Getting Specific About Dizziness

People use the word dizziness when referring to lightheadedness, unsteadiness, motion intolerance, imbalance, floating or a tilting sensation.

Comments: 170

  1. I have found that wearing progressive lenses and, say, nodding in response to something someone has just said, can provoke a momentary dizziness. Or looking at the person with whom I'm conversing and then seeing someone else's face in the distance. Another reason to dislike cocktail parties.

  2. And another reason to dislike progressive lenses. I gave them up shortly after getting them, when I went hiking and discovered that the frequent looking up and down on a trail triggered dizziness - mild, but constant under the circumstances and therefore unacceptable.

  3. There is a solution (I was a sufferer too). You have to learn to move your head to look through your glasses at a different distance. Don't just move your eyes. Tilt your head. Your eyeglass shop can show you what I mean. My problem occurred while driving. I was not moving my head up and down to change from looking at the road to looking at the dashboard, or out at the rear view mirrors. Got dizzy because I was shifting from one correction to another suddenly.

  4. If vertigo is episodic and associated with tinnitus ( ear ringing) or hearing loss Meniere's disease must be considered.

  5. As well as Vestibular Migraine.

  6. Thanks for the tip. I get "regular" migraines so have to check it out.

  7. I don't like when doctors frame the problem like this: "Patients are generally nonspecific in describing their symptoms." I went to the ER in 2013 with intense dizziness and a brief headache and an uneasy/anxious feeling. By the time I was seen, I felt nearly back to normal, but I did go into detail about my dizziness (feeling like I and/or my surroundings were rocking back and forth -- experienced while seated, an hour or so after eating). The doctor was in a hurry to treat me and move on. I don't think he took detailed notes -- just enough to bill my insurance. He did a basic exam (no blood work or follow up tests), said I had a tension headache, and advised me to take ibuprofen. Fast forward to 2015, and I was diagnosed with type 1 diabetes. I now know that my first major dizziness episode was a result of high blood sugar -- now a familiar feeling/symptom. I know healthcare providers don't have time to spare, but please give patients more credit in their ability and willingness to explain their symptoms in detail. This is a systemic failure and not a patient shortcoming.

  8. As a current medical student, I completely agree with you. This responsibility falls on doctors, not patients.

    That said, the emergency-room physician you saw should have emphasized that his/her job is to keep you alive in the immediate future, not provide a detailed diagnosis and treatment plan with ongoing follow-up and monitoring. The emergency room is not the place to get ongoing medical care; you MUST follow-up with your primary care provider no matter how nonchalant an ER doctor may seem about your symptoms.

    In a perfect world (one with Medicare-for-all), the healthcare system would have assured you were followed by your PCP after your initial (and thankfully uneventful) ER visit. Until then, most people who don't work in the "system" sadly will receive fragmented care.

  9. I had 2 attacks of acute vertigo in he 2 years before having surgery for my vestibular schwannoma (acoustic neuroma), and none in the 40 years post-op.

  10. Vertigo can be the first symptom of vestibular schwannoma, and in such cases, so far, I have found hearing loss follows within 1 year. Obviously, there's a first time for everything, so there may be a person somewhere in the world who has gone more than 1 year with a schwannoma causing vertigo and no hearing loss--I haven't seen it though. The person with a tiny, early schwannoma may first become aware of a problem because of trouble understanding whispered or other quiet speech.

  11. It is so important to bring dizziness to a higher level of awareness, especially among older adults where falling often leads to one of life's major degrading consequences, broken bones and long rehabilitation.

    I wish Jane's article would have explored the many ways that you can take some degree of control over the growing inability to maintain good balance as we age. This includes muscle strengthening, Tai-chi and other balance-improving activities. It also means making your home safer with accessories like bathroom grab-bars, removing or stabilizing area rugs, etc.

  12. Also what causes dizziness and hearing loss, is an acoustic neuroma. To learn more about this type of brain tumor, go to the ana.org(Acoustic Neuroma Association). Our son was diagnosed with this type of brain tumor and it grew on his balance nerve. He was working and living in CA at the time in 2008. He was specific with describing his symptoms to the ENT in 2007 when living here on the east coast and was told that it was allergies and to take Allegra. He went to the ENT in CA and again was specific with describing his symptoms,the CA ENT orders an MRI on 2/20/2008. Ou son calls us on 2/21/2008 with the news, we flew out on 2/23 from the east coast, drove to Los Angeles on 2/24 which included his girlfriend and met on 2/25 at the House Ear Institue for consultation with Dr. Derald Brackman and his collegeas at 7am. I will never forget how we were told, we had no other options, there was no time for a 2cd opinion and that the tumor was so big, he had 2 months to a year to live. He went into surgery at noon and was in ICU at 11pm that night. His right balance and hearing nerve was sacrificed. His facial nerve was "jarred" as Dr. Schwartz put it to us but remained intact. They saved his life. He is now 32 years old, married to that wonderful girlfriend for 6 years and are parents to a beautiful baby girl.

  13. I am happy for you that your son's story has a good ending. Thank goodness for the gruff but excellent doctor he found in California.

  14. A bit surprised they didn't check for an acoustic neuroma sooner. I was checked for that with an MRI as part of my work-up for Meniere's disease, my ENT considered it standard to check for it. Glad that it came out OK, quite a scare!

  15. It was the CA ENT that was looking into the Ménière's disease and ordered the MRI as part of his work-up. The east coast ENT was not at all helpful or professional. His case was first sent to Stanford University School of Medicine. He was to meet with the doctor in two weeks. His medical information was sent ahead, our son received a phone call from that doctor telling him he needed to be in LA on 2/25 and meet with Dr. Brackman. The comment on his MRI, "WOW!!!! Giant Acoustic Neuroma!" It grew from his right side and was encroaching to the left side of his brain. It was wrapping around the base of his brain(deafness in his right ear, dizziness, partial facial paralysis and now breathing issues). We were at the time visiting relatives in SC( we live up north). We had to call our 15 year old son at the time and tell him the news. We had to tell him we did not know when we will be home again. My parents were living with us at the time. My Dad had Alzheimer's and Parkinson's and it was through the great support and help from our neighbors that got our younger son and parents got through this crisis. Getting on that plane on 2/23, I asked my husband, would this be consisdered our journey. His response, " no, our nightmare".

  16. You fail to mention that the Reply Maneuver makes you dizzy to reposition the stones.

    You must get dizzy to correct the stones which may be a frightening experience to sensitive people.

    There is no 100% guarantee the stones will always fall in the proper place in the ear which may exacerbate the dizziness.

  17. I suspect you mean the "Epley" maneuver for BPPV (mentioned in the article) which is most often done by physical therapists specially trained to do the movement who are referred by an Ear Nose and Throat specialist or an aware internist. Getting the name correct and finding the right PT person is very important. The therapist can also give at home exercises to prevent future problems, but many people do have more than one episode. The first diagnosis of BPPV can take months if testing is thorough to rule out tumors or other serious problems. There is considerable information about BPPV available on medical sites to answer questions.

    My first BPPV episode started when I turned over in my sleep. I thought I was having a heart attack from the symptoms. I would not have been so afraid if I had been aware I was in an age group at risk for this problem. It took time to go through my internist to a ENT specialist to a Balance Center to a PT until the symptoms were relieved. Great medical care, but appts took time.

  18. A well educated and competent ENT doctor or neurologist should be able to do the Epley procedure. It is described in the Merck Manual.

  19. Anybody can do the Epley maneuver. You can learn to do it yourself. It's quite simple. You don't necessarily have to visit a specialist (I'm a cardiologist) or a physical therapist.
    Incidentally, I was struck by Jane Brody's initial reaction. A strange and scary symptom led to an internet search, and she was reassured when her symptoms fit an obscure condition. She was sure that was it. Ah, medicine in the 21 st century. Trying to figure out your diagnosis yourself by internet is fraught with difficulty and can be dangerous.
    I agree with the other physicians who have commented. It's important to be a good historian and a good physician will patiently attempt to use that history to tease out an accurate diagnosis and hopefully a helpful therapy. History is usually 90% of the diagnosis.

