Dizziness and Vertigo

Dizziness is a general term — it can mean light-headedness, unsteadiness, or the spinning sensation called vertigo. The cause matters: vertigo usually comes from the balance system (inner ear or brainstem), while non-spinning dizziness often comes from blood pressure, blood sugar, heart, medicines, or anxiety.

Red flags — dial 112

• Sudden severe vertigo with weakness, numbness, slurred speech, double vision, difficulty walking — rule out stroke of the brainstem/cerebellum.
• Sudden severe headache.
• Chest pain, breathlessness, palpitations.
• Fainting with injury; loss of consciousness without warning.
• Hearing loss with vertigo.

Common causes of vertigo (spinning)

• BPPV (Benign Paroxysmal Positional Vertigo) — brief spinning with head movements (turning in bed, looking up). Caused by loose inner-ear crystals. Treated in one visit with a head-positioning manoeuvre (Epley/Semont) — dramatic relief.
• Vestibular neuritis / labyrinthitis — sudden severe vertigo with nausea, lasts days, often post-viral.
• Ménière's disease — recurrent vertigo with hearing loss, tinnitus, ear fullness.
• Migraine-associated vertigo.
• Stroke of brainstem/cerebellum — red flags above.

Common causes of non-spinning dizziness

• Low BP on standing (orthostatic hypotension).
• Low blood sugar in diabetics.
• Heart rhythm abnormalities.
• Anaemia.
• Medicines — many BP, anxiety, anti-epileptic medicines.
• Dehydration, hot weather.
• Anxiety/panic.

Approach

• History and examination — often enough to identify cause.
• BP lying and standing; ECG; blood tests.
• Dix-Hallpike test for BPPV.
• MRI for suspected central cause.
• ENT or neurology referral as needed.

Treatment

• BPPV — positioning manoeuvre; teachable to the patient.
• Vestibular rehab — exercises retrain balance; excellent for chronic vestibular disorders.
• Medicines — short-term for severe vertigo (avoid long-term).
• Migraine treatment — for migraine-associated vertigo.
• Treat underlying cause — hydration, stop offending drug, manage heart/BP.