Dizziness – all you need to know

Do you sometimes feel that you or the world around you are spinning and wonder what on earth is going on? You are not alone.

Three in ten people aged 60-plus complain of persistent dizziness, which often remains unexplained despite specialist assessment. 

Dizziness increases as we age

Feeling dizzy, lightheaded or off balance are usually signs of 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’s 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 the Royal Infirmary of Edinburgh.

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. 

We’re better at treating dizziness now

Dizziness and balance problems have until recently often been poorly recognised and treated. However, a new discipline called neuro-otology is helping to highlight them and there is an increasing number of vestibular rehabilitation services. 

"By far the most common cause [of dizziness] in older people is benign paroxysmal positional vertigo (BPPV)," says physiotherapist Tom Wright, who runs a falls prevention service at the East Sussex Healthcare NHS Trust. 

What exactly is BPPV?

"It’s when small crystals get stuck in the semicircular canals in the ear and stop them working properly to maintain balance," says Wright.

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 in the neck, which is untrue," says Professor Stone.

"Although many more doctors are now aware of BPPV, knowledge catches up slowly so people can still be misdiagnosed."

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.

What else causes dizziness in later life?

Another common cause 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. 

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.
• Side effects of medication, such as anti-epilepsy and blood pressure lowering drugs, tranquillisers, sleeping pills, and drugs to reduce anxiety or depression.
• Dizziness can also be a feature of Long Covid or ME/chronic fatigue syndrome. 

Then there are conditions that affect one or more of the senses needed for balance – including Parkinson’s, MS, stroke, heart disease and diabetes. But dizziness won’t be the only symptom for these.

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 they are 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."

Tips for tackling dizziness

1. Slim down your prescription

Taking three or more medications (known as polypharmacy) is linked to an increased risk of dizziness and falls.

Ask your GP or pharmacist for a medicines review to work out if you still need all your medication.

2. Eye exercises can help

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, including teaching you to do an Epley manoeuvre if you have BPPV.

"I wish more people with BPPV realised how easy it is to learn the Epley manoeuvre themselves," says Professor Stone. "A huge amount of unnecessary worry and suffering could be relieved if people learn about this one thing, so do ask your GP about it."

3. Maintain muscle strength

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) training or whole-body weight exercises twice a week.

A 2021 study found that Pilates was effective.

4. Foot health can make a difference

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. Check your heart and circulation

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.