If you are experiencing a medical emergency, please call 911 or seek care at an emergency room.
Feeling dizzy can be scary—and rightfully so. We see many patients in the emergency department or urgent care seeking medical attention to determine the cause and the cure for their dizziness.
Dizziness comes in two forms:
- Lightheadedness, which can lead to fainting
- Vertigo, when patients feel a disturbing sense of motion or that the room is spinning
Both types are alarming to experience, and both can be either relatively harmless or a symptom of a more serious condition.
Lightheadedness, or the feeling you are going to faint, is caused by lack of blood flow to the brain—even momentary—for a variety of reasons. A common cause is the vasovagal response . That’s when your body responds to a scary, painful, or emotional situation by dropping your heart rate and blood pressure. We see this when a patient gets lightheaded while having blood drawn or faints when they see their loved one in the intensive care unit.
A more concerning reason for lightheadedness is low blood pressure caused by anemia (low blood count) or dehydration (from vomiting, diarrhea, or fever). This is most noticeable to the patient when he or she moves from lying or sitting to a standing position and feels lightheaded—with the gravity challenge of standing up, it takes a few extra seconds to get enough blood flow to the brain and fainting or near-fainting can be the result. The other serious but rare cause of lightheadedness is abnormal heart rhythm. If the heart rate (pulse) is way too fast or way too slow, it can’t generate enough blood pressure to get good blood flow to the brain.
What to do if you feel lightheaded
If you feel like you might faint (lightheaded, flushed, nauseated, or like you “need some air”), you very well might faint if you don’t get more blood flow to the brain immediately. To achieve that, lie down with your head even with your heart. Always be cautious—it’s better to see the doctor than to risk an injury from falling.
When to see the doctor about fainting or lightheadedness
If you actually faint, if the lightheadedness persists more than a few minutes, or if you have any chronic medical problems (especially any history of heart trouble), you should see a doctor immediately. If you are a young, healthy person and you experience momentary lightheadedness that goes away immediately, you are probably OK to be checked out soon at your doctor’s office.
The doctor can determine whether there is a concerning cause of your symptoms by asking about your symptoms in detail and examining you. The doctor can check your heart with an ECG and perform lab work or imaging if necessary. Depending on the doctor’s assessment, you could need a variety of interventions, from simple reassurance to IV fluids, blood transfusion, and/or admission to the hospital for further evaluation.
Vertigo is a less common type of dizziness, but we see it frequently in the emergency department and urgent care settings because it is often very disturbing to patients, and it usually starts without warning. Vertigo is the sensation of movement when there is no movement. It can range from mild seasickness to a feeling that the room is spinning to loss of balance. It can come from either the inner ear (peripheral vertigo) or the brain (central vertigo). Because the two types can feel the same, and because central vertigo can have a serious cause, vertigo warrants a doctor’s visit.
The most common cause of vertigo by far is benign peripheral vertigo (BPV), which is a malfunction of the balance mechanism inside the ear. It causes problems when you move your head quickly, sending a nerve signal to your brain that your head is moving or spinning when it is not. This can be nauseating and can even cause vomiting.
BPV can happen to people of all ages and has no known risk factors—frankly, most cases are just bad luck. The inner ear balance mechanism can be damaged by longstanding diabetes or by a chronic degenerative condition called Meniere's disease. But usually, the dizziness in those cases arises more gradually over time. Dizziness from BPV is harmless, and episodes pass quickly as long as you keep your head steady for a minute or so when symptoms arise. Overall, the symptoms can last from as short as one to three days or as long as up to two weeks.
Central vertigo is much less common than peripheral, and it is much more serious. It is called central because it arises from the brain, which is part of the central nervous system. Central vertigo produces the same sensation as BPV, but it is usually more severe, is not brought on by moving your head, does not go away when you keep your head still, and often affects balance to the point where it is difficult to walk. Unlike BPV, central vertigo can have sinister causes, such as stroke, brain tumor, or bleeding in the brain. Risk factors include older age, high blood pressure, high cholesterol, diabetes, and taking blood thinners.
What to do if you experience vertigo
Keep your head as still as possible to reduce the abnormal messages from your ear. Closing your eyes also might help.
When to see the doctor about vertigo
If the dizziness persists for more than 10 minutes, get to a doctor right away. Call 911 if you are elderly, have a severe headache, or have risk factors for stroke such as high blood pressure, history of stroke, or heart problems. Any vertigo requires a medical assessment because it can be difficult for the patient to determine peripheral from central vertigo.
The doctor will ask key questions and do a thorough physical exam to determine whether you are having peripheral or central vertigo. People who are diagnosed with BPV might be prescribed meclizine, a mild medication that alleviates symptoms by essentially hiding vertigo from the part of the brain that is experiencing it. Additionally, there is a technique called the Epley maneuver, in which a doctor moves a patient’s head in a series of positions in an attempt to reset the inner ear balance mechanism and restore functionality. If patients have persistent vertigo, we can refer them to an otolaryngologist (ear, nose, and throat doctor) for additional testing.
If the diagnosis is possible central vertigo, patients who see us have access to doctors and nurses who participate in the National Institutes of Health (NIH) stroke program, which provides oversight for clinical trials to develop treatments for neurological disorders and stroke. These clinicians are experts in diagnosing central causes of vertigo and have rapid access to any testing or treatment that might be needed.
Dizziness isn’t something to take lightly, especially if it is recurrent or accompanied by severe symptoms. Particularly in older patients, dizziness could be a red flag for a more serious condition.