Dizziness is a common complaint that many people experience at least once in their lives. This condition can be described in different ways by different patients such as “my head is spinning, surroundings are slipping, I’m losing balance.” Actually, dizziness is not a disease by itself, but a symptom that can occur due to many different causes.

Dizziness can originate from inner ear and balance system problems, and can also be a sign of cardiovascular, neurological, or metabolic diseases. Therefore, it is difficult to find the actual cause without proper evaluation and necessary examinations.

Dizziness is one of the frequently encountered complaints worldwide, and is a condition experienced by 15-20% of the adult population at some point in their lives. Dizziness, although seen more frequently especially in elderly people, can be encountered in every age group. Dizziness can significantly affect daily life. It can make it difficult for a person to do their work, drive a car, or even perform simple household tasks. Therefore, correct diagnosis and appropriate treatment are of great importance both to increase quality of life and to prevent recurrences.

What Is Dizziness?

“Dizziness” is a condition that occurs when a person feels as if they have lost their direction and balance. It is not a disease by itself, but a symptom that can originate from different causes. People can describe this condition as “my head is spinning, surroundings are slipping, I feel like I’m in space, I feel like I’m going to faint.”

In medicine, dizziness is examined in four main groups:

1. Vertigo: Feeling that surroundings are spinning.
2. Presyncope: Feeling like fainting, generally related to blood pressure or heart problems.
3. Disequilibrium: Imbalance especially when walking.
4. Lightheadedness: Feeling of being in space or dizziness.

Dizziness occurs as a result of different organs and systems not working together. Balance information coming from the inner ear, eyes, muscles, and joints is processed in the brain. If one of these systems doesn’t work properly, dizziness can be experienced.

Dizziness is described differently in each patient. Some say “surroundings are spinning,” some say “ground is slipping from under my feet.” Therefore, it is very important for the doctor to listen to the patient in detail and analyze symptoms.

What Should You Tell Your Doctor During Dizziness History?

When you go to the doctor with a dizziness complaint, conveying the symptoms you experience in as much detail as possible is very important for correct diagnosis. Dizziness (general feeling of dizziness) or vertigo (feeling as if surroundings are spinning) can originate from different causes. Therefore, it will be beneficial to give your doctor the following information:

• How the complaint started: Did it happen suddenly, or did it develop gradually?
• Type of dizziness you feel: Are surroundings spinning (vertigo), or is it just lightheadedness or imbalance (dizziness)?
• How long it lasted: Does it continue for minutes, hours, or days?
• Accompanying symptoms: Are there situations such as nausea, vomiting, ear ringing, hearing loss, blurred vision, feeling of fainting?
• Triggering factors: Does it happen when you move your head, does it increase when you stand up, or does it appear in a specific situation?
• Whether you’ve experienced it before: Is this the first time, or is it a recurring problem?
• Its effect on your daily life: How much does it affect your work, driving, walking, or social life?

Sharing this information will make it easier for your doctor to understand the cause of your dizziness and create the most appropriate treatment plan for you.

What Causes Dizziness?

Dizziness can originate from many different causes. Therefore, determining the correct cause is critically important for creating an effective and safe treatment plan.

Vestibular system diseases, meaning diseases affecting the balance organ in the inner ear, are among the most common causes of dizziness. Inner ear disorders such as Benign Paroxysmal Positional Vertigo (BPPV), vestibular neuritis, Meniere’s disease, and labyrinthitis are frequently encountered examples. In these diseases, the function of balance organs in the inner ear is disrupted and additional symptoms such as nausea, ear ringing, or hearing loss usually accompany dizziness or vertigo.

Cardiovascular causes are also one of the causes of dizziness. They are especially important in the elderly. Conditions such as orthostatic hypotension, cardiac arrhythmias, heart failure, myocardial infarction, and aortic stenosis can lead to dizziness by reducing blood flow to the brain. If these causes are not recognized, they can create serious consequences.

Neurological pathologies include migraine, multiple sclerosis, brain tumors, stroke, transient ischemic attack, and posterior circulation insufficiency. These diseases affect the central nervous system’s balance mechanisms. They mostly appear together with other neurological symptoms such as weakness, visual impairment, speech difficulty, or loss of coordination. Vestibular migraine is also one of the important causes of dizziness. Headache should be questioned especially in middle-aged and female patients presenting with dizziness complaint.