  20. Many medications list "dizziness" as a possible side-effect. It can be difficult to treat one's symptoms when the cause is a drug one needs to take. Most people who have never had serious issues of "dizziness" from whatever cause find it hard to understand how much it can limit normal activities such as walking, driving, bending over for household tasks or childcare. In many cases it can take months of testing to determine which type of "dizziness" one has and whether there is any relief for the symptoms. In the meantime, falling is a real risk as are accidents with cars, tools, household appliances.

    The variable nature of "dizziness" which can be affected by exercise, light, stress, vision changes and many other factors can often make those who suffer episodic "dizziness" feel as if their health care providers think they are making every symptom up since reproducing some symptoms in an office or testing situation is not always possible. BPPV with its eye movements is often such a relief as a diagnosis!

    Dizziness is a serious symptom which needs health care providers to take seriously when evaluating and treating a patient.

  21. The article fails to mention Vestibular Migraine that also presents with vertigo and dizziness, which does not respond well to the Epley maneuver, but rather should be reviewed and treated by a neurologist, who specializes in this particular variant of migraine.

  22. I have this...it had been a long and frustrating process to get this diagnosed. I've suspected migraine was the cause for the past year, and finally found someone to treat it after being told by multiple Doctors that it was so rare there was no way I could have it, that if I did have it I was no big deal and there was no point in treating it etc. I finally got a referal to a migraine specialist by lying to my G.P. and telling her that another specialist had told me to have her send me there. The migraine Dr recognized my symptoms right away and a put me on a calcium channel blocker...I totally have my life back after having a vertigo attack every day for the past 30 months. More people need to know about this condition

  23. This is true, though I would add benign paroxysmal positional vertigo (BPPV) seems to aggravate vestibular migraine. After successful treatment of BPPV with Epley maneuvers, vestibular migraine symptoms may abate.

  24. Not mentioned is another cause of vertigo, Meniere's Disease. I've had occasional bouts of it since my early 20's, now have increasingly severe tinnitis, and suspect that I'm losing some hearing in one ear - another related complaint. In my case I suspect( but don't know for sure) it was related to allergies, and possibly once frequent bouts of strep.

    In the past you've written about Normal Pressure Hydrocephalus, which causes balance and coordination problems but may or may not cause sensations of vertigo per se.

  25. Some hearing aids have a setting for tinnitis . And thre is supposed to be a program of low sounds which is also supposed ot halp with tinnitis. Asprin is supposed to make tinnitis worse.

  26. I've had it periodically for the last 12 years. During one episode I couldn't sit up - I could barely move because the vertigo was so severe. It's a horrible feeling to have the room spinning around you and there's nothing you can do to stop it. I've learned to live with it and I can now predict when an attack is coming on. Wish there was a cure but unfortunately there is not.

  27. You omitted to mention the half somersault (has been the subject of an article) as an alternative to the Epley Maneuver for BPPV. It is easy to do at home and seems to be as effective. The instructions are this article.
    https://www.karger.com/Article/FullText/337947

  28. Brilliant! I'll have to remember this one if mine ever comes back.

  29. Had episode of loose calcium particles after a day long gardening task where I was on hands and knees with my head down. Lasted for several months and was put on daily meclizine (same stuff as non-drowsy dramamine.) Could walk and stand upright but tying shoes was impossible. Really disturbing at the time not to know how long it would last or if it might be Meniers since there was (is?) no test. Think the Eppley maneuver also works on calcium crystals.

  30. When doctors say loose calcium particles in this context, they almost certainly mean benign paroxysmal positional vertigo (BPPV). For "garden variety" posterior canal BPPV, the Epley maneuver is highly effective (sorry for the pun--couldn't resist).

  31. "Patients are generally nonspecific when describing their symptoms. They should spend some time thinking about their symptoms before they see the doctor."

    Singularly unhelpful. When a history is difficult, communication lapses are on both ends. Yes, docs are taught to try to distinguish (broadly) between vertiginous/unsteady dizziness and fainting/lightheaded dizziness. When they very carefully listen for keywords of one category of dizzy? Later on the category can change.
    Very HELPful in the article? Attention to time course, waxing/waning, and onset. Descriptors are more misleading than useful.
    https://www.ncbi.nlm.nih.gov/pubmed/17976351

  32. I have had a few bouts of dizziness and here is how I dealt with it, a very low tech and non-medicinal way: sitting upright, use your head to trace the alphabet in the air, I use capital print letters, but one can choose lower case or cursive. I did this several times a day and in a couple of days, the dizziness was gone. When I remember, I repeat for maintenence. Easy to do at your desk or even when waiting at a red light. It might work for you too.

  33. Very interesting. Does anyone know why this would work?

  34. In New England, it might earn you a traffic stop. Ciao bella.

  35. If you take the counsel offered in this article, think about your symptoms, and describe them as specifically as possible to the doctor, he will write you off as a hypochondriac crank. OTOH, if you just go in whining 'oh please doc, it huuurts', he will write you off as an idiot. However, you are probably better taking the latter approach, since it does not risk damaging the ego of the M. Deity.

  36. I started having week long bouts of dizziness after moving to a country that is more northern with less hours of winter light. When I returned to the US, after 15 years, I was diagnosed with extreme low levels of vitamin D. After getting those levels back to normal, I haven't had an episode since. I'm not sure if there is science to back this, but it certainly seemed to help.

  37. Vitamin D deficiency reportedly is associated with benign paroxysmal positional vertigo (BPPV). We don't know whether taking vitamin D prevents BPPV, but you have to wonder.

  38. Based upon my experience, it does not. I have taken 5,000 IU of D for years and still got BPPV.

  39. I have had balance issues off and on for some 10 years. I recently found an organization that is a clearing house for information on various types of "dizziness" and balance problems. They publish a newsletter and refer people to health professionals and therapists who will take these issues seriously. When I called their hotline I found them helpful and knowledgeable about treatments across the country.
    http://vestibular.ong/about

  40. If you feel like you may fall, broaden your base. Place your feet at least a foot apart and bend the knees and keep the back straight..a temporary stabilizer...and find something to hold on to if possible.. Also there was a good article in this paper last week about how to fall. Fall on your fattest parts.

  41. I lost my hearing 5 years ago because of an ear infection. Nearly all the equipment in my inner ears was destroyed; I had surgeries to replace my ear drums with grafts; and my balance was severely compromised. I live with both tinnitus and "auditory hallucination." Nevertheless, I manage to hear fairly well with one hearing aid and a bi-cros device, and I do not experience vertigo or dizziness. I had hoped this article would help me define a distinction between dizziness and imbalance, but it seems to conflate the two instead. While imbalance is an obvious result of dizziness, in my experience imbalance exists independently. I walk sometimes with a cane, sometimes without. I use trekking poles for extended walking. And I take two weekly classes in Feldenkrais (Awareness Through Movement), a practice that, to oversimplify, retrains the brain to connect with the body in new ways to enable movement and enhance safety. The classes help greatly, but the condition is permanent. I am frequently frustrated by having to explain my situation (particularly to a health insurance representative who insisted that I have dizzy spells--no, I don't). I wish the distinction could be made more explicit. Oh, yes: I will be 80 in May 2017.

  42. Yes, people have told me Feldenkrais seemed to help balance. The current ICD-10 classification of diseases doesn't do a great job of making distinctions such as those you describe. With insurance companies, I'll sometimes use the term "abnormality of gait" which they may consider to differ from "dizziness."

  43. Glad Ms. Brody recovered from her dizziness attack, and she even found such had a name, namely "postprandial hypotension".

    Unfortunately, dizziness may be confounded with something else, something where that prefix hypo- might be deadly.

    When a person with Type One diabetes has his/her blood-glucose level drop too low (typically under 40 mg/dL), the person may appear dizzy but, using Ms. Brody's words, "the brain is relatively deprived". If the person's BGL drops even more, the brain will become even more deprived, in which case the person may no longer be able to help him/herself, and without help from someone else, death could be imminent.

    Hypoglycemia is extremely serious, and should you notice such symptoms in someone slowly stumbling in the street or elsewhere, forget about wasting time by first calling EMS and quickly get some sugared soda or juice for the person to drink, which usually leads to an instant recovery and reorientation for the person. (Of course if such is not the case, then call EMS while still giving the person more sugar.)

