stroke or TIA in the brainstem or cerebellum: less common, but important. Vertigo with double vision, slurred speech, numbness, weakness or inability to walk needs emergency care.

Presyncope: lightheaded and about to faint

This is reduced blood flow to the brain. It improves when you lie down.

• Orthostatic hypotension: blood pressure drops when you stand. Common with dehydration, blood pressure medicines, diuretics, older age, Parkinson's disease and diabetes.
• Dehydration from heat, vomiting, diarrhea or not drinking enough.
• Vasovagal syncope: the common faint, triggered by pain, the sight of blood, standing for long periods or heat, with warning signs of feeling hot, sweaty and nauseated.
• Anemia or blood loss.
• Heart problems: arrhythmias, heart block, aortic stenosis and heart failure. Dizziness during exertion or with palpitations is a red flag.
• Low blood sugar in people taking insulin or some diabetes tablets.
• POTS: a fast heart rate on standing, mostly in young women.

Disequilibrium: feeling off balance

Unsteadiness when standing or walking, without spinning:

• peripheral neuropathy, for example from diabetes, causing reduced feeling in the feet
• poor vision, new glasses or cataracts
• damage to both inner ears, sometimes from certain antibiotics
• Parkinson's disease, cerebellar disorders, normal pressure hydrocephalus
• muscle weakness and joint problems in older adults
• alcohol and sedating medicines

Nonspecific dizziness

• Anxiety and panic: dizziness with a racing heart, tingling and fast breathing. Overbreathing lowers carbon dioxide and causes lightheadedness. See anxiety.
• Medicines: sedatives, antidepressants, antiepileptics, blood pressure drugs and opioids are frequent causes, especially in combination.
• Persistent postural-perceptual dizziness (PPPD): a chronic, non-spinning dizziness lasting months, worse in busy visual environments, often following an episode of vertigo.
• Viral illness, fatigue and low blood sugar.

How doctors work out the cause

Expect questions about what the dizziness feels like, how long episodes last, what triggers them, and accompanying symptoms: hearing loss, ringing in the ears, headache, palpitations, chest pain, numbness or weakness. List all your medicines.

The exam may include:

• blood pressure and pulse lying down and after standing
• eye movement checks for nystagmus (jerking eye movements)
• the Dix-Hallpike test, a quick head-positioning test that triggers vertigo and eye flickering in BPPV
• the head impulse test and gait and coordination tests, which help separate inner ear causes from stroke
• hearing tests
• an ECG, and blood tests for anemia, blood sugar and salts

MRI is reserved for neurological signs, one-sided hearing loss or an unclear cause. Heart monitoring is used for dizziness with palpitations or fainting.

Treatment and what helps

During an episode

• Sit or lie down immediately to avoid falling.
• If lightheaded, lie flat and raise your legs.
• Keep still in a quiet room and focus on a fixed point during vertigo.
• Drink water if you may be dehydrated, and eat something if you have missed a meal or have diabetes.

Treating the cause

• BPPV: the Epley maneuver, done by a clinician or taught for home use, cures most cases in one to three sessions.
• Vestibular neuritis: short-term anti-nausea medicine, sometimes steroids, then early movement and vestibular rehabilitation exercises.
• Meniere's disease: limiting salt, diuretics and other treatments from an ENT specialist.
• Orthostatic hypotension: more fluids, standing up slowly, compression stockings and reviewing medicines.
• Vestibular migraine: migraine trigger management and preventive medicines.
• Anxiety: breathing techniques, cognitive behavioral therapy and sometimes medicines.

Medicines such as meclizine and prochlorperazine ease acute vertigo for a few days but slow recovery if used long term.

Preventing falls

Get up slowly in stages, use night lights, remove trip hazards, and use a cane if unsteady. Older adults who are dizzy have a higher risk of falls and fractures.

Frequently asked questions

What are the different types of dizziness?

There are four main types: vertigo, a spinning sensation usually from the inner ear; presyncope, feeling faint from reduced blood flow to the brain; disequilibrium, unsteadiness when walking; and nonspecific dizziness, a vague woozy feeling often linked to anxiety or medicines. Each type has different causes.

What is the most common cause of dizziness?

For spinning vertigo, BPPV is the most common cause: brief spinning set off by head movements. For lightheadedness, dehydration, low blood pressure on standing and medicines are the most frequent causes. Anxiety is also a common cause of ongoing nonspecific dizziness.

When should I worry about dizziness?

Call 911 or your local emergency number if dizziness comes with weakness, numbness, slurred speech, double vision, trouble walking, chest pain, palpitations, a sudden severe headache or fainting. Also see a doctor for dizziness that is new, persistent or recurring, or that started after a new medicine.

Why do I get dizzy when I stand up?

Standing causes blood to pool in the legs, and blood pressure may drop briefly before your body adjusts. This orthostatic hypotension is more likely if you are dehydrated, take blood pressure medicines, are older or have diabetes. Stand up slowly and drink enough fluids. See a doctor if it keeps happening.

Can anxiety cause dizziness?

Yes. Anxiety and panic can cause lightheadedness, often from overbreathing, along with a racing heart, tingling and chest tightness. Anxiety can also follow an inner ear problem and keep dizziness going. Other causes should be ruled out first, and breathing techniques and therapy help.

What is the difference between vertigo and dizziness?

Dizziness is the broad term for any feeling of lightheadedness, unsteadiness or wooziness. Vertigo is one specific type: the false feeling that you or the room are spinning or moving. Vertigo usually points to the inner ear, while lightheadedness points to blood pressure or blood flow.