Dizziness
Breakthrough Findings on Dizziness
Jeffrey P. Staab, MD
University of Pennsylvania Health System
magine waking up in the morning and deciding what to do that day based on how dizzy you feel. Are you stable enough to walk down the stairs... drive a car... lift your grandchild? Now imagine that doctors have told you they could not find a cause and there was nothing more they could do to help.
Up to 15 million people in the US have recurrent episodes of dizziness, and about 3 million feel dizzy nearly every day. These are not cases of mild light-headedness, but true dizziness that can affect a person's ability to work, shop, take care of his/her family and perform other daily tasks.
Latest development: New research is enabling doctors to properly diagnose nearly everyone who suffers from chronic dizziness -- and offer treatments that may eliminate or significantly reduce symptoms.
WHAT IS DIZZINESS?
Two main categories of dizziness...
Vertigo. People with vertigo experience "rotary motion" -- they feel that they are spinning or tumbling or that the world is spinning around them. Vertigo is caused by a problem in the inner ear or in the balance center of the brain.
The most common causes of vertigo are relatively easy to diagnose. They include benign paroxysmal positional vertigo (BPPV), in which calcium crystals in the inner ear break loose and enter one of the semicircular canals that help with balance... viruses that infect the vestibular nerve (which carries balance and coordination signals to the brain) or the inner ear... and Ménière's disease (which is associated with abnormal buildup of fluid in the inner ear). A physical exam, balance function tests and a magnetic resonance imaging (MRI) or computed tomography (CT) scan of the brain may be needed to diagnose the specific cause of vertigo.
No vertigo. Some patients develop chronic dizziness without ever having vertigo. Others have had bouts of vertigo in the past but now have chronic dizziness with no vertigo. In both cases, there may be no overt signs of inner ear damage or disease.
In the last few years, a condition called chronic subjective dizziness (CSD) has been described in medical literature to help doctors understand patients who have persistent dizziness without vertigo. People with CSD have a sense of being unsteady, swaying or rocking, but not spinning. They are sensitive to motion -- they can feel dizzy when they are physically active... or even in a mall or crowded party, where there is a great deal of visual stimuli.
HIDDEN CAUSES OF DIZZINESS
Until recently, about 25% to 30% of people with chronic dizziness were considered medical mysteries, and their dizziness went untreated because no definite physical cause could be found.
Now: A February 2007 study of 345 people with CSD found that all of these cases were due to one of the following causes...
Anxiety-related hypersensitivity to motion cues. Sudden episodes of dizziness can be caused by a physical illness, such as those described above, or a psychiatric condition, such as a panic disorder.
Patients who experience acute attacks of dizziness may develop hypersensitivity to motion cues -- that is, they become cautious about their own movements and hypervigilant about the motion of objects around them. Motion hypersensitivity may last for many years, even after the problem that triggered the original symptoms has resolved.
Migraine. In migraine sufferers, dizziness can occur before, during or after the headache. Some migraine patients don't experience severe headaches but rather a sensation of pressure in the head or behind the eyes.
Mild concussion. A mild concussion is a head injury that does not cause visible physical damage to the brain but is characterized by headache, moodiness, dizziness, confusion and/or memory problems. In this case, the dizziness is thought to be due to fraying of the nerve connections in the brain that regulate balance.
Autonomic dysfunction (dysautonomia). As we get older, our autonomic nervous system, which regulates such vital functions as breathing and heartbeat, begins to function less efficiently, and we lose the ability to adjust to the effects of gravity on blood flow. When we change position, such as when getting out of bed, gravity pulls our blood toward our feet.
The autonomic nervous system counteracts this effect, preserving blood flow to the brain and other vital organs. But people with autonomic dysfunction become dizzy when they get up quickly or stand for long periods of time.
Heart problems. Disturbance of heart rhythms (arrhythmias) may cause dizziness, usually in spells lasting for minutes to hours. People who experience episodic (not constant) feelings of dizziness, along with palpitations (a rapid or fluttering heartbeat) and shortness of breath, should be evaluated as soon as possible for heart problems.
BEST TREATMENTS
Research shows that three treatments can reduce or eliminate dizziness in most people who experience CSD...
Antidepressant medication. Selective serotonin reuptake inhibitors (SSRIs) -- such as fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft) -- can decrease or eliminate dizziness, even in people who don't feel depressed or anxious. These medications may work by reducing activity in parts of the brain that promote motion sensitivity.
Physical therapy. A special treatment called vestibular and balance rehabilitation therapy (VBRT) helps patients identify movements and situations that trigger their symptoms. A specially trained physical therapist can develop a plan that includes a variety of movements designed to improve balance reflexes and decrease sensitivity to motion. To find a physical therapist trained in VBRT, consult the neurology section of the American Physical Therapy Association (800-999-2782, www.neuropt.org).
Cognitive behavioral therapy (CBT). Cognitive behavioral therapists can help patients counteract worries about the consequences of being dizzy and resume a more normal lifestyle. To find a CBT practitioner, consult the American Psychological Association (800-964-2000, http://locator.apa.org).
Bottom Line/Health interviewed Jeffrey P. Staab, MD, attending psychiatrist at the University of Pennsylvania Health System's Balance Center in Philadelphia. Dr. Staab was a contributing writer for The Consumer Handbook on Dizziness and Vertigo (Auricle Ink) and has published more than 30 journal articles on dizziness and anxiety.