  44. It should also be noted that dizziness may be related to beginning to take a new drug, or an increase in the dosage of a drug already being taken. Interaction between drugs can also produce dizziness, so reviewing any changes in drug therapy is an important early step to take in determining causation.

  45. Excellent point. Some meds do list dizziness and blurred vision as side effects.

  46. I believe this is what caused my vertigo. Oral surgery mess clindamycin and prednisone. Symptoms have pretty much gone away as the drugs leave my system. St but going to ent dr to get evaluated

  47. "Patients are generally nonspecific in describing their symptoms. They should spend time thinking about their symptoms before they see their doctor."

    Dr Kerber's bedside manner leaves a lot to be desired. He is not a doctor I would want to visit. Of course patients are vague and do not use specific medical terms, they are not doctors. Why can't he just ask specific questions of patients and zero in on what the problem may be.

  48. I felt much the same as you. The questions he asked were easy enough to understand and answer. With a modicum of patience and attention, he could get the info he wants and actually see and hear the person he's examining. For many of us, that would be novel, and welcome.

  49. I don't give a hoot about bedside manner. The latter has no relationship to outcome. I just want the best sleuth for a diagnostic problem and the best pair of hands for surgery. Brusque is fine with me.

  50. Asking specific questions and zeroing in is why lawyers depose witnesses and parties in litigation. Lawyers have that duty to perform. I have never met a physician who did not think he or she was smarter than every lawyer. If doctors are smarter, they need to act smarter, zero in and do their duty. Good doctors perform their duty. Full disclosure: I much like physicians and personally have not had a complaint, but I understand what I read.

  51. I had a birth control implant in my arm -- Nexplanon or Implanon or whatever you call it. I was lightheaded-dizzy for two consecutive years while trying to raise two children under the age of 4. I had to sit down in between chores, especially if I was bending over to pick stuff up off the floor, something a person who is raising toddlers has to do 50 times a day. Eventually I had it removed and the dizzyness went away.

  52. As one who experiences dizziness and loss of balance frequently, I found this article very useful. Thank you.

  53. Sure,
    Ask your doctor, Ablemofol, Piaxatrim, ask your doctor. The stock needs boosting according to the hedge fund guy and you have payments on that new summer house. It will eventually eat away at the guys liver but thats what lawyers are for. Plus big Pharma will put you up in the Bahamas for a long weekend. Medicare will pay. Ask your doctor is Ableximen is right for you. And now cut to people doing yoga in the park on a sunny morning. My right pinky nail grows faster than my left pinky nail, is there a drug for that?

  54. Hater, the drug companies, who care about your well being btw, are only showing you that if you follow their advice you too can move around in slow motion and once more be a regular person. But you go ahead and suffer with irritable bowel syndrome or worse if you and your wife get the notion to drop down in the park and do it you could find yoursel having to go pee first.

  55. One important distinction is whether you are suffering from vertigo or dizziness. Having experienced both, I can affirm that they are very different.
    With dizziness, you feel unsteady in a stable world. You walk like a drunk. You have to hold on to things to remain standing. You can’t walk in a straight line.
    With vertigo, the world seems to spin around you. Most people not only can't walk in a straight line but also can't even stand up. True vertigo is often accompanied by nausea and vomiting. It can be a symptom of Meniere's or of migraine (without a headache), in addition to many other conditions.

  56. In my experience, B.P.P.V. does not usually respond to the Epley maneuver. Unfortunately it is only effective in a minority of patients.

  57. The reason you did not find the Epley helpful may have been because it was the wrong treatment for your condition The purpose of the Epley is to get debris out of your posterior semicircular canal, which is the most frequent cause of BPPV. However, BPPV can result from debris either in the superior or horizontal semicircular canal. If that is the case the Epley will not be successful, and different procedures are needed.
    Seeing a Physical or occupational therapist who is certified in Vestibular Rehabilitation can help you to determine this and get suitable treatment.

  58. It's worked for my BPPV (for which I am deeply grateful!), though, when I've had especially severe, long lasting bouts of vertigo (occurring throughout the day for months), I had to seek further treatment by a physical therapist (as prescribed by my physician). The PT involved more complicated maneuvers, and ongoing exercises. It might be worth a trip to your doctor to get a prescription for physical therapy. It took some time, but it did help me, and it gave me some additional tools for resolving vertigo when it recurs (my experience is that the sooner I treat the shorter the bouts).

  59. I've had vertigo twice in the past eight years. The first time, due to the nausea and vomiting, I figured it was some sort of food poisoning although I'd never, ever experienced my head spinning like that; I lay down with my head hanging over the end of the bed for ten minutes, and when I got up, I felt much better ( a sort of faux Epley maneuver.)
    The second time I woke up in the middle of the night and felt my head spinning even in the darkness of the room. The feeling continued through the morning, getting worse and making me nauseous (vomiting, etc.) - I really believed I might be having a stroke; if it hadn't been for that first experience, I would have had someone take me to the ER. I googled 'vertigo' instead and found the Epley maneuver. I couldn't look at the video long enough to follow the instructions, so I asked my partner to tell me the proper movements. I went through the sequence (about four minutes in all) and sat up. Vertigo gone! I might have mischosen the correct side, the correct ear and had to do it a second time, but considering the little amount of trouble and time involved, the result was very, very gratifying. And immediate. Definitely worth a try.

  60. Another cause of dizziness is the relatively unknown Mal de Débarquement Syndrome (MdDS). I got off a cruise at 8 am, by 2 pm I thought I was having a heart attack &d wound up in bed unable to focus for 2 days. A chance meeting with someone whose sister had the same problem yielded the diagnosis. After 3 months of tests (that cost $$$$), the doctors finally agreed that it was MdDS & sent me for vestibular therapy where I was finally able to get the symptoms under control. There is no cure & no way of knowing if it will ever come back. Now and then the symptoms return & I have found that standing against a wall, preferably in a corner, feet planted firmly on the ground, eyes closed can make it stop. Something about my eyes, ears & brain getting in synch. It will also work in a chair, but your feet have to be flat on the floor.
    Also, for years before this incident, I suffered off and on from vasovagal synocope, brought on by overeating or heat or moving from one temp to another. I have found these episodes are always accompanied by what appears to be an extreme spike in body heat. Once I feel that, I know what I need to do: lie down, feet elevated, cold compresses on my forehead and neck. If I can do those things, I can stop the fainting.
    The worst part of these and the other problems described in the article are that they are mostly dx’s of exclusion - it takes a lot of time and expensive medical tests to figure out what is really happening and it’s very frustrating.

  61. Some people with MdDS also have other types of dizziness or problems with balance. For example, you can have a broken bone from a skiing accident and osteoporosis. While, it's common for MdDS to go unrecognized by doctors, a related problem is that doctors may accept a diagnosis of MdDS and overlook other recognizable disorders that may be playing a role.

  62. Thanks to this article I have self diagnosed myself with benign paroxysmal positional vertigo.

    I work in a job where I am constantly staring at multiple computer screens and combing through fine lines of data and reading at length. I often experience "dizziness" and lightheadness frequently in the late afternoon. The episodes are rather brief and last only a few seconds but are truthfully unsettling especially for one in their early 20's and considered to be very healthy.

  63. Those symptoms don't sound like vertigo to me. Perhaps eye strain, or low blood sugar, but not vertigo. I, too, stare at computer screens all day and attend to fine lines of data, so hear your pain. However, vertigo isn't lightheadedness - vertigo is a sensation either that you are spinning or that the room is spinning around you. It's impossible to stand or remain upright when it happens, and, at least for me, it causes nausea and lasts for much much longer than a few seconds. I'd investigate other causes.

  64. I have had vertigo problems since I was a child. It wasn't diagnosed until I was in my 30's. After the tests I could barely get home and spent the rest of the day on the bathroom floor. I also have terrible motion sickness from types of movement in cars, in airplanes, etc. I have to take Zofran to get through a flight. Previously if I was on a flight and there were extreme movements of the plane I would periodically black out. I have had an extremely large percentage of medications or anesthesia cause violent unbearable nausea and vertigo. After surgery I have had to go off all pain relief. I have heard doctors say if they have ever experienced it that they would rather have pain than the violent vertigo a drug can give you. It can rule your life.

  65. Vertigo is one of the most horrible medical issues I've had---unpredictable, debilitating and induces a kind of brain fog---and I've had cancer and other ailments. It has not shown its ugly head for a 1.5 years and I'm hoping never comes back!

