In a spin: dizziness causes and treatments

Do you sometimes feel that you or the world around you are spinning and wonder what on earth’s going on? You are not alone. Three in ten people aged 60-plus complain of persistent dizziness, which often remains unexplained despite specialist assessment, according to a study reported at a recent conference. The results showed this was partly caused by damage to small blood vessels in nerve fibres found deep in the brain.

Feeling dizzy, lightheaded or off balance are usually signs of so-called vestibular disorders, problems with parts of our inner ear and brain that process incoming sensory cues and control balance and eye movement. Such problems are increasingly common as we get older; our ageing society probably explains why they’re on the rise.

But while the cause of dizziness is rarely life threatening, it is not an inevitable part of ageing so it is important to get it checked out. ‘A bad episode of vertigo or lightheadedness, especially if someone has a fall or near fall, can be scary and affect confidence and quality of life,’ says consultant neurologist Professor Jon Stone from Edinburgh’s Royal Infirmary.

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This is borne out by a 2021 Swedish study, which found that 54% of participants, average age 79, complained of dizziness. They took more medication, experienced greater fatigue, walked more slowly, were more afraid of falling and rated their overall health worse than those unaffected.

Dizziness and balance problems have until recently often been poorly recognised and treated. But a new discipline called neurotology is helping to highlight them and there is an increasing number of vestibular rehabilitation services. Physiotherapist Tom Wright runs a falls prevention service at the East Sussex Healthcare NHS Trust. He says, ‘By far the most common cause in older people is benign paroxysmal positional vertigo (BPPV), when small crystals get stuck in the semicircular canals in the ear and stop them working properly to maintain balance.’

One study found that the over-60s were seven times more likely to be affected by BPPV than 18-39s. The risk is raised by diabetes and/or vitamin D deficiency, head injury or whiplash.

‘Sufferers experience episodes of spinning, usually when rolling over in bed or looking up,’ says Professor Stone. During these bouts they often experience nystagmus – rapid, involuntary eye movements when the eyes visibly jump or twitch.

Unfortunately, GPs often misdiagnose BPPV as labyrinthitis, infection of the inner ear, and prescribe antihistamines that don’t tackle the underlying problem and can even make matters worse. ‘Back in the 1980s and 1990s doctors were taught that this kind of vertigo was due to squashing of the arteries, which is untrue. Although many more doctors are now aware of BPPV, knowledge catches up slowly so people can still be misdiagnosed,’ says Professor Stone.

A simple repositioning technique called the Epley manoeuvre that clears crystals out of the ear canals can be effective and often works in just one session, says Wright. Essentially, it’s a specific sequence of head and neck movements that you do while lying in various positions, guided by a physio. It’s increasingly offered at physiotherapists and GPs, as well as ENT and neurology professionals.

There are many other causes of dizziness in later life. Another common one is vestibular migraine, an underdiagnosed condition that often doesn’t cause a headache but may involve a visual aura and/or light and sound sensitivity. Then there are conditions that affect one or more of the senses needed for balance – including Parkinson’s, MS, stroke, heart disease, diabetes and high blood pressure.

A condition called multisensory dizziness – presbyequilibrium or presbyvestibulopathy (PVP) – caused by age-related decline in the eyes, ears and nervous system, is another potential culprit in people in their eighties and nineties. Other causes include postural hypotension, a sudden fall in blood pressure when you stand up, often because of dehydration, an irregular heart rhythm or side effects of medication, such as anti-epilepsy and blood pressure lowering drugs, tranquillisers, sleeping pills, and drugs to reduce anxiety or depression. Dizziness has also been reported to be a common neurological manifestation of Covid and can be a feature of Long Covid.

The good news is that vestibular rehabilitation – specially tailored head, neck, eye and balance exercises – is effective for many types of dizziness (but not if it is heart related or medication induced) and can restore quality of life, although it doesn’t always provide a complete cure. Life for dizziness sufferers is finally looking up, says Professor Stone: ‘Although there is still lack of awareness, things are now improving as doctors become aware of how treatable many of the causes of dizziness are.’

"I crawled into bed and stayed for two days"

Four years ago Anna Smith, 71, experienced an intense bout of dizziness and nausea while walking upstairs. She got to the bathroom but once there couldn’t stand for fear of falling, lying on the floor for two hours.

‘Every time I moved my head, I experienced this terrible spinning. Eventually I managed to crawl into bed where I stayed for two days. If I moved my head the spinning would kick in and my eyes were jumping,’ says the former further education teacher from Hove.

‘Initially my GP thought I might have an inner ear infection and prescribed sea sickness tablets, which I decided not to take as I wanted to tackle the root cause, rather than the symptoms. I couldn’t walk in a straight line and could only stand if I had something to hold on to. I had to cancel all my usual activities – the gym, a Charleston class, my art group and other social events. My symptoms began to ease after a week but by then my confidence had taken a battering.

‘Eventually I went online and discovered my symptoms were typical of benign paroxysmal positional vertigo (BPPV). I found a local physiotherapist who came to my house, tested me and then performed the Epley manoeuvre, which involved moving my head in a set sequence to dislodge the offending crystals.

‘I had to stay still for the rest of the evening but when I woke next morning I was no longer dizzy – it was a brilliant feeling. I know BPPV can return but I’ve now learned how to do the manoeuvre online so if it comes back I’ll know what to do.’

7 ways to help yourself

1. SLIM DOWN YOUR PRESCRIPTION Taking three or more medications (polypharmacy) is linked to an increased risk of dizziness and falls. Ask your GP or pharmacist if you still need your medication.
2. KEEP AN EYE ON IT What experts call gaze stability – the ability of eyes to stay fixed on a stable point when the head is moving – is vital for balance. Vestibular rehabilitation specialists can suggest exercises tailored to you.
3. MUSCLE UP Strong muscles help you act on the messages your brain receives from your eyes, joints and movement centres in the brain. Aim to do strength (resistance) or whole body weight exercises twice a week. A 2021 study found that Pilates was effective.
4. WATCH YOUR STEP Poor circulation and arthritic changes can make you unsteady on your feet. See the podiatrist or chiropodist regularly. Choose firm, supportive well-fitting shoes.
5. TAKE HEART Heart and circulatory problems can cause vertigo or light headedness, especially in people with diabetes. Check with your GP.
6. EAT AND DRINK WELL Low blood glucose caused by skipped or irregular meals and dehydration can cause dizziness.
7. STAY ACTIVE Exercise and regular physical activity is the best way to restore function of the vestibular system. The Otago exercise system designed to challenge balance is especially effective. See Later Life Training

Try these other simple ways to reduce dizziness

Useful contacts

The Association for Chartered Physiotherapists Interested in Vestibular Rehabilitation
Brain & Spine Foundation
For more on orthostatic hypotension, visit stopfainting.com

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