Metabolic and endocrine disorders can also cause dizziness. Diabetes, hypoglycemia, thyroid diseases (hypothyroidism, hyperthyroidism), anemia, dehydration, and electrolyte imbalances are in this group. These conditions are a reflection of disruption of the body’s general metabolic balance.

Medication use is an important and frequently encountered cause of dizziness. Antihypertensives, sedatives, anticonvulsants, ototoxic drugs such as aminoglycosides and furosemide, antidepressants, and alcohol can lead to dizziness. Drug interactions are a risk factor especially in elderly patients using multiple medications. Therefore, medications used must be questioned in patients with dizziness complaint.

Psychological factors are also being emphasized more nowadays. Anxiety disorders, depression, panic attacks, and somatization disorders can lead to dizziness. They are often together with other psychosomatic symptoms and require a multidisciplinary approach.

Cervical pathologies (for example, cervical spondylosis, vertebrobasilar insufficiency) can manifest with dizziness triggered by head movements. Additionally, eye diseases, refractive errors, and oculomotor problems can also lead to disruption in balance perception.

One of the most important causes of chronic dizziness is a condition called PPPD (Persistent Postural-Perceptual Dizziness). PPPD generally appears after a dizziness attack and continues with complaints of imbalance and lightheadedness felt almost every day for at least three months. This condition becomes even more pronounced especially when standing, walking, or in crowded and visually moving environments (for example, in shopping malls).

PPPD develops as a result of the body’s balance systems adapting incorrectly rather than permanent damage in the inner ear or brain. Anxiety disorder and stress can also increase these complaints. Treatment can generally use balance exercises (vestibular rehabilitation), psychological support (for example, cognitive-behavioral therapy), and in some cases medications (especially low-dose antidepressants). With correct diagnosis and appropriate treatment, the quality of life of people living with PPPD can improve significantly.

In Whom Is Dizziness Seen?

Dizziness is a common symptom that can be seen in every age, gender, race, or socioeconomic group. However, it appears more frequently in some groups and people with risk factors.

Age: Advanced age is one of the most important risk factors. The rate of dizziness occurrence especially in people over 65 years old rises up to 30-50%. The reason for this is weakening of the inner ear and balance system with age, increase in cardiovascular diseases, multiple medication use (polypharmacy), and other accompanying health problems becoming more frequent. Dizziness in elderly individuals also increases the risk of falling and injury.

Gender: Dizziness is seen 2-3 times more frequently in women compared to men. This difference is explained by hormonal changes, menopause, migraine being more common in women, and osteoporosis and anxiety disorders being seen more in women. Especially during menopause period, dizziness frequency increases significantly.

Chronic diseases: Dizziness is experienced more frequently in people with diabetes, hypertension, heart diseases, migraine, anxiety disorders, or previously experienced inner ear diseases. The presence of these diseases also provides clues to understand the cause of dizziness.

Occupations: Workers at heights, pilots, divers, musicians, or those working in noisy environments experience vestibular system problems more frequently. At the same time, dizziness complaints can also develop in people working sedentary at desks for long periods.

Genetic factors: Risk is higher in people whose family has migraine or inner ear diseases. Additionally, some genetic syndromes and predisposition to autoimmune diseases can also be associated with dizziness.

Lifestyle: Sedentary life, irregular sleep, stress, alcohol and smoking, and unhealthy eating habits are important factors triggering dizziness. Getting these causes under control plays a critical role in preventing dizziness.

What Are Dizziness Symptoms?

Dizziness can be felt in very different ways. Different symptoms can be prominent in each patient. Good understanding of these symptoms is important for both correct diagnosis and appropriate treatment.

Empty Feeling in Head

Patients say their head feels empty, light, or like cotton. Descriptions such as “walking in air” or “inside my head feels empty” are frequently seen. Generally increases when standing up, during sudden movements, or during stress. This feeling can be related to low blood pressure, hypoglycemia, fluid loss, or anxiety.

Vision Darkening

It is a symptom that frequently accompanies dizziness. Described as “my vision is darkening, I feel like I’m going to faint.” Generally occurs as a result of short-term decrease in blood flow to the brain. Sudden standing up, standing for a long time, being in hot environment, heart diseases, or anemia can cause this condition.

Wavering Feeling Inside Head

Some patients complain of “waves circulating inside my head” or “my head is swaying” feeling. This condition is seen in diseases such as vestibular migraine, anxiety disorder, or PPPD. Generally increases with stress, fatigue, or sleep deprivation.