  66. I'm somewhat surprised there has not been more mention here of the unsteadiness that naturally seems to creep up on most of us as we age. In my Silver Sneakers exercise class, a significant portion of our efforts are spent to preserve or improve our balance. When you watch a room full of old people trying to balance on one foot, it is pretty obvious most elderly have balance issues.

    I find if I turn my head suddenly, my unsteadiness can become dizziness. If you find yourself paying much more attention to the acquisition of non-slip soles on your shoes, and being careful to reach out and hold onto bannisters, you may be getting old and experiencing age-related unsteadiness.

  67. Great article. If you tell your doctor that you have dizziness, and your doctor does not ask you, "are you dizzy (room spinning) or are you lightheaded (really want to lie down)" then you should talk to another doctor. It's good for the patient to know the difference, but it's really up to the doctor to be sure about what the patient is describing. Some causes of lightheadedness are vitamin B12 deficiency (particularly a problem for older vegetarians unless they supplement), mineral deficiencies (can be common in countries where purified bottled water is used), and air pollution (really common in many places in China, and in some cities in Southeast Asia). Again, the dizziness vs. lightheadedness distinction is so important. Thanks for the article.

  68. Note - B12 deficiency occurs in older people due to less ability to absorb it from food, easily rested for and easily treated with shots and/or sub-lingual supplements.

  69. Yes--despite being a health blogger for more than 10 yrs and a former reporter for WebMD, guess what--I have a B12 defiiciency...it happens evenif you think you know what's what.

  70. Having been one of those patients, I was told that there were 59 different things commonly referred to by patients as dizziness. Later, a neurologist read me the riot act for saying "dizzy" instead of "lightheaded". Patients use the word as it is used in the vernacular, and doctors should just get over it. It isn't up to the patient to study up before going to the doctor, most neurologists will hit the roof if you mention that you looked up anything on the internet anyway.

    Rather doctors should develop their own strategy for doing a differential diagnosis. When a patient is unresponsive do they believe that the patient should "spend some time" regaining consciousness before seeing their doctor? Maybe doctors just need to lengthen their appointments and talk to their patients a bit more. It takes so long to get appointments in some offices, they also have plenty of time to send out a questionnaire that tells the patient what information they want collected.

  71. My observation -- backed up by personal experience -- is that patients who present with complaints of frequent dizziness/vertigo coupled with the pre-existing condition of being female (especially if they are older than 45) are most often met with dismissivness, a pat on the hand, and an exercise instruction sheet. Men get an MRI. I experienced severe vertigo and other varieties of dizziness for a couple decades before a few bouts of temporary loss of vision "earned" me further attention. Turned out I'd had an ischemic stroke years earlier -- clearly evidentbon the MRI views -- the symptoms of which had been ignored by doctors.

  72. In fact, a woman doesn't even have to be middle-aged to be dismissed with a pat on the hand if she's exhibiting symptoms that are hard to quantify. When I was 23 years old, I had an attack of dizziness that lasted several weeks. I was told to rest, asked if there was some emotional disturbance in my life (I had been married about a month); seeing a specialist was never mentioned. The doctor did no tests at all beyond checking my blood pressure.

    Finally a friend recommended an ENT doctor, who immediately diagnosed labyrinthitis. The drug he prescribed, meclizine, didn't help -- I later found out that it's used for motion sickness and isn't effective if you have vertigo without nausea, but it was then and may still be the only game in town for vertigo sufferers -- but at least I had finally been taken seriously. I think that experience in 1969 was among the factors that made me a feminist.

  73. Peaches, Yes doctors are often dismissive of female patients complaints. For more than 3 years a woman friend who suffered severe headaches, chronic, incapacitating dizziness, bad taste and smell, begged her doctor for an MRI. He scoffed and finally ordered the test. She had a brain tumor that had grown around a major blood vessel and could only be partially removed.

  74. On the less serious end of possible causes for dizziness I would add dehydration. I experienced this myself a few weeks ago for the first time and it completely disabled me. Now that I have experienced it, I know the earliest symptoms which I had easily overridden before. Now I drink twice as much water; it is still not the volumes recommended but it has made a difference.

  75. I have, a theory based on my family: the people in my family who experince dizziness, vertigo, motion sickness, and fainting all have one thing in common: they are the migraine sufferers. The ones who have never had the above dizziness, and other symptoms, have also never had a migraine. Perhaps there is a connection?

  76. Carol, I agree about the migraine connection. While I've had an injured ear in which I've had ongoing tinnitus the extreme vertigo I experienced for about 2 years seems connected to migraines. Vertigo with me can last up to 3-4 hours and then about 3 days of brain fog and headaches.

  77. good question. I have serious vertigo episodes and migraines. my mother has the vertigo but never has had migraines. love to find the research

  78. I had vertigo as a child, I'm a fainter but I've never had a migraine.

  79. I went to a Neurologist after going to Primary, then Ear Nose and Throat doctors. He did a series of tests and questions and diagnosed me with Vestibular Migraine with Vertigo. I am on Depacote and haven't had a major episode since. I sometimes get a little dizzy, but NOTHING like the nausea and dizzy spells I used to get for 3 years off and on every couple months. Not for everyone, but suggesting a D.O. Neurologist. Good luck if you have it-its awful!

  80. Interesting article! I've had tinnitis for about 25 years, hearing loss treated with hearing aids for 20 years. About 7 years ago had my first bout of vertigo. Very disconcerting! Thinking a stroke I went to the local ER. The Dr there did a few tests, explained the calcium bits and sent me home as I was getting better.

    Next episode was last year. Felt like I'd been hit with a baseball bat, totally wiped out dizzy. Unable to stand or walk. After a few minutes started vomiting, that last 30-40 minutes. (Absolute worst time of my life.) Then lay flat on my back for 5-6 hours. Eyes jumping to the right continuously, stayed in bed for 12 hours. Next day started to feel better, but still feeling a little sick. After 4-5 days back to OK. I had these episodes every 3-4 weeks for 4 months. GP had me do an CAT scan, no problems. Did Physical therapy, eyes and Epley maneuver. Now 6 month later it's settled down to 5-6 times per day I am dizzy, unsteady on my feet if I stand still, and need to do Epely 3-4 times per day. Not sure what happens next, I figure best case scenario is I'm getting a walking stick and doing Epley's for the rest of my life. Oh, and keeping myself well hydrated seems to help.

    The article is nice, I see I'm not totally unique and that there are possible names associated with this condition.

  81. It's very difficult to keep track of the episodes when the circumstances are different each time, and the episodes are infrequent--say, twice per week, at different times of the day. And as I write this, I suddenly developed a piercing headache, change in vision, and spasms in my eye. This has happened on other occasions, and I forget to tell my doctor about them.

    And now my heart is pounding, so I need to sign off. The acute pain has dulled, but I now want to lie down for a bit.

  82. I can add another vestibular disorder - Superior Canal Dehiscence Syndrome/Disorder. It can cause imbalance, rocking sensation, lightheadedness, tinnitus (pulsatile, rining, hissing), ear pain, an ear fullness feeling, hearing loss, autophony, hypercusis, oscillopsia, intense fatigue, brain fog and more. It's awful. And yet, to all outside appearances you look normal.

    I have bilateral SCDS. Had surgery on one side at Johns Hopkins which helped a great deal. Now the symptoms in the other ear are ramping up.

    You have to adapt to it. That lesson took me years to accept as I kept trying to push through it all.

    I agree with the other poster - vestibular.org was quite helpful to me too.

  83. When I turned 64 in 2000, I was advised, ordered by my VA doctor to take Atenolol to lower my blood pressure. While I had been told by doctors that I had high blood pressure since I was about 20, none of today's medications were available. But I was very active as a young fellow and never felt anything was wrong with me. And I felt fine running, pumping iron and keeping up with my dogs and my wives. But then in 2000 when I started taking Atenolol I began to feel dizzy, etc., and even had an operation to determine that I had no arterial clogging. But as time passed I continued to feel dizzy. In 2009 I had a stroke, could barely walk, talk, or think. And then in 2015 I had a "heart attack", no pain but I was lying on my kitchen floor unable to get up, like the lady in today's TV commercial. After a lot of reading and thought it occurred to me that lowering my blood pressure with Atenolol might be keeping my heart and my brain from getting all the blood they needed when they needed it. And so I read on the subject and saw that many people my age who were lowering their blood pressure were suffering from the same stuff. And so I stopped taking Atenolol, went cold turkey and kept up my exercise program of walks, hikes, pumping iron and doing chores. Gradually the dizziness abated and now I feel much like I felt before I started lowering my blood pressure, and no strokes or heart attacks. So call your doctor and ask about those blood pressure pills. Maybe you don't need them.

