What Causes Dizziness? Root Cause Evaluation is Key
Often times, dizziness can have more than one cause. This blog discusses what causes dizziness, specifically in the head and neck area.
The Inner Ear
The first thing I do when I evaluate people for vertigo or dizziness is I check out all of the nearby structures to the inner ear, which is our vestibular balance system.
There are many vestibular causes of dizziness, but BPPV is the most common.
After that, I also examine other areas of the body, especially the structure of the head and neck.
The Eyes
One area that may cause dizziness or vertigo is the eyes, so it is important to look at your vision.
Old glasses prescriptions that are out-of-date may cause dizziness. Sometimes what causes dizziness is as simple as new bifocals, trifocals, or progressive lenses.
Someone experiencing dizziness or vertigo might need their eyes checked to ensure proper lenses, or to detect a possible eye disease that nobody has picked up on yet.
Everyone’s eyes have normal changes with aging, even in the absence of eye diseases. An example of an age-related change to vision include reduced depth perception.
Some people need to see an optometrist or ophthalmologist. Other people need vision therapy if their eyes are what causes dizziness.
I also ask if bright indoor lights, or complex visual environments like supermarkets or crowds, cause dizziness or vertigo. I also want to know if outdoor sunlight or riding in the car makes symptoms feel worse.
That is important information to determine the root cause of dizziness symptoms related to vision as well.
If people complain that stationary objects appear to be moving, or straight lines appear wavy, or their vision gets blurry for a few seconds when they turn quickly, then they may have “oscillopsia.” This complaint is best treated by Vestibular Rehabilitation.
Now you are beginning to understand why I am so focused on analyzing symptoms in detail!
The Nose and Sinuses
Another area that may contribute to dizziness or vertigo is the nose and sinus.
Dizziness or vertigo may be related to a sinus problem or a sinus infection. It may be important to see an ear, nose, and throat doctor (ENT MD) to diagnose further.
Some people feel pressure in their ear when their nose or sinus is clogged, correlating with dizziness.
Other people may feel dizzy after a sinus infection or during allergy season every year. Those are some of the clues I look for when I am evaluating what causes dizziness in each case.
Over the years, I have developed specific tips and treatments for my patents with symptoms related to their nose and sinus.
The Brain
The brain is also an important factor. Problems with blood flow through the neck to the brain, migraines, and concussions are examples of brain problems that can cause dizziness or vertigo.
I screen everybody to see if they have signs of neurological disease in their brain. Maybe they will need to be referred to a neurologist for an MRI or other diagnostic testing if we want to investigate the brain further.
The Teeth and Jaw
The teeth can be part of dizziness and vertigo for people, and may even occur after major dental work.
You may need to see a dentist or an orthodontist if you are having issues with their teeth. Some people need a night guard for sleeping.
The jaw joint is another major factor. The vestibular system is housed very closely to the jaw joint, so issues with the jaw joint may affect with the vestibular system.
People with symptoms of dizziness related to their teeth, their jaw, chewing, and things like that, can affect the inner ear and may cause dizziness.
The Lips
I usually ask people if they had a cold sore break out around their mouth or lips prior to the initial onset of vertigo.
A commonly overlooked cause of vertigo is a viral attack of the cold sore virus (herpes) on the inner ear.
The Ear
Hearing loss, ringing in the ears (tinnitus), and chronic ear infections can be related to dizziness and vertigo.
Middle ear infections can cause damage to the inner ear as well, if the bacteria or virus migrate inward towards the inner ear.
That’s what I had as a child also: chronic ear infections from swimmer’s ear, that left me with permanent vestibular problems in my inner ear.
The Neck and Headaches
One last thing that can cause dizziness is the entirety of the neck. This includes motion, muscle tenderness, and headaches.
If people get headaches, I want to know what part of their head hurts, and if lights or sounds make their head hurt worse.
Migraines are an often overlooked cause of dizziness and vertigo.
A Perfect Storm
All of those things really need to be looked at if we are going to figure out what causes dizziness. It is typically not just one reason.
Often it is many reasons, but a lot of times all of these aspects can all be addressed in different ways.
What I tell people when they come to me to be evaluated for their dizziness and vertigo is:
“I am confident we can reduce, if not completely eliminate your vertigo.”
With all of the different factors that can contribute, we have to determine root cause to develop a targeted treatment plan.
If you have symptoms of dizziness and vertigo, it may be best to seek help from a vertigo professional to get to the bottom of what causes your dizziness.