Tendency to Fall

Expressed as “I’m losing balance, I feel like I’m going to fall.” This symptom is especially important in the elderly in terms of falling and injury risk. Vestibular diseases, neurological problems, musculoskeletal system problems, and some medications can trigger this complaint.

Objects Slipping from Under Feet

There is a feeling like “ground is slipping” or “like walking on ice.” The person feels insecure when walking, constantly needs to hold on. Can be related to peripheral neuropathy, vestibular diseases, or disorders in the balance system.

Foot Meeting Bump or Gap When Walking

Patients may say “when I step, my foot falls into a gap” or “I feel like I’m stepping into a hole.” This feeling is more pronounced especially when climbing stairs or on sloped ground. Shows disruption in the harmony of visual and vestibular systems.

How Is Dizziness Diagnosed?

Dizziness diagnosis requires a systematic approach due to the subjective nature of the symptom and numerous possible causes. Evaluation is supported by anamnesis, physical examination, laboratory, and imaging tests.

Anamnesis: It is the most critical step. Symptom onset, duration, frequency, triggers, relationship with position, and accompanying findings are questioned. Medication history, additional diseases, and family history are recorded.

Physical Examination: Neurological and vestibular evaluation is performed. Vital signs, orthostatic changes, cardiac examination are checked. Vestibular tests (Dix-Hallpike, supine roll, head impulse, Romberg) and balance tests (tandem walking, standing on one foot) are applied.

Laboratory: Selected for etiology. Complete blood count, electrolytes, kidney/liver functions, fasting glucose, HbA1c, thyroid functions, and B12 level are frequently used. According to clinical suspicion, cardiac enzymes, D-dimer, and inflammatory markers can be added.

Vestibular Tests: Audiometry, caloric test, video-nystagmography, video head impulse (vHIT), and VEMP are used in advanced evaluation.

Imaging: Selected according to clinical suspicion. Cranial MRI (central causes), temporal bone MRI (inner ear), cervical MRI (neck pathologies), and carotid-vertebral doppler (vascular causes) can be applied. Posturography objectively measures balance functions.

Cardiac Evaluation: ECG, echocardiography, Holter, and stress test can be performed. Tilt-table test is especially useful for orthostatic hypotension.

Multidisciplinary Approach: In complex cases, neurology, cardiology, endocrinology, psychiatry, and physical therapy consultation may be needed. Diagnostic process can be reshaped according to patient follow-up and treatment response.

How Is Dizziness Treatment Done?

Dizziness treatment is not the same in every patient. Because dizziness can have many different causes. Therefore, treatment is planned according to finding the cause and the person’s needs.

1. Cause-Oriented Treatment

• Crystal displacement (BPPV): Crystals are repositioned with simple head movements (such as Epley maneuver).
• Vestibular nerve inflammation: Cortisone treatment can be beneficial in the early period.
• Meniere’s disease: Salt restriction and diuretic medications are used.
• Heart-origin causes: Regulation of blood pressure, treatment of rhythm disorder or heart failure is needed.

2. Medication Treatment

• Medications reducing dizziness can be used short-term, but are not recommended long-term.
• Medications preventing nausea and vomiting also alleviate symptoms.
• Stopping unnecessary medications, reviewing medications with side effects is important.

3. Balance and Exercise Treatment

• Balance exercises and special head movements reduce dizziness.
• Regularly performed exercises help the body relearn balance.

4. Lifestyle Adjustments

• Drink plenty of water, eat regularly.
• Limit coffee, alcohol, and cigarettes.
• Sleep regularly, reduce stress, be active.
• Take safety precautions at home to prevent falling in the elderly (such as securing carpets, installing grab bars, removing thresholds).
• Wear comfortable sports shoes instead of slippers at home.

5. Psychological Support

Dizziness sometimes increases anxiety. Anxiety also worsens dizziness. To break this vicious cycle:

• Relaxation techniques, breathing exercises
• Psychological support is beneficial when necessary.

6. New Technologies and Support

• Balance studies done with virtual reality glasses
• Special balance devices
• Assistive tools such as cane or walking support increase safety.

7. Patient Education

• Causes of dizziness and treatment options should be explained to the patient.
• In which situations they need to urgently apply to doctor should be clearly stated.
• Expectations from treatment should be realistic, regular follow-up is important.