  84. Atenolol is a beta blocker--slows heart rate. Sounds like you did have a bad time with it. I think the blood pressure "normals" for older people are being raised. I like to think the blood needs to get to the top floor,

  85. Stress. Effect on adrenal glands. Dizziness indicates adrenal function decline. Read an old, outstanding, out of print book entitled "Let's Get Well", by Adelle Davis (1965). In it, learn the symptoms are as readers describe. To neglect the symptoms will result in further adrenal function decline and seemingly unrelated serious medical "diseases" until one feeds the adrenals the food it needs, in ever-increasing quantities because they (2 adrenal glands; above the two kidneys) rob required nutrients to feed the adrenals from wherever they are stored in the body if they are not replenished by food or, better, high quality (organic) nutrient supplements (to get the mandatory higher dosage after long neglect; and because most highly processed, not-organic foods are nutrient deficient now). In early stages, salt intake should be reduced. The adrenals and body (all cells) MUST have pantothenic acid (vitamin B5) and C. Requirement for C is "tremendously increased by stress". If, instead, the nutrients the adrenals require continue to be deficient, they will also require higher dosages of vitamins E, A, D. Magmesium is also essential for adrenals. Essential fats as well. Linoleic acid. As Davis writes, "a slight deficiency (of the above) can limit hormone production and cause a degeneration of the adrenal cortex". Again. Read "Lets Get Well". It will literally save your health!

  86. Dizziness is a hard one; I had periodic spells of dizziness and lightheadedness that grew worse between the ages of 38 and 53. I felt like the floor was tilting; it made me nauseous. Sometimes a quick spin of the head resulted in my tipping over. And my vision was affected -- I had jittery eye movements that I could not feel but that others could see. I just knew that my eyes got tired easily. After one episode of dizziness, I was rushed to the hospital and told I was having a panic attack. Another time I drove myself to the ER and passed out in front; I was diagnosed with vertigo and given meds (that didn't work). At a later time doctors said I had vestibular issues without fully testing me. Then in 2015, the dizziness got worse and I felt like I could tip over any time I turned my head. I was taken out of the subway by ambulance after laying down and not being able to get up because the whole room was spinning. ~An MRI showed that I had a chiari malformation, a crowding of the cerebellum that had been there since birth but worsening as I aged and my posture changed. The cerebellum was pushing down into my spinal column and crowding the brainstem, causing visual disturbances (nystagmus), dizziness and nausea. Left untreated, it would likely get worse and could affect nerves in my neck and arms. In 2015 a very good surgeon performed a decompression surgery, removing part of my skull and replacing it with a patch. I haven't been dizzy since!

  87. I have both Menieres and a chiari malformation, and I am fairly certain that they are related. One of my siblings also has a chiari malformation and has some Menieres-type symptoms. The Menieres has left me mostly deaf in one ear and with constant tinnitus in that ear, but the violent attacks of vertigo went away after about eight years. The chiari malformation is type 1 and I don't need surgery for it.

  88. thanks for the info. i think i learned about BPPV hey i think i may see my doctor cause this article stated things i have been experiencing for years.

  89. I was sitting at my computer, eating a salad, when I suddenly felt intensely dizzy. I blacked out, probably for only a second, and when I woke up, the hand holding the fork was jumping around so intensely that the fork flew out of the salad bowl. I looked on the internet and concluded that I had experienced an episode of syncope, but my family doctor insisted it was petit mal (epilepsy). It took nine months before I could see a neurologist. After hearing what I had experienced, she immediately said syncope and was shocked that the family doctor had misdiagnosed it. She sent me to a cardiologist and after a stress test I was told that I had probably been dehydrated and to make sure to drink plenty of water, which I now do, religiously. I changed family doctors. The difference in presentation between petit mal and syncope is so obvious that I can no longer trust his competence.

  90. Several years ago I has episodes of dizziness when I stood up. Went to my GP who sent me to a neurologists who sent me for an MRI. His conclusion? Get more exercise.

    Now I was mid-fifties with an above average physical activity level and about average weight. The neurologists just repeated himself and the appointment ended.

    Two months later I was in an ER with sever seizures, which were initially identified as a stroke. Fortunately I was transferred to another hospital where the third Neurologists I had seen in two months finally gave me the correct diagnosis of epilepsy.

    I've been fine since. The moral of the story (which is a subtext of the article regarding patient responsibility), is keep pursuing a reasonable diagnosis. If the first doctor doesn't help, find another.

  91. The introduction to this essay contains food. Over eating. What I'd like to know, speaking of nonspecific, is what kind of food, specifically, was ingested. What's the age of the person ingesting the food, because as we as a nation who eat white flour coupled with fats and salts and sugars creating perfect storms of complex carbos in our systems wonder why we may feel dizzy is a case that is self explanatory.

  92. Thank goodness I first person I saw when I experienced my only every case of vertigo was my daughter who is a physical therapist. I had asked her to drive me to the ER because I thought there was something very seriously wrong. She did a two minute evaluation of my symptoms and eye movements and said "my crystals" were out of alignment. I thought I had wasted all that money on her education and now she was into some crazy alternative medicine thing. I was wrong. She did the Epley maneuver twice that day and vertigo was gone! I have followed her advice about staying hydrated especially when I have a cold and it has not reoccurred. I told someone at work who had been suffering from vertigo on and off for a year. He saw a physical therapist and - magic - all better!

  93. In did not see Ménière's disease mentioned. Ménière's causes a never ending reoccurrence of vertigo episodes (extreme attacks of vertigo that can include vomiting and cold sweats) due to a fluid malfunction and rupturing in the inner ear. This leads to permanent hearing and balance loss as the hair cells in the inner ear are damaged. As well as unrelenting tinnitus at varying volumes. There is no known causes or cure for Ménière's.

  94. Yes, I would have included Meniere's as a major cause of vertigo. I was misdiagnosed with BPPV for a year, during which I had 36 vertigo attacks. Months of Epley maneuvers did nothing until I sought out a vestibular specialist who diagnosed my Meniere's. The only treatment that helped me was steroid injections (dexamathosone) in the affected ear over a period of another year. Although I have lost all my hearing in that ear, and my balance (vestibular) organ is "burned out," I am thankful the vertigo has not recurred.

  95. While it can be useful to refer to Google in reference to chronic medical conditions, it can be dangerous to rely on Google to evaluate acute symptoms.

    While it is certainly possible that the author's symptoms are from "post-prandial hypotension", this is usually diagnosed in people who have recurrent symptoms and a benign evaluation that shows no evidence of cardiac or neurologic origin of their symptoms. If I were the author (or anyone else experiencing new dizziness), I would go to see my doctor (or go to the emergency room if my symptoms were persistent, frequent, or accompanied by chest pain, palpitations, or other serious symptoms).

    Other than that, this is a nice primer for the layperson on the problems associated with the evaluation of "dizziness".

  96. "it can be dangerous to rely on Google to evaluate acute symptoms."

    There are legitimate medical sites with current information: Medscape, Mayo Clinic, Cleveland Clinic and others.

    Google has nothing yo do with it.

  97. " it can be dangerous to rely on Google to evaluate acute symptoms"

    This is important! But I am sure the author of this article is well aware of the importance of checking the accuracy of Interrnet information.

    I have found that online health information found at either the Mayo clinic website or Medline is particularly reliable.

  98. I get dizzy when I am constipated and often that is associated with migraine. Though it's a chicken egg problem not sure if migraine causes constipation or the other way around. But I certainly feel a load on my brain and a feeling of dizziness.

  99. Constipation...load on your brain...Brings to mind a stegosaurus, with a second brain in its hip. (Just trying to make light of the problem, so to speak.)

