Professional golfer Jason Day fell on the ninth hole of the third round of the 2015 U.S. Open in June. He had been feeling dizzy and nauseated all day; he was struggling with any quick movements of his head. He laid on the ground for a few minutes but was able to get up and continue playing, though he didn’t feel right for the rest of the round. That night, he went through medical therapy but struggled through the remainder of the tournament.
Dizziness, which is a sense of unsteadiness or unstable movement, is a common symptom most people have experienced. To a great extent, dizziness falls into three large categories:
— Vertigo, which is associated with a sense of spinning or movement
— Imbalance or unsteadiness
— Faintness
Depending on the severity of the symptoms, it can be both frightening and, at times, incapacitating. Approximately 15 percent of people experience dizziness each year. It’s difficult to determine the exact rate, as many people don’t seek medical care for their dizziness.
Elderly people have even higher rates, with some studies suggesting it’s as high as 40 percent in the older age groups. This can lead to an increased risk of falling. In people who are over 80 years of age, the prevalence of falls is more than 30 percent. Falls, in turn, are the most common initial event leading to deaths in the elderly.
The balance system is a complex interaction between three major body systems that are located in an area of the brain called the cerebellum. Dysfunction of any one of these systems can lead to dizziness.
— The first is the ears. The inner ear balance mechanism helps measure and coordinate balance as it relates to movement (turning, leaning, acceleration, deceleration) and gravity. The ears lead to the dizziness that occurs after an amusement park ride or sea sickness. It’s also the reason people have a sense of spinning when they’ve had too much alcohol.
— The second system is the touch receptors that are spread throughout the body, such as sensors in the feet that sense the position of the body and in each of the joints that detect even subtle shifts in position.
— The last system is the eyes, as all people feel more stable in a light rather than dark environment. If you look at the horizon on that sea-sick cruise, your dizziness will lessen.
To better understand the specific causes and treatment of dizziness, it is reasonable to separate these into the three large categories of symptoms aforementioned.
Vertigo
Vertigo, which is the sense of spinning or moving in space, is largely due to problems in the inner ear. The most common cause of vertigo is benign paroxysmal positional vertigo, or BPPV. People experience vertigo, often with nausea, related to changes in position, particularly with turning of the head or lying down. They’ll get a sense of spinning, which can at times be very intense, but it usually gets better after a few seconds to a couple of minutes. People who avoid the position that bothers them have worse symptoms when they eventually get into those positions. BPPV is caused by crystals that can shift around in the ear, and it can be treated by a series of positional maneuvers that can get those crystals back into the right position (Eply maneuvers).
Meniere’s disease is a disorder where episodes of vertigo last for a few hours at a time and may be associated with pressure, decreased hearing or ringing in one of the ears. It will be associated with intervals of normal balance in between episodes. These normal intervals can be a few days to many months in between. People with bad Meniere’s may have some permanent loss of hearing over time. Meniere’s is treated either medically or surgically with different treatments recommended depending on the severity of the symptoms.
Vestibular neuronitis is an acute, intense bout of vertigo lasting for a few days to a couple weeks. Although this will get better on its own, people are usually fairly miserable when it happens. They often require vestibular medications such as dimenhydrinate, scopolamine or diazepam. Some patients with migraines will get vertigo with their migraines (vestibular migraines).
Unsteadiness, Imbalance or Falling
People with unsteadiness, imbalance or falling are harder to categorize, since there are numerous potential causes. A very common cause is postural hypotension, which is a drop in blood pressure when people stand up quickly after sitting or lying for a while. This can be diagnosed by obtaining blood pressures in different positions. Another cause is a gradual overall change in balance with age. This is not dissimilar to a gradual reduction in hearing and eyesight that occurs with age. As with all these age-related changes, they vary considerably between individuals. It’s very important in this older population to create a safe environment in the home, with handrails, good lighting and safety measures related to stairs. Balance rehabilitation with a physical therapist or vestibular therapist can be very helpful. People with some progressive neurologic diseases, such as Parkinson’s disease or ALS, will usually have balance dysfunction as part of their disease, although it’s usually not the first initial symptom.
Fainting
Faintness or a sense of fainting can also be associated with multiple causes, including postural hypotension as noted above, and certain medications. Beta blockers, which are commonly used blood pressure medications, prevent the development of high heart rates. When getting up quickly, people who take blood pressure medications cannot increase their heart rate to maintain their blood pressure and may feel faint. Neurologic disorders can also result in fainting. Fainting is not caused by the ears and should usually be evaluated by a general medical doctor.
There are very few life-threatening causes of vertigo or dizziness if balance symptoms are the only symptoms. Although some patients with vertigo are concerned initially that they may be having a stroke or a brain tumor, that’s rarely the case without other neurological symptoms. In fact, most guidelines now do not recommend a CT scan or MRI scan as the initial workup of dizziness, even in patients who come in through the emergency room.
The bottom line is that if you have dizziness or vertigo without other symptoms, you don’t need to worry that something bad is going to happen. There are, however, things you can do to treat your symptoms. The ears are sensitive to salt, so a low-salt diet can help. Balance problems are both more common and worse in people who are obese, so diet and weight loss can help too. The balance system also has a remarkable capacity to adapt to changes in the environment. People who are physically active and in good shape have fewer problems with their balance, and they get better quicker after having a balance disorder.
So, go out and enjoy practicing your favorite sport. Maybe hit a few golf balls!
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You’re Feeling Dizzy. Should You Be Worried? originally appeared on usnews.com
