Dizzy spells - a common complaint with many possible causes

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This is such a common symptom and feedback from the website shows that this page is the third most often visited and so hence this update!

There are two approaches to analysing the cause of dizzy spells. The first is the entirely logical one and the second is the "common things are common" approach. So, let us go through the logical reasons why one may suffer from dizzy spells first.

Logical reasons for dizzy spells

By dizzy spells people can actually mean several different things. If by dizzy spells they mean that the world is spinning round, associated with nausea and hearing loss and noises in the ear, then this is suggestive of labyrinthitis, which may be caused by inflammation in the inner ear, or poor blood supply to the inner ear. Click on the link to see a very helpful article on the type of dizziness called Benign Paroxysmal Positional Vertigo. It contains a section on the Brandt-Daroff exercises, which can be done by the sufferer at home. I give them at the bottom of this page. If you highlight the exercise section in the web page, you will be able to hear the instructions read out via your speakers. In this page BPPV for patients aimed at sufferers you will find information about the inner ear and what may go wrong there.

However, the vast majority of dizzy spells are not due to inner ear pathology. These cases of dizziness result either from poor fuel supply to the brain, or poor oxygen supply to the brain, or both combined.

Causes of poor FUEL supply to the brain (oxygen supply OK)

See -

Causes of low OXYGEN in the blood (fuel supply OK)

  • Respiratory failure – obviously if the lungs do not work properly then oxygen tensions will be low. This only occurs in severe advanced respiratory disease (chronic obstructive airways disease, pulmonary embolus, collapsed lung, lungs full of fluid, cancer etc) and is accompanied by severe shortness of breath.
  • Hyperventilation – in hyperventilation, the rate of respiration is too fast. When this occurs carbon dioxide is washed out of the blood, which changes the acidity in such a way that oxygen sticks more avidly to haemoglobin. So oxygen levels in the blood as measured are fine, but this oxygen cannot be released at the tissue levels, where it is needed. See Hyperventilation for further details.
  • Carbon monoxide poisoning – here the mechanism for low oxygen is the same as for hyperventilation. Interestingly carbon monoxide is also produced when the metabolism is stressed, i.e. one does not have to be exposed to carbon monoxide from the outside world to suffer CO poisoning. See Carbon Monoxide Poisoning
  • Patent foramen ovale This, according to Cheney, is present in 90% of patients with CFS. It explains sudden worsening of symptoms, including feeling dizzy and acute fatigue, following a fairly minor stress. See Patent foramen ovale as a cause of fatigue

Causes of poor fuel and oxygen supply - i.e. poor blood supply

"Common things are common" - common causes of dizziness

My experience is that the commonest causes of dizzy spells in order of likelihood are:

  • Hypoglycaemia.
  • Dehydration and mineral deficiency
  • Prescription medication and other such poisonings!
  • Low blood pressure due to low cardiac output
  • Lack of sleep
  • Hyperventilation - usually occurs with panic attacks. Most people who hyperventilate don't think they are!
  • Poor thyroid and/or adrenal function

Brandt-Daroff exercises

Brandt-Daroff exercises: these were developed as a series of home exercises to loosen and disperse inner ear debris.

  • Sit on the side of bed with their head rotated 45° to one side.
  • Close eyes to minimise vertigo.
  • Quickly lie down to the opposite side until the head touches the bed (if the head is turned to the left, lie on the right side), nose up and lateral occiput resting on the bed.
  • Stay in this position for 30 seconds then sit up.
  • Turn head to the other side and repeat on the opposite side.

One session should include five or six repetitions to each side; repeat three times daily until free of vertigo for at least 48 hours.

See Brandt-Daroff Exercises for details of these exercises.[NB - The UK NHS usually prescribes Brandt Daroff for the treatment of Benign Paroxysmal Positional Vertigo (BPPV), specifically, but these exercises can help all forms of vertigo.]
See also YouTube - Brandt-Daroff habituation exercise

Could it be POTS?

See -

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