  100. I was diagnosed with labyrinthitis when I was a child (15). Room spinning, vertical axis also spinning. Horrible and debilitating for 2 weeks at a time, almost always in early spring. Zofran helps.

  101. I was diagnosed with this at the end of last spring. My symptoms lasted about 2 months. What a crazy virus.

  102. Dehydration. I began having debilitation days-long episodes of dizziness three years ago. Drinking lots of fluids is the answer. Ginger helps, too, but water is key.

  103. The Epley maneuver is only useful if the BPPV is due to a problem with the posterior semicircular canal The purpose of the Epley is to get debris out of your posterior semicircular canal, which is the most frequent cause of BPPV. However, BPPV can result from debris either in the superior or horizontal semicircular canal. If that is the case the Epley will not be successful, and different procedures are needed.
    Seeing a Physical or occupational therapist who is certified in Vestibular Rehabilitation can help you to determine this and get suitable treatment.

  104. Timely discussion! How about this: NPH-normal pressure hydrocephalus?

  105. Thanks especially to Robert and Doc below. Rely on the Mayo Clinic online and VEDA or vestibular.org rather than a google spiral that will likely lead to despair about symptoms. I lived with intermittent and terrifying vertigo symptoms for more than 4 years before a curious and kind doc helped me narrow down a diagnosis: Meniere's. This after at least two others doctors provided zero feedback. In the intervening years, acupuncture, rest, walking, and massage provided some measure of relief from physical pain and mental despair. I hope our culture more humanely faces the reality that "being healthy" isn't something that just happens. Unlike many diseases with which we learn to live.

  106. I had a similar experience. It took years for my ENT to figure out the cause of my vertigo, deciding it was menopause of all things. UCSF to the rescue, to this day I take a simple low dose diuretic once a day, no more vertigo from Meniere's!!

  107. I have had maybe two occasions when I felt dizzy after eating, and this column suggests a possible explanation. I had attributed it to excessive coffee-drinking, and I still suspect that too much caffeine was at least a factor. (With caffeine causing heart palpitations and those causing ineffficient absorption of oxygen.) Perhaps someone in the know can say whether this is plausible.

  108. Good column. My dizziness (in which I felt like I was going to black out) was caused by an electrical problem in my heart that stopped my heart from beating, and thus, the blood from circulating. The last time it happened, I did black out while walking. Face plant. Luckily, my heart started up again. My doctor had several theories, but he promptly put a portable cardiograph on me. The next day - problem diagnosed. I quickly had a pacemaker put in. That was 8 years ago. No dizziness since! Great doctor! Great technology! (Good insurance too since I get it at my job.)

  109. I went to two doctors and the ER for dizziness about a year ago. Two doctors said it might be vertigo, the ER said it could be dehydration. It turned out to be Graves Disease, diagnosed a few months later by my Gynecologist. I went about 6 months feeling intermittently dizzy, sometimes while walking, driving, or teaching a class. Very frustrating! My advice is if you have any sort of dizziness, or frankly any other unexplained symptom (intestinal symptoms, fatigue, hair and skin changes, vision problems, hormonal fluctuations, insomnia) check your thyroid! It turns out it controls almost every function in your body.

  110. I had BPPV for about 15 years before going to a physical therapist a few months ago. Why the long wait? My primary physician seemed to have little knowledge or understanding of the condition, merely handing me a pamphlet about doing the Epley Maneuver at home and telling me to learn to live with it, it's not going to kill you. I finally couldn't handle it any more and, on the advice of a yoga instructor who noticed my distress, went to a PT. Because I let this go on so long, it is taking more visits than usual (6 as of this writing) to resolve things but we are making definite progress. My message to fellow sufferers: get yourself to a dizziness and balance PT as soon as you notice symptoms, they will not go away on their own.

  111. People with BPPV--even those who have had symptoms for a prolonged period of time--often experience extended waits before referral for treatment of BPPV. There seems to have been a common belief that if one allows some time, most people with BPPV will spontaneously recover and that therefore, there is no immediate need to perform or refer for treatment maneuvers. I don't agree with the latter concept. Admittedly, I may be biased by seeing so many people who have had adverse consequences, as a result of BPPV going on for prolonged periods of time. I believe the medical consensus on this issue is slowly changing. The jury is out on the effectiveness of paper handouts alone. Instructions from a health care provider on how to perform home maneuvers may be a reasonable option, and paper handouts are a beneficial part of that process. In addition, the use of videos that are freely available online offer major advantages over constraining instruction to the use of paper handouts alone.

  112. I guess that when my grandmother told me not to go swimming right after eating she knew something, no?

  113. To make this short - I complained about feeling that I would faint for three years, and for the most part, my doctor acted like I wanted attention. Finally, my NP put a hotler monitor on and we found out my pulse would drop as low as 27. I have sick sinus syndrome, and now I have a pacemaker. I fainted 6 or 7 times between 15 and 20, but no one thought anything of it. I was very physically fit most of my life, but around 58 or so the genetic problem finally caught up with me. I am fine now - and thank God for pacemakers and technology and engineering and NPs who listen.

  114. Astigmatism correction in eyeglasses can cause serious vertigo if the lenses are out of alignment. Was scheduled for exploratory brain surgery when I broke my glass fames. Once the lenses were remounted correctly, the vertigo was gone.

  115. Post prandial hypotension would be more likely if your heart's pumping is weak (never happened when you were 16). Also the cerebellum in the back of the brain is where balance is regulated. Ischemia or stroke here is often manifested by dizziness. A full cerebellar stroke is devastating. You lay in bed with your head spinning permanently.

  116. Be careful. I know someone who suffered with dizziness for a month (started while running) functioned normally, went to doctors until finally an MRI revealed a stroke in the cerebellum.

  117. At the age of 30, my balance completely evaporated. Unsteady is the best way to describe it, and it took different forms, but it was 24/7 persistent. I couldn't stand without falling unless I was clinging to walls/furniture/friends. Doctor didn't believe me because all obvious tests indicated I was healthy and normal. Eventually I brought a male friend with me to ask doctor to give me a neuro referral, because doctors take men more seriously than they do me. Neuro said my brains were fine, sent me to ear doctor. Ear doctor said my ears were fine, sent me to the ear brain doctor. Ear brain doctor said my ear brains were fine, so it was probably "chronic subjective dizziness" which, he conceded, may or may not exist. Still, people with this designation benefited from antiquated anti-depressants and physical therapy. I turned down the meds and went for the physical therapy, which cleared it all up. This whole ordeal lasted a hideous horrible year. Will be picking up this book.

  118. As a physician I think it's absurd to expect accuracy from patients in defining symptoms. It's up to us to ask the right questions.

  119. Yea--that comment in this story sounded like scolding the patient.

  120. Thanks for this column. I was extracted from a restaurant while having lunch with a friend and taken by ambulance to the ER four years ago. The room was spinning so violently that I could not function and had to cover my eyes. Before I was loaded into the ambulance, I vomited suddenly, without having felt nausea. The diagnosis was vertigo and, fortunately, nothing beyond that. I had two recurrences the following week, then none since. The Epley never worked for me, and I feared that I had Ménière's disease. I requested a hearing test, as Ménière's can do damage, but my hearing is excellent for my age (mid-60s). I was surprised later to find out how common vertigo is. I don't ever remember feeling as helpless. I advise others who experience dizziness or vertigo to pursue it. My doctor sent me to a physical therapist, a vestibular expert, who spent an hour with me. She did not "cure" me, but the wealth of information was invaluable.

  121. My occasional dizziness disappeared once my cataracts were removed.

  122. A brief, structured diagnostic interview by the health professional would probably be the most effective means of differentiating the type of dizziness and its implications, rather than hoping for patients to be able to differentiate symptoms and articulate them.

  123. Overall, a good article. I would've appreciated a bit of info on treatment for orthostatic hypotension, though--which I believe I have. I can look it up, of course, but...just a comment.

  124. I went through this a month ago. ER, CAT scans, etc. Verdict was BPPV. Showed me how to do the Epley, and kept me over night. Went home next day with a prescription for Meclizine. Tried to do the Epley before I got the Meclizine. Worst experience of my life, immediately felt as though I'd been thrown off the roof of a tall building. Tried it the next day, same thing. I'm not fond of meds (and, apparently, not too smart either) but I took the Meclizine the third day, waited a few hours, did the Epleys, and that was that. Occasional minor vertigo for the next week or two, but nothing too intense. Since then, nothing.
    So my advice is to take the Meclizine asap and then do the Epleys.
    One more thing. My experience is that the BPPV is not dizziness. It felt more like standing on the deck of a small sailboat in a gale.

