Neurologist reveals what could be causing your dizzy spells… and what you can do to stop the world spinning

Millions of Britons suffer from dizziness that lasts months or even years — with many of them struggling to obtain a correct diagnosis or access treatment which could quell the disorientating sensation.

Patients with the condition complain of being off-balance, giddy, light-headed or faint.

The feeling is common, but for most it goes away within days.

However research suggests that more than two million Britons are living with chronic dizziness.

GPs admit that when a patient comes to see them complaining of dizziness it is a ‘heart sink moment’.

‘It is challenging when a patient comes in with dizziness symptoms,’ says Dr Dean Eggitt, a Doncaster based GP.

‘Your heart does sink a little, as without an easy explanation it can be hard to work through all the possible causes while the patient still suffers with the symptoms.’

Dizziness experts say that patients should not be fobbed off without an explanation.

‘Patients are often told that their symptoms can not be treated, but this is not the case. Common causes of dizziness are often overlooked,’ says Dr David Herdman an expert in the condition from University College London and private clinician.

‘This means that patients often have to see a number of clinicians, waiting months or even years to get an adequate diagnosis.

‘If a patient has been stuck with unexplained dizziness, it is important for them to know that long-standing dizziness can improve and it is worth persevering.’

Experts say that patients must be aware of the common conditions which are often forgotten but can cause debilitating symptoms.

So here is our expert guide on the possible causes of chronic dizziness.

Persistent Postural Perceptual Dizziness

A ‘hidden’ cause of dizziness, persistent postural perceptual dizziness (PPPD), is undiagnosed in thousands according to experts.

Key symptoms of the condition are dizziness and unsteadiness most days for three months. It is exacerbated by being upright, walking or being in a busy environment.

Symptoms will usually improve if sitting in a quiet area or lying down, but not always.

The condition often begins after a short term bout of dizziness or vertigo caused by an infection for example. The brain adapts to become hyper vigilant to help the body adapt to this temporary state.

However, if that state becomes locked in after the temporary change to the ear has passed it leads to PPPD.

Research shows that one in five patients referred to Ear Nose and Throat specialists for a diagnosis, have PPPD. With patients waiting an average of two years for the diagnosis.

‘This is an often overlooked cause of dizziness, because it is not functional — there is no damage to the brain or ear,’ says Dr Herdman.

‘This means that scans will come back clear, so doctors sometimes believe that there is a mismatch between the symptoms that the patient is describing and what they see.

‘That does not mean though it is all in the mind, it can be a very disabling condition and is the most common condition we see in patients with chronic dizziness.’

Luckily it can be treated through a combination of physiotherapy or cognitive behavioural therapy. Sometimes patients are also prescribed SSRI’s commonly used to treat depression, to help rid them of the condition.

Benign Paroxysmal Positional Vertigo

Another common cause of chronic dizziness, is benign paroxysmal positional vertigo.

Our sense of movement and balance is controlled by a system inside the inner ear of tiny fluid-filled channels, including a chamber — the labyrinth — that connects with three semi-circular canals.

The canals are lined with hair-like sensors that send messages about head movements to the brain.

The vestibule also contains tiny crystals and BPPV occurs when a tiny fragment of crystal moves into one of the semi-circular canals.

This then brushes against the hair sensors, which send false messages to the brain that the head has moved.

This condition is more common in patients over 65, and unlike PPPD the patient is unlikely to experience vomiting.

It is characterised by sudden onset, short periods of intense dizziness and is often triggered by head movements.

‘There are very specific symptoms that would suggest that a patient is suffering with BPPV,’ says Dr Herdman.

‘This would be symptoms — often short lived episodes less than a minute — that are triggered by looking up or bending down or common on when lying down. It is also a common cause of falls in older adults.’

The condition is treated through manipulation by a physiotherapist. This is done using a simple treatment called the Epley Manoeuvre, which involves contorting the head through a series of poses.

Although some experts say that this condition is often over-diagnosed in primary care and warn patients, they must make sure that the correct test is performed before BPPV is given as the answer.

The dix-hallpike manoeuvre is the gold standard for diagnosing BPPV, the procedure involves the patient lying down and their head being tilted 45 degrees.

‘We often see patients who have been diagnosed with BPPV, particularly those under 65, but have never had this test,’ says Dr Diego Kaski, a neurologist and dizziness expert at University College London.

‘As a result many patients are left suffering with their chronic dizziness.’

Low blood pressure

AN easy to diagnose cause of dizziness, is often missed by GPs according to specialists.

Low blood pressure can cause light-headedness, blurred vision and fatigue as well as dizziness.

‘This is a really common cause of dizziness that we see in clinic,’ says Dr Diego Kaski. ‘And really it should have been diagnosed before someone is referred to us.

‘Often it is mistaken for BPPV but if a patient is suffering dizziness, particularly if it is triggered by sitting or standing up then blood pressure should be checked.’

Lifestyle changes such as increasing salt intake, consuming more fluids and compression stockings may help; while some patients may be prescribed medication to increase blood pressure.

Deficiencies

Deficiencies in vitamin B, vitamin D, magnesium and iron, as well as excessive caffeine consumption can also cause dizziness.

‘This is a really important one to assess when a patient comes in with dizziness symptoms,’ says Dr Eggitt. ‘As it means a specialist referral to ENT is likely not appropriate and it could be easily fixed with supplements or diet changes.

‘One of the common ones we see is iron deficiency in young women, who are menstruating, and have dizziness.

‘Deficiencies are often easy to spot as a doctor but not something that a patient often considers to be the cause.’