Dizziness

Diagnosis

Diagnosis involves the steps your healthcare professional takes to find the cause of your dizziness or vertigo. You may need imaging tests such as an MRI or a CT scan right away if your healthcare professional thinks you might be having or may have had a stroke. You also may need one of these imaging tests if you are older or had a blow to the head.

Your healthcare professional asks you about your symptoms and the medicines you take. Then you'll likely have a physical exam. During this exam, your healthcare professional checks how you walk and maintain your balance. The major nerves of your central nervous system also are checked to make sure they're working.

You also may need a hearing test and balance tests, including:

• Eye movement testing. Your healthcare professional may watch the path of your eyes when you track a moving object. And you may be given an eye motion test in which water or air is placed in your ear canal.
• Head movement testing. If your vertigo may be caused by benign paroxysmal positional vertigo (BPPV), your healthcare professional may do a simple head movement test. It's called the Dix-Hallpike maneuver, and it can confirm that you have BPPV.
• Posturography. This test tells your healthcare professional which parts of the balance system you rely on the most and which parts may be giving you problems. You stand barefoot on a platform and try to keep your balance under various conditions.
• Rotary chair testing. During this test you sit in a computer-controlled chair that moves very slowly in a full circle. At faster speeds, it moves back and forth in a very small arc.

You also may be given blood tests to check for infection. You may need other tests to check your heart and blood vessel health too.

Treatment

Dizziness often gets better without treatment. The body usually adapts to whatever is causing the condition within a few weeks.

If you seek treatment, your treatment is based on the cause of your condition and your symptoms. Treatment may include medicines and balance exercises. Even if no cause is found or if your dizziness keeps happening, prescription medicines and other treatments may make your symptoms better.

Medications

• Water pills. If you have Meniere's disease, your healthcare professional may prescribe a water pill, also called a diuretic. This medicine along with a low-salt diet may help you have bouts of dizziness less often.
• Medicines that relieve dizziness and upset stomach. Your healthcare professional may prescribe medicines to provide fast relief from vertigo, dizziness and upset stomach. These medicines include prescription antihistamines and anticholinergics. Many of these medicines cause drowsiness.
• Anti-anxiety medications. Diazepam (Valium) and alprazolam (Xanax) are in a class of drugs called benzodiazepines. These can cause addiction. They also can cause drowsiness.
• Preventive medicine for migraine. Certain medicines can help prevent migraine attacks.

Therapy

• Head position movements. A technique called canalith repositioning or the Epley maneuver involves a series of head movements. The technique usually helps benign paroxysmal positional vertigo get better more quickly than simply waiting for dizziness to go away. It can be done by your healthcare professional, an audiologist or a physical therapist. It often works after one or two treatments. Before you get canalith repositioning, tell your healthcare professional if you have a neck or back condition, a detached retina, or a condition that affects blood vessels.
• Balance therapy. You may learn exercises to help make your balance system less sensitive to motion. This physical therapy technique is called vestibular rehabilitation. It is used for people with dizziness from inner ear conditions such as vestibular neuritis.
• Talk therapy. This involves talking with a psychologist, a psychiatrist or another mental healthcare professional. This type of therapy may help people whose dizziness is caused by anxiety.

Surgery or other procedures

• Injections. Your healthcare professional may inject your affected inner ear with the antibiotic gentamicin. This medicine stops the inner ear's balance function. Your other, healthy ear takes over that function.
• Removal of the inner ear sense organ. A treatment that's rarely used is called labyrinthectomy. A surgeon removes the parts of the ear causing vertigo. This causes complete hearing loss in that ear. The other ear takes over the balance function. This technique may be used if you have serious hearing loss and your dizziness hasn't gotten better after other treatments.