  125. My primary care doctor prescribed Meclizine, other doctors say to use it, but the Ear, Nose, and Throat folks said not to take it because it weakens the vestibular system.

    Wonder what the real answer is on that.

  126. You missed a not uncommon cause of severe dizziness with no other symptoms, as did a dozen doctors for year, in my case: Vestibular migraines. When severe, these can be disabling, but are not hard to treat.

  127. Glad to see orthostatic hypotension mentioned, but would have been great to include postural orthostatic tachycardia syndrome (POTS), which impacts and estimated 1-3 million Americans. POTS comes with lightheadedness upon standing, as well as many other symptoms caused by poor blood flow to the brain. It is most often seen in women ages 12-50, although males and people of any age can be impacted.

  128. Many kids diagnosed with "anxiety" and some diagnosed with ADHD have POTS. My question, as a non-pediatrician is this. Should some kids try water and pickles before medication? The same goes for adults, but I think POTS in children is frequently overlooked.

  129. I suffered severe debilitating dizziness that struck without warning and many times ended up in nystagmus where my eyes would rotate up and down like the room spinning. The only way to control it was to breathe very deep and slow. I went to several Doctors of all disciplines with no success until moving to Savannah and kindly old country MD shortly before he retired told me after a couple of visits he suspected I had blood pressure swings. Sure enough after being on blood pressure medicine for a few days I felt a whole lot better and no more dizziness.

    One more thing as well as heavy eating causing a drop in blood pressure if you perform aerobic exercise such as running at a constant pace for a while and suddenly stop you will suffer a huge blood pressure drop because the blood has pooled in your legs and your heart has to quickly work overtime to pump it back up to your brain.

  130. I've had my latest episode of BPPV for 3 months. Mine presents with spinning that feels like someone put me in a clothes dryer. I've had vertigo before but only for a week or so at a time. The frequency seems to be increasing as I get older - and this time on both sides. The good news is that my doctor at the Michigan Ear Institute has ruled out any other medical conditions, including vestibular nerve problems. The bad news is I still have vertigo - much less, though, after 2 treatments in the state-of-the-art Omniax chair which luckily is near me. I just wish I knew what causes my episodes and how I could prevent them, but to date, I simply don't know. This might be the hardest thing about BPPV - the not knowing why you get it or when it will rear its ugly head again. Thanks for this article. I hate to say misery loves company, but in a manner of speaking, there's a certain comfort in knowing that there are so many other people who experience dizziness.

  131. You needn't suffer, alone OR in good company. An ENT doctor with BPPV discovered this simplified technique which I have used successfully for the past 3 years following a severe concussion. Take a look:
    https://www.youtube.com/watch?v=_8ucpWIIC3g

  132. Interesting. Postural hypotension seems more frequent than thought, giving rise to dizziness. Lying down is the answer, no matter what triggered it. Those that are hypertensive and on medication seem even more susceptible, reason why some may stop taking their prescription, a dangerous move to prevent a stroke, or a heart attack, or renal failure. Dizziness, if recurrent, may be worth our attention, and our physician's.

  133. It was encouraging to read that ms.Brody, like many of us, gets her preliminary information from the internet.

  134. Internet information can lead one down the wrong path. In Ms. Brody's situation, she searched the next day for general answers online instead of seeking immediate medical attention for herself.

  135. BPPV is one of the most common disorders, that most health care professionals either minimize, don't know about, don't want to deal with, or don't treat properly. I've had it 3 times, in my 50's. My Dad's had it twice, in his 80's. The first time I had it, I saw my primary care provider, who gave me Meclizine for dizziness. I cancelled a trip to Florida. When I called my friend Cindy to tell her I couldn't visit, she said, it sounds like you have vertigo, which can be treated with the Epley manuever. Went to PT and it was an instantaneous magical cure. I was able to treat myself the next 2 times I got it. When my father developed it, he waited 4 days to see his neurologist, who did the Epley and gave him the wrong post-Epley instructions. It re-curred shortly after, and he let me treat him. Another magical instantaneous cure. I'm always glad to see vertigo written about, for the masses to read about, because we often learn more from each other than from health care professionals.

  136. Psychological problems like anxiety can also cause dizziness, it's not always a physical issue.

  137. When dizziness results from anxiety, the affected person often hyperventilates either stopping or breathing to rapidly without consciously noticing...I recommend yoga to re-teach breathing when under stress or any adverse situation in life.

  138. Yes---apparently. After my mother died, for weeks I was so dizzy I could not walk across a room. I finally got a referral to an ENT doctor, thinking it was vestibular. He said no...but did I want my new hearing aids now or would I rather wait. I waited. Finally, in desperation, I went to Urgent Care. The doctor there said it was grief. I protested...but eventually it trailed off, so it probably was a reaction to her death. The mind can really jerk you around.

  139. Actually, it's more often the reverse. If you have dizziness and anxiety, consider that dizziness can trigger the anxiety centers in the brain. Just as it can trigger the nausea centers. My dizziness triggers my anxiety, not the other way around.

  140. I too have sensations that you might call disey. But it is actually floating and not disey at all. When I am done with a cruise I get land legs for up to one week. I have always thought that this is not worth mentioning to my doctor.

  141. this is called mal debarquement and is a well recognized vestibular condition.

  142. Eric
    Goodle MdDS. I have this floaty sensation,. but can not get rid of it. What do you do to get rid of it?

  143. As someone who has a severe vestibular disease with a complete, sudden vestibular loss in my left inner ear caused by autoimmune disease complicated by the migraine spectrum, I find this article to be very poorly written or even useful. Relying on the authors of one book instead of talking to some of the leading experts like those at the Mt. Sinai Motion & Dizziness Center in NYC or at those Johns Hopkins Hospital in Baltimore. More simply put BPPV, the most common of the vestibular issues, is caused by crystals coming loose from the inner ear canal. Thus, when folks move their head they experience dizziness and/or vertigo. The Epley maneuver performed by a GP or vestibular therapist on an examining table, moves the head from side to side at very specific angles while watching for nystagmus or movement in the eyes. They determine which ear is effected by the movement in the corresponding eye and the maneuver is most often successful with one or more Epley maneuvers. However, BPPV is completely separate from the Migraine component. The research re: migraines and vestibular issues has increased dramatically. There is something called Vestibular Migraine, a migraine that exists without the pain of a headache but instead causes dizziness, vertigo, nausea and unsteadiness or all of those symptoms. In fact, Vestibular Migraine causes more constant unsteadiness and even an inability to walk than the most common & overly diagnosed vestibular disease, Meniere's.

  144. Vestibular migraine has other names, too. Migraine Equivalent, Migraine Event, Migraine Aura Without Headache, Silent Migraine. I have been very fortunate to learn that Gabapentin (Neurontin) can control dizziness of this kind. I take 900 mg, three 300 mg doses each day. I hope someone else sees this who could ask their doctor to try this medication.
    I too was disappointed that this type of diagnosis was not mentioned in the article. I want through all the testing for all the other causes, and this was the answer!

  145. I’m very surprised that Jane Brody omitted any reference to MdDS. She cites a book written by Dr. Gregory T. Whitman and Dr. Robert W. Baloh. Both doctors are on the “Find a Doctor” list on the MdDS Balance Disorder Foundation website, at http://www.mddsfoundation.org/diagnosis-and-treatment/health-care-provid... .

    I would concur with Dr. Whitman, that MdDS can be very difficult to diagnose. I have had MdDS for 14 years. It is a disease of exclusion. One cause after another has been ruled out. There is no remedy in sight. It has had a dibilitating impact on my life. I am at my wits end and can only hope that articles like Ms. Brody’s will someday include MdDS and inspire awareness and a cure for this horrible disability.

  146. as a neurotologist, i see 100s of "dizzy" patients a month. what's even less helpful is the icd-10 diagnosis doesn't distinguish between vertigo, dizziness or imbalance; they are all given one code. if we are to expect out patients to be more specific when describing dizziness then our coding needs to appropriately change.