Jeffrey P. Staab, MD
University of Pennsylvania Health System
magine waking up in the morning and deciding what to do that day based on how dizzy you feel. Are you stable enough to walk down the stairs... drive a car... lift your grandchild? Now imagine that doctors have told you they could not find a cause and there was nothing more they could do to help.
Up to 15 million people in the US have recurrent episodes of dizziness, and about 3 million feel dizzy nearly every day. These are not cases of mild light-headedness, but true dizziness that can affect a person's ability to work, shop, take care of his/her family and perform other daily tasks.
Latest development: New research is enabling doctors to properly diagnose nearly everyone who suffers from chronic dizziness -- and offer treatments that may eliminate or significantly reduce symptoms.
WHAT IS DIZZINESS?
Two main categories of dizziness...
Vertigo. People with vertigo experience "rotary motion" -- they feel that they are spinning or tumbling or that the world is spinning around them. Vertigo is caused by a problem in the inner ear or in the balance center of the brain.
The most common causes of vertigo are relatively easy to diagnose. They include benign paroxysmal positional vertigo (BPPV), in which calcium crystals in the inner ear break loose and enter one of the semicircular canals that help with balance... viruses that infect the vestibular nerve (which carries balance and coordination signals to the brain) or the inner ear... and Ménière's disease (which is associated with abnormal buildup of fluid in the inner ear). A physical exam, balance function tests and a magnetic resonance imaging (MRI) or computed tomography (CT) scan of the brain may be needed to diagnose the specific cause of vertigo.
No vertigo. Some patients develop chronic dizziness without ever having vertigo. Others have had bouts of vertigo in the past but now have chronic dizziness with no vertigo. In both cases, there may be no overt signs of inner ear damage or disease.
In the last few years, a condition called chronic subjective dizziness (CSD) has been described in medical literature to help doctors understand patients who have persistent dizziness without vertigo. People with CSD have a sense of being unsteady, swaying or rocking, but not spinning. They are sensitive to motion -- they can feel dizzy when they are physically active... or even in a mall or crowded party, where there is a great deal of visual stimuli.
HIDDEN CAUSES OF DIZZINESS
Until recently, about 25% to 30% of people with chronic dizziness were considered medical mysteries, and their dizziness went untreated because no definite physical cause could be found.
Now: A February 2007 study of 345 people with CSD found that all of these cases were due to one of the following causes...
Anxiety-related hypersensitivity to motion cues. Sudden episodes of dizziness can be caused by a physical illness, such as those described above, or a psychiatric condition, such as a panic disorder.
Patients who experience acute attacks of dizziness may develop hypersensitivity to motion cues -- that is, they become cautious about their own movements and hypervigilant about the motion of objects around them. Motion hypersensitivity may last for many years, even after the problem that triggered the original symptoms has resolved.
Migraine. In migraine sufferers, dizziness can occur before, during or after the headache. Some migraine patients don't experience severe headaches but rather a sensation of pressure in the head or behind the eyes.
Mild concussion. A mild concussion is a head injury that does not cause visible physical damage to the brain but is characterized by headache, moodiness, dizziness, confusion and/or memory problems. In this case, the dizziness is thought to be due to fraying of the nerve connections in the brain that regulate balance.
Autonomic dysfunction (dysautonomia). As we get older, our autonomic nervous system, which regulates such vital functions as breathing and heartbeat, begins to function less efficiently, and we lose the ability to adjust to the effects of gravity on blood flow. When we change position, such as when getting out of bed, gravity pulls our blood toward our feet.
The autonomic nervous system counteracts this effect, preserving blood flow to the brain and other vital organs. But people with autonomic dysfunction become dizzy when they get up quickly or stand for long periods of time.
Heart problems. Disturbance of heart rhythms (arrhythmias) may cause dizziness, usually in spells lasting for minutes to hours. People who experience episodic (not constant) feelings of dizziness, along with palpitations (a rapid or fluttering heartbeat) and shortness of breath, should be evaluated as soon as possible for heart problems.
BEST TREATMENTS
Research shows that three treatments can reduce or eliminate dizziness in most people who experience CSD...
Antidepressant medication. Selective serotonin reuptake inhibitors (SSRIs) -- such as fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft) -- can decrease or eliminate dizziness, even in people who don't feel depressed or anxious. These medications may work by reducing activity in parts of the brain that promote motion sensitivity.
Physical therapy. A special treatment called vestibular and balance rehabilitation therapy (VBRT) helps patients identify movements and situations that trigger their symptoms. A specially trained physical therapist can develop a plan that includes a variety of movements designed to improve balance reflexes and decrease sensitivity to motion. To find a physical therapist trained in VBRT, consult the neurology section of the American Physical Therapy Association (800-999-2782, www.neuropt.org).
Cognitive behavioral therapy (CBT). Cognitive behavioral therapists can help patients counteract worries about the consequences of being dizzy and resume a more normal lifestyle. To find a CBT practitioner, consult the American Psychological Association (800-964-2000, http://locator.apa.org).
Bottom Line/Health interviewed Jeffrey P. Staab, MD, attending psychiatrist at the University of Pennsylvania Health System's Balance Center in Philadelphia. Dr. Staab was a contributing writer for The Consumer Handbook on Dizziness and Vertigo (Auricle Ink) and has published more than 30 journal articles on dizziness and anxiety.
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