Occasional dizziness is very common in adults, but it may surprise you to learn that vertigo — a related but more serious condition that makes you feel like the room is spinning as you stand still — affects nearly 40 percent of people over 40 at least once, according to the University of California San Francisco Medical Center.
While dizziness can make you feel momentarily unbalanced, and ranges in severity from merely annoying to seriously debilitating, vertigo may be a major symptom of a balance disorder. It can also cause nausea and vomiting.
To get the facts about both conditions and learn how to differentiate between the two, we asked a few of the nation’s leading experts on dizziness and balance problems to share their insights. Here’s what they had to say:
1. Feeling Dizzy Could Be a Sign of an Inner Ear Problem
“One of the most surprising causes of dizziness is benign paroxysmal positional vertigo, or BPPV,” says Gregory Whitman, MD, an ear and brain specialist with Massachusetts Eye and Ear's Balance and Vestibular Center at Braintree Rehabilitation Hospital. Your inner ear contains calcium and protein-based sensing crystals called otoconia, says Dr. Whitman. If these crystals are dislodged and float into your inner ear’s canals, you may have a brief spinning sensation. “It’s a simple mechanical problem that can and should be corrected with physical therapy, and not with medication or surgery,” says Whitman.
Though BPPV is the most common inner-ear-related balance disorder, it affects only about 1 out of 1,000 people per year, according to the Vestibular Disorders Association (VEDA). And while it can affect adults of any age, it primarily affects older adults. Most cases occur for no apparent reason, but BPPV has been linked to trauma, migraines, inner ear infections, diabetes, and osteoporosis. After treatment, 50 percent of patients may experience the problem again within five years, especially if it was the result of trauma, say experts at VEDA.
2. Your Ear’s Balance System Controls Blood Flow
“We’ve learned that our inner-ear balance system contributes to the control of our blood flow," says Whitman, "and that the inner ear has the ability to know which way is up, much like an Apple watch." When you move from lying down to standing up, two inner ear structures, the utricle and saccule, detect gravity. They tell your cardiovascular system to direct blood flow to accommodate your change in position, says Whitman. If that process goes awry for any reason, you could end up feeling dizzy.
3. Low Vitamin B12 Levels Can Make You Feel Dizzy
Deficiencies in this essential vitamin can lead to a number of neurological problems, including feeling off-balance, and having low blood pressure and decreased blood flow to your brain, says Whitman. “Vitamin B12 deficiency is easy to detect and treat, but is an often overlooked cause of dizziness,” he notes.
Ask your doctor about having a simple blood test to check your B12 levels if you're having dizzy spells. Good sources of vitamin B12 include meat, dairy products, and fortified breakfast cereals. About 3 percent of adults over 51 have a vitamin B12 deficiency, according to the Centers for Disease Control and Prevention (CDC).
4. Dizziness May Be a Symptom of Heart Disease
One simple cause of dizziness is sudden movement, like when you get up too suddenly from your seat or bed. But sometimes dizziness is a sign of a heart condition. Among the cardiovascular-related causes of dizziness are leaking or narrow heart valves, arrhythmias like atrial fibrillation, and atherosclerosis, says Patricia Blau, PhD, associate professor of physical therapy at the University of Texas Southwestern Medical Center in Dallas. These can cause dizziness because they reduce blood flow to the brain, according to VEDA.
5. Migraines Sometimes Cause Vertigo
“It surprises some people to know that dizziness is commonly linked to migraine disease, either with or without headaches,” says Debara L. Tucci, MD, a professor of surgery at Duke Medicine in Durham, North Carolina, and one of the lead ear, nose and throat physicians in the Duke Vestibular Disorders Clinic. Other symptoms of migraine-related vertigo include sensitivity to motion, light, and sound, adds Dr. Tucci. About 40 percent of people who have migraines experience dizziness or vertigo, according to VEDA.
6. Feeling Dizzy May Be Related to Anxiety
Many people who experience dizziness, especially people in their twenties, may also have anxiety, says Whitman. “They usually don’t want to hear that dizziness can be linked to anxiety, because it suggests that it’s all in their heads,” he notes. “But what’s in your head is your brain. And anxiety can reflect a brain function disturbance that's possibly genetic.”
Compared to people who don’t have anxiety, people with anxiety disorders appear to sway more when subjected to a moving visual environment, Whitman says. And they sway in a way that seems to be synchronized with the visual movement. “These people may be abnormally sensitive to visual stimulation, because their dizziness can increase when they’re watching moving objects or walking through a large, bright store,” says Whitman. This is called visual dependence; little is known about how common it is. “We need to develop better tests of visual dependence, and we need laboratory tests for what we now call anxiety disorders," ways Whitman. "It’s likely that in the future, these disorders will be reclassified, in part, based on genetics.”
7. A Boat Ride or Water Bed Can Cause Dizziness
It’s pretty common to experience a rocky, dizzy feeling on your first day back after a cruise, says Carol Foster, MD, director of the balance laboratory at the University of Colorado Hospital in Aurora. “For a few people, this feeling, called mal de debarquement, can last for months or even years,” says Dr. Foster. Some 75 percent of all sailors can experience the problem. Airplanes, cars, and trains can also cause a wobbly-legs feeling. Even relaxing on a water bed can make some people feel dizzy.
8. Dizziness and Vertigo May Be Side Effects From Drugs
So many medications can cause dizziness that it’s too many to even list, says Whitman. “That said, high doses of blood pressure medications can cause dizziness, especially in older adults and in people who have started a dose that’s too high for them," says Whitman. "In my dizziness clinic, I tend to start people on ultra-low doses of medication. Sometimes, less is more."
Check to see if any drugs you’re taking may include dizziness, vertigo, or loss of balance as possible side effects by speaking with your pharmacist or physician. “A careful review of medication lists, and looking for opportunities to decrease dosages, can sometimes yield surprising benefits,” Whitman adds. “Don’t think that you shouldn’t take a medication just because dizziness could be a potential side effect. Most people don’t experience the side effects a drug may cause.”
9. Your Diet or Dehydration Could Make You Dizzy
Even mild dehydration can cause dizziness, according to the American Heart Association. Dehydration can also cause blood pressure to drop, which can lead to feeling dizzy, notes the AHA. Dieting can also result in feelings of dizziness, because some diets cause dehydration, says Dr. Blau. And according to the AHA, mild dehydration that follows the loss of just 1 to 2 percent of your body weight can lead to dizziness.
10. There Are Several Less Common Causes of Dizziness and Vertigo
Pay attention to all bouts of dizziness, because along with other symptoms, they could point to something more serious. See your doctor to rule out health problems related to frequent or severe bouts of dizziness or vertigo.
“Even though less than 1 percent of my patients have a life-threatening or previously unsuspected cause of dizziness — such as stroke warning symptoms or a brain tumor — I still take all cases of dizziness seriously,” says Whitman. If you have a brain tumor, it's usually not the only symptom you have, he says.
One very rare condition linked to vertigo is Ménière’s disease. “If you have prolonged episodes of whirling vertigo along with hearing problems in one ear, it could be Ménière’s,” says Whitman. He estimates that this affects only about 0.2 percent of the population, and is sometimes found in adults between the ages of 40 and 60. Though it can’t be cured, it can be treated.