  147. My first episodes of B.P.P.V occurred 20+ years ago. After various medical explorations I finally figured it out myself. While working some long days at my office I would on occasion take a nap on my two seat couch. This caused my my head to be bent forward. I stopped doing that and my symptoms disappeared. More recently I had more problems. I changed my pillow and solved the problem. So watch your head position.

  148. My situation, and one I'm sure shared by many, was lightheadedness from a medication commonly taken by male seniors. When I complained about the condition, another drug was advised. That medication caused me to understand what true dizziness was. I've learned to adjust to the original prescription.

  149. Could you kindly share which medication to which you are referring? This may be the link that could help my Dad. Thank you!

  150. After two decades of experiencing all the symptoms you describe and numerous doctors visits I seem to have at last found a physical therapist who is fixing the dizziness. It was a physician's assistant who referred me.

  151. I am eighty years old and am afflicted by both benign paroxysmal positional vertigo and post-prandial hypotension. My BPPV is usually effectively treated using a self administered Epley maneuver. There have been instances, however, when the problem has persisted up to six-weeks, during which I must also take medication, for which I use and otc called antivert which seems to help somewhat. I use a stronger antihistamine if the antivert does not work. My experience with PPH is that it can be serious but only after a heavy meal, which for me, is rare. After meals, when I stand and hold fast to the table until my instability subsides.

    All that being said, a sudden head movement or when walking leads to at least momentary instability which, so far, has not led to a fall to the floor because I usually walk near a wall or some other stable object to prevent falls. I infrequently use a cane as a precautionary assist when I know I am experiencing a continuing bout of dizzyness.

  152. For many years I complained to every doctor and physical therapist that I saw about a chronic feeling of spaciness. It turned out on a routine blood test to be a B-12 deficiency, a severe one. Luckily this has totally reversed. I was at the point that I was afraid to drive any distance and walking and exercise were difficult.
    Why wasn't a B-12 deficiency even considered by the medical personnel?

  153. This also happened to me! I was also diagnosed with MTHFR. A lot of my issues resolved, but I still get dizzy when I drive, so I'm still looking for an answer for that. Happy you figured it out!

  154. My doctor told me I had an adrenal problem and prescribed Fludrocortisone 0.1mg. When it didn't help after a few weeks, I just stopped taking it after doing some research. Haven't told her - she likes to prescribe prescriptions for everything. And she's better than other doctors I've seen in the last 20 years.

  155. As you can see by the huge variety of stories in this comments section, dizziness, light-headedness and imbalance can be caused by a myriad of issues. After a half dozen years of misery (nausea, imbalance, vertigo, etc.) and many desperate trips to two ENTs, a physical therapist, a vestibular physical therapist, an otolaryngologist, an accupuncturist, and a chiropractor -- I diagnosed the problem myself: allergies/sinus issues. My ears fill with fluid. I now have things mostly under control by religiously using a Neti-Pot and Nasacort. I'd die without them.

  156. On the off-chance that this might help someone else, I'll add my daughter's experience here. For background, Sara has NLD, a learning disability on the autism spectrum, which includes anxiety and can lead to depression. I mention this because we ended up with fat folders of testing and diagnostics (academic, emotional/social, and physical), "progress" reports, and IEP's by the time Sara was in 8th grade.

    Sara had developed a love of running as a way to cope with stress. She was not a fast or graceful runner, but was welcomed on the high school cross-country team by some kind and supportive kids, and the coach. But Sara began to complain more and more frequently of feeling dizzy when she ran - so much so that she had to stop, and had fallen a few times. After months of appointments with specialists (pediatric cardiologist, neurologist, pulmonologist, gait testing), the word "proprioception" came up in a medical paper I'd found online, and it rang a bell. I realized I'd seen the term in one of the elementary school PT (physical therapy) reports on Sara. We asked her pediatrician about it, and we finally had our "aha" moment. If any of Sara's story sounds familiar to you, check on the definition of proprioception and it's effect vis-a-vis dizziness. Maybe it will apply to your situation, perhaps not. Here's hoping it'll help shorten the search for an answer.

  157. I am coming a little late to this discussion, but I have a little tidbit of info to offer. I have had 2 brief episodes of BPPV - first brought on by a too quick rolling sliding style getting up from a high bed. This was diagnosed for me by a nurse friend because she had experienced it herself. It went away after a few days and more care getting up.
    The second time occurred when I was supine in the dentist's chair and the chair was raised too quickly. Fortunately, I recognized the feeling immediately, but had a difficult time explaining to the dentist and assistant. Also I couldn't remember the exact name for it, and I think they thought I was a bit of a nutcase. Neither had ever heard of it. A few days later I did send them an article explaining it. In the article it said my experience in the chair was not uncommon and that the same situation sometimes takes place in hair salons when the chair is raised back after hair washing.

  158. An excellent resource for professionals, patients and family is the Vestibular Disorders Association and their website. VEDA has accurate and helpful information on many causes and treatments of vestibular based dizziness as well as references and a practitioners guide.

  159. I am surprised that vestibular migraine and Meniere's disease were not at all mentioned here.
    1.6 Americans suffer from these (probably related) causes of vertigo and for some, all the sensations and suffering mentioned in this article. But, it lasts a lifetime and has no effective treatment or cure. Hearing loss and tinnitus is also associated with both.
    It is important to point out that, while those with a headache might also have vestibular migraine, it is also not uncommon for a person to have NO HEADACHE and have vestibular migraine. Researchers suspect many thousands of people with other "migraine" symptoms like vertigo, nausea, neck pain, muscle stiffness, gastro intestinal problems, etc., but no headache, remain undiagnosed.

  160. I'm surprised that MdDS (Mal De Debarquement Syndrome) is not mentioned in here. It causes a floating/bobbing up and down sensation as through one is on a boat. It typically occurs after a cruise of 7 days or more, but also can occur spontaneously. there is not known cure many times can impact the patient for the rest of their lives.

  161. Following a bicycle accident where i sustained a traumatic brain injury, and severe BPPV, I was first treated by a vestibular physical therapist with three sessions using the Epley Maneuver. I thought i was "cured" but the symptoms recurred. I found this new maneuver which is much easier to self-administer, and I am able to manage recurring episodes on my own.
    https://www.youtube.com/watch?v=_8ucpWIIC3g

  162. I was much dismayed by this article because I suffered a stroke after displaying the same symptoms as Ms. Brody experienced in her "attack" -- nausea after overeating and extreme dizziness. She was foolish, in my opinion, to avoid going immediately to the nearest ER for medical intervention and diagnosis.

    I was dismayed to read Ms. Brody's article on dizziness, because I experienced an episode similar to hers that turned out to be a stroke -- nausea after overeating, followed by extreme dizziness. She would have been wiser to go immediately to the nearest ER for proper diagnosis and treatment.

    the same symptoms as Ms. Brody initially experienced herself.

  163. I have had problems with menieres and I have hypo-tension. Since I started adding more salt to my diet a few years ago, I have only had mild attacks that ave only lasted one night. Preciously I once ended up in hospital. I was put on an intravenous machine as my electrolyte levels were way too low.

  164. I have Meniere's diseases. Reader's should be aware that the standard medical advice for Meniere's sufferers is to LOWER sodium intake to the range of 1500 to 1800 mg per day. Check with your doctor before increasing sodium content in diet to deal with dizziness and vertigo.

  165. If you have vertigo that may benefit from the Epley manuver, try this.
    https://www.youtube.com/watch?v=1VWyPgfMuvM

    University of Colorado professor. You need to be relatively fit to do this ( if you have done or are currently doing yoga level 1-that works).

    worked well for me. did the erercise about four times- and it cleared then disappeared. it has been back, and cured quicker the second and third time.

    have not had a recurrence in over a year

  166. I've recently battled vertigo and related nausea. The culprit? Stress. My neck and shoulder muscles were so tense that they were pulling on my neck and skull, throwing off my inner ear and creating the problem. A few visits with a good chiropractor eased the problem greatly, getting me back to normal. The hard part? Trying to not get stressed anymore!

  167. the epley maneuver is a sure cure for BPPV.

  168. You forgot to talk about the danger of falling with orthostatic hypotension.