Lifestyle and home remedies

If you tend to have repeated bouts of dizziness, follow these tips:

• Be aware of the risk of losing your balance. This can lead to falls and serious injury. Walk with a cane for balance if needed. And try not to make fast or sudden movements.
• Fall-proof your home. Remove tripping hazards such as area rugs and exposed electrical cords. Use nonslip grip mats on your bath and shower floors. Use good lighting.
• Sit or lie down right away when you feel dizzy. Lie still with your eyes closed in a darkened room if you have a major bout of vertigo.
• Don't drive a car or run heavy machinery if you often become dizzy without warning.
• Limit use of caffeine, alcohol, salt and tobacco. Too much use of these substances can make your symptoms worse.
• Drink enough fluids, eat a healthy diet, get enough sleep and manage stress.
• If your dizziness comes with an upset stomach, try medicine called an antihistamine. Get the kind that's sold without a prescription. Examples include meclizine (Dramamine Less Drowsy) and dimenhydrinate (Dramamine). These might make you sleepy. But antihistamines that don't have this side effect aren't as effective.

If you know why you become dizzy, you can take steps such as these:

• If your dizziness is caused by a medicine, talk with your healthcare professional about lowering the dose or safely stopping the medicine.
• If your dizziness is caused by overheating or not being hydrated enough, rest in a cool place and drink water or a sports drink (Gatorade, Powerade, others).

Preparing for your appointment

Your main healthcare professional likely will be able to find and treat the cause of your dizziness. You may be referred to an ear, nose and throat doctor called otolaryngologist. Or you may see a doctor called a neurologist who treats conditions of the brain and nervous system.

Here's some information to help you get ready for your appointment.

What you can do

Take a family member or friend with you to the appointment if you can. Someone who goes with you can help you remember the information you get. Other things to do before the appointment include:

• Be aware of any restrictions before the appointment. Ask your healthcare professional's office if there's anything you need to do before your checkup. For instance, you may need to restrict your diet. If you need vestibular testing, your healthcare team gives you instructions about any medicines you shouldn't take the night before. You're also given information about what to eat on the day of testing.
• Be prepared to describe your dizziness in specific terms. When you have a bout of dizziness, do you feel like the room is spinning, or like you are spinning in the room? Do you feel like you might pass out? Your description of these symptoms is key to helping your healthcare professional find the cause.
• List any other health conditions or symptoms you have. Include any that may not seem related to your dizziness. For example, if you have felt depressed or anxious recently, this is important information for your healthcare team.
• List key personal information, including any major stresses or recent life changes.
• Make a list of all medicines, vitamins or supplements that you take. Include medicines and supplements that you bought with or without prescriptions.
• List questions to ask your healthcare professional.

For dizziness, some basic questions to ask your healthcare professional include:

• What's the most likely cause of my symptoms?
• Are there any other possible causes for my symptoms?
• What tests do you recommend?
• Is this problem likely short term or long lasting?
• Is it possible my symptoms will go away without treatment?
• What treatment options might help?
• Do I need to follow any restrictions? For example, is it safe for me to drive?
• Should I see a specialist?
• Is there a generic version of the medicine you're prescribing?
• Do you have any brochures or other printed material that I can take home with me? What websites do you recommend?

What to expect from your doctor

Your healthcare professional likely will ask you questions such as:

• Can you describe what you felt the first time you became dizzy?
• Is your dizziness ongoing, or does it happen in bouts or spells? If your dizziness happens in bouts, how long do these bouts last?
• How often do your dizziness bouts happen? When do they seem to happen, and what triggers them?
• Does your dizziness cause the room to spin or produce a sense of motion?
• When you feel dizzy, do you also feel faint or lightheaded? Do you lose your balance?
• Do your symptoms happen along with a ringing or fullness in your ears, trouble hearing, or blurred vision?
• Is your dizziness made worse by moving your head?
• What medicines, vitamins or supplements are you taking?

What you can do in the meantime

If you tend to feel lightheaded when you stand up, take your time making changes in posture. If you have had bouts of dizziness while driving, have someone else drive you in the weeks before your healthcare checkup. For instance, you could ask a relative or friend to drive you as needed. Or you could use a rideshare service or public transportation.

If your dizziness causes you to feel like you might fall, take steps to lower your risk. Keep your home well lighted and free of hazards that might cause you to trip. Remove area rugs and clear away exposed electrical cords. Place furniture where you're not likely to bump into it. And use nonslip grip mats in the bathtub and on shower floors.