Dizziness (incl. BPPV)

If spinning dizziness lasting twenty minutes to hours comes each time with a feeling of pressure, a rushing and fluctuating hearing on the same side, that has a name of its own and a treatment of its own. Without those ear symptoms it is something else.

If everything spins and nausea follows, the origin usually lies in the balance organ, not in the stomach. The nausea is then a consequence — and it is the dizziness that is treated.

Sit upright on the bed, turn the head 45 degrees towards the affected side, lie back quickly with the head slightly over the edge, wait 30 seconds; then turn the head 90 degrees to the other side, another 30 seconds; then roll body and head further in the same direction until you look at the floor, another 30 seconds; sit up slowly. Repeat two to three times, over several days.

Sit up in bed first, stay sitting for 30 seconds, tense the calves a few times, then stand. If things go black, sit or lie down at once and raise the legs.

A large glass of water right after waking, drink enough across the day, salt food normally; if prone to going black, cross the legs and tense the muscles.

In positional vertigo the attack lasts under a minute and is set off by a head movement — that short time course is the identifying mark. In a Menière attack it is twenty minutes to twelve hours, in nerve inflammation days. The repositioning manoeuvre works in about eighty out of a hundred people after one to three runs; in about one in three it returns within a year.

Vertigo drugs such as betahistine or dimenhydrinate damp the balance organ — that eases the nausea but delays the brain’s adaptation, which is why they are given for only a few days. In positional vertigo they do not help at all: there a repositioning manoeuvre settles it in one to three runs, because the crystal is moved back into place. No medicine can replace that.

A swaying that comes and goes with head position is often blamed on the neck. Positional vertigo, by contrast, spins hard, lasts seconds to a minute and is triggered by lying down or turning in bed — not by holding the head. The difference decides the route: one is fixed with a manoeuvre, the other with movement.

A carousel feeling points to the balance organ, going black and empty in the head to the circulation, unsteadiness without spinning to nerves and legs. This first question sorts the whole field.

Seconds on lying down and turning over: crystals in the balance organ. Minutes: circulation or blood supply. Hours with hearing loss and pressure in the ear: Menière. Days on end: inflammation of the balance nerve. The duration is the second signpost.

Getting up from lying, turning the head in bed, looking up at a shelf, straightening after bending. These triggers are so characteristic that they often provide the classification.

Double vision, disturbed speech, trouble swallowing, numbness or weakness of one side of the body, a sudden severe headache, being unable to walk or sit. That belongs in hospital at once.

Blood pressure drugs, water tablets, sleeping and calming tablets, certain antibiotics, antidepressants and alcohol. In older people that is the most common treatable cause of all.

Anaemia can cause dizziness and light-headedness.

Without B12 the insulating layer of the nerves is not maintained. A lack causes tingling, numbness and unsteadiness in the dark — and it is one of the few reasons for nerve trouble that can be fully undone if found early.

Makes sure the muscle lets go again after tensing. A lack favours cramps, twitching and inner restlessness — and the blood value reflects the store poorly.

The nerves cover their energy needs through thiamine. It runs short with alcohol, after stomach operations, with long-lasting vomiting and under water tablets.

Sets the excitability of muscle and nerve. A low value causes weakness and cramps, a high one is dangerous for the heart rhythm — here one measures rather than guesses.

Here both count: a lack harms the nerves, and too high an intake over months harms them as well. Supplements therefore belong taken in a dose that has a reason.

Studied in positional vertigo: in a larger trial people with a low level had fewer relapses on vitamin D and calcium — 20–50 µg (800–2000 IU) a day over months. It does not act on the acute attack; there the repositioning manoeuvres do.

For dizziness from the inner ear, 240 mg a day over 12 weeks was compared with a medicine and was similarly effective. It influences clotting — on blood thinners that belongs discussed.

Anaemia causes blacking out on standing, not spinning. The difference between the two is the single most important question — it decides where to look.

Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.

Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.

Blacking out on standing is not spinning vertigo. This hormone holds salt and water in the circulation — which is why more salt and more fluid helps there, while it achieves nothing with positional vertigo.

Positional vertigo occurs distinctly more often in women after menopause — the same crystals that come loose are made of calcium carbonate. The link with bone metabolism is described.

A low blood sugar causes dizziness, trembling and sweating — but concerns almost only people on insulin or certain diabetes tablets. In everyone else it is a rare explanation.

Dizziness on standing often has a simple cause: too little to drink. 1.5–2 litres a day, more in heat. In positional vertigo drinking changes nothing — that comes from the inner ear.

Anaemia and B12 deficiency cause light-headedness described as dizziness. Both are measurable and correctable — worth checking before any further search.

In positional vertigo a simple manoeuvre often ends the problem in one session.

Balance training speeds up the adaptation after a nerve inflammation.

Traditional and well studied for nausea with dizziness.

At the crown; in TCM the point that orders upward — for dizziness and light-headedness.

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Listed values: 60 Hz