Around one in four people experience dizziness. Although it becomes more common with age, it can occur for a variety of reasons. People with a vestibular disorder may also experience dizziness due to other causes. Below is a list of some of the possible non-vestibular causes of dizziness. If you are experiencing symptoms of dizziness it is important to see a qualified health professional to find out the cause of your symptoms and for advice, treatment and referral to a specialist if necessary.

Side effects of medications

Some medications list dizziness as a side effect. If you take more than four different types of medication, this may also cause dizziness and increase your risk of falling.

Stress, tiredness and concentration

If you feel particularly stressed, anxious, angry or fearful, your heart rate increases and your breathing gets faster as blood is pumped to your muscles. A side effect of this is that you may feel sick or dizzy, since breathing too fast (hyperventilation) causes you to take in too much oxygen, which can make you dizzy. If you are tired or doing things you have to think about, this can affect balance.

Ageing

Around one in five people over 60 are affected by dizziness and imbalance. As people get older, the parts of the body which help maintain balance, e.g. the muscles, eyes and vestibular system in the inner ear, begin to function less well. Seeing in bad light may become difficult and there may be a permanent feeling of unsteadiness. Dizziness, however, does not tend to result from age-related changes alone and it is more likely to occur in people with a disorder or as a side-effect to medication.

Restricted blood flow to the brain

Dizziness and unsteadiness can also be the result of conditions that cause a temporary decrease in the blood flow to your brain. These conditions include:

  • Low blood pressure after standing up (postural or orthostatic hypotension) -  is a condition in which your blood pressure briefly drops when you get up quickly from sitting or lying down, causing nausea, dizziness, unsteadiness or blackouts. This is common and can be caused by dehydration, standing still for too long, becoming too hot and not eating enough or regularly enough (hypoglycaemia).
  • Low blood pressure after eating (postprandial hypotension) - is a condition in which after eating (particularly after a large, high carbohydrate meal), your body does not compensate for the increased blood flow to your digestive system, causing dizziness, unsteadiness, or blackouts.
  • Osteoarthritis - a condition that causes damage and swelling of the joints. If the neck joints are affected, the blood flow to the brain can become restricted, causing temporary dizziness when you turn your head.
  • Arteriosclerosis - a build up of fatty deposits and cholesterol makes arteries become hard and narrow, reducing blood flow to the brain, which can cause dizziness. Arteriosclerosis can be caused by high blood pressure, diabetes, and an unhealthy lifestyle, and can lead to heart disease, stroke and blood clots.

Neurological diseases

Dizziness and unsteadiness can also be the result of damage to the areas of the brain that coordinate balance, e.g. in people who have MS, stroke, Parkinson’s disease or brain tumours.

Lack of exercise

Regular exercise is important for maintaining flexibility and strength, which can help balance. The stronger and more flexible the muscles and joints are, the better your body will be able to deal with different surfaces and keep you balanced.

Postural tachycardia syndrome (PoTS)

What is PoTS? PoTS stands for Postural Tachycardia Syndrome. It is a disorder of the autonomic nervous system that causes problems with control of heart rate, blood pressure and other symptoms. In a healthy individual, rapid reflexes adjust heart rate and blood pressure to changes in body position to ensure adequate blood supply to important organs like the brain. In PoTS these reflexes don’t work correctly.

What are the symptoms of PoTS? People with PoTS experience symptoms which are mainly in upright positions, especially with prolonged standing. There can be palpitations from a rapid heart rate,  fainting or near fainting episodes. Dizziness is a very common symptom. The dizziness of PoTS is often a lightheadedness. It is typically most noticeable on standing, and improves when lying down. Migraines and other kinds of headaches are also common in PoTS. Other possible symptoms include fatigue or excessive tiredness, breathlessness most noticeable on exertion, and chest pain. Some individuals with PoTS also have problems with the gut or bladder.

How is it diagnosed? PoTS is diagnosed based on the history of symptoms and by making measurements of blood pressure and pulse in different positions. This is sometimes done using formal equipment called a Tilt Table. Other tests of heart function and blood or urine tests are sometimes recommended.

How is it treated? Many people with PoTS can manage symptoms using lifestyle adjustments based on good education around the condition and factors which exacerbate symptoms. Medications that affect heart rate control can be offered in some cases. Other treatments like physiotherapy, are tailored to specific symptom patterns.