Disclaimer
This blog is provided for informational purposes only. The content is 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 I might see and do not describe the circumstances of a specific individual.
. I have had chronic vertigo since age 13. I’ve been to Mayo, Clev Clinic, Johns Hopkins. Tried crystal in ear maneuver, migraine diet (caffeine does worsen dizziness), balance therapy, and just about everything. My PCP truly believes it’s due to a concussion sustained during my many years playing soccer. I tend to agree the older I get with the studies that come out.
My recent episode, the dizziness was more like vertigo w seeing things move around me. It started last Saturday (9 days ago) very suddenly and very intense-ground started moving as I got out of the car. I fell and couldn’t walk. It scared me despite my experience with dizziness. I’ve been extremely dizzy ever since. I’m unable to go to work (I’m an RN). I have been getting what i call “lightning headaches” on the right side of my head 5/6 times a day. Very intense/painful headaches that last about 3 seconds. These began prior to experiencing the vertigo. I have pressure in the right ear and dull pain (no ear infection). Muscles in my neck, shoulders (everywhere) are extremely tight, They always have been-I have panic disorder.. I have been getting a hot feeling on the surface of my face/forehead and have recently had some blurry vision up close since this episode started.
I do have some mild congestion but nothing I would expect to cause this amount of dizziness. I can’t walk very far or move head in certain positions without it worsening significantly. Light seems to worsen headaches. Been taking zofran for nausea due to extreme dizziness, antivert (doesn’t help), mucinex, zyrtec when I don’t take antivert, saline nasal spray, flonase….anything I can think of to try to get rid of this. Did Epley maneuver out of desperation to try to get back to work. It’s not working. Any advice?
Please respond, thanks
Hi Lesley,
I am sorry for what you are going through.
Since you are a clinician, I will list off the first things that go through my mind in reading your story. This is not medical advice, but just general information for you to consider.
Concussions usually cause cervical problems as well due to the impact. That can explain a lot about your symptoms. I suggest that you find an upper cervical specialty provider. That would be either an orthopedic manual physical therapist who specializes in the spine or an upper cervical chiropractor.
Many people take anti-anxiety medication to get through a health crisis, especially if they have a panic disorder. Your doctor can advise you if that is right for you or not.
This blog is on anxiety and vertigo.
This blog is alleviating anxiety.
This blog is on the link between PTSD and vertigo.
I share about common pitfalls of trying to treat yourself in this blog, and reasons why the epley maneuver does not work in this blog.
For people with concussions, Vestibular Physical Therapy and upper cervical care are key components of rehab.
Two other treatments that can help people with post-concussion syndrome are neurofeedback and vision therapy.
To learn about Neurofeedback, you can check out this website hosted by one of my mentors, Nikki Sopchak. If you decide to rent a unit, please tell Nikki I referred you.
Vision therapy is supervised by a Neuro-optometrist. You should find one with the credentials OD, FCOVD. That consists of a binocular vision exam and exercises specific to your situation.
One thing for sure is that all of my post concussion patients required a team of specialty providers for their recovery. All of the treatments I mentioned can help with headaches as well.
I hope you feel better soon!
Sincerely,
Kim Bell, DPT
I have dizziness with normal blood test workup, not related to ear and eye problem.There ‘s a 2 mm plague in Carotid in yr. 2016.
I had C.T. scan of brain 6 months ago and normal. What tests should I go through please?
Is my dizziness related to the anti -hypertensive medication Losartan Possium?
Hi Anna,
These are very specific questions that must be directed to the healthcare providers who know your whole story and have evaluated you in person. The tests required are determined case by case.
You could certainly research the side effects of any medications you are taking by asking your pharmacist.
You can find a vestibular physical therapist using this blog.
Best wishes,
Kim Bell, DPT
Hi, my dad had a heart attack 2 years ago. He had quad by pass and thank gd all is okay. Around a year later he has terrible vertigo spells and recently he starts to pass out, get dizzy.
He has done all tests for vertigo( ears nose et ) he did tests on his heart to see that it’s all okay. He did gastroscope too. Now all tests are clear but he is still getting these dizzy spells and feels pressure in his upper stomach. Any ideas? Any help? Advice?
Hi Michelle,
I am glad he has been tested for the common medical causes of vertigo.
If this dizziness and pressure in his upper stomach is occurring after eating, you may want to check out this blog.
I hope he feels better soon!
Sincerely,
Kim Bell, DPT