Lightheadedness and Presyncope

When a patient complains of “dizziness,” it may not always be a vestibular issue. There are many non-vestibular causes of dizziness.

Lightheadedness and Presyncope are two symptoms that patients may be experiencing when they say they feel “dizzy.”


The vague complaint of “dizziness” is usually associated with lightheadedness from various medical causes.

The primary care provider is usually in the best position to manage this type of medically-related lightheadedness. The key is to manage the underlying health condition.

These complaints of dizziness typically require patient education by the treating physical therapist. Physical therapy case management, or coordinating the patient’s care with the physician, can also be a service provided by a physical therapist.

Common causes of lightheadedness and presyncope include medication side effects or interactions and cardiovascular disease. Some cardiac problems that can lead to lightheadedness include blood pressure issues (hypertension, hypotension and orthostatic hypotension) and cardiac arrhythmias like a-fib.

Also, lightheadedness can be caused by low oxygen levels.

Other common causes of lightheadedness include anxiety, blood sugar fluctuations and/or dehydration, along with other medical causes and stress.

Lightheadedness can also be psychogenic or idiopathic.

Idiopathic means “no known cause.”

If you are feeling lightheaded, you should talk to your doctor.

You may even want to consult with a vestibular physical therapist to rule out a vestibular cause.


Presyncope is a feeling of fainting and the impending loss of consciousness.

This is often described by patients as “feeling dizzy.”

Lightheadedness with presyncope is considered a symptom of cardiovascular disease.

If unaddressed, presyncope can evolve into “syncopal episodes” which are the loss of consciousness due to cerebral hypo-perfusion. That occurs when people faint or pass out, due to lack of blood flow to the brain.

Patients with syncopal episodes can have falls with the resulting consequence of new-onset of BPPV (Benign Paroxysmal Positional Vertigo) or intracranial hemorrhage (ICH) due to head trauma with the falls.

Both BPPV and ICH, along with other serious injuries that can result from falls.

Fall-related injuries exacerbate balance impairments, so it is important to identify and address dizziness from presyncope.

Skull fractures and brain injuries can occur due to fainting spells.

Talk to Your Doctor if you have Lightheadedness or Presyncope

If you feel like you might pass out or faint, you may have presyncope. You should talk to your doctor to get some testing and individual medical advice.

If suspected, lightheadedness and presyncope is best assessed by a physician or physician extender.

Your doctor will also perform a thorough clinical examination. They may order bloodwork to check your organs.

The physician may order testing with EKG and 24-hour Holter monitoring to rule out arrhythmias and vasovagal instability.

If you are experiencing lightheadedness and presyncope, talk to your doctor.

Make note of things like your body position at onset, duration, and frequency of symptoms, along with the time of day of onset and preceding events.

This information is helpful to share with your healthcare provider. This is helpful to differentiate the causes of lightheadedness and presyncope.


This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.

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