Dizziness has many causes — from positional vertigo to circulatory or nerve problems. Accompanying symptoms are decisive.
Possible causes
Benign paroxysmal positional vertigo
Spinning vertigo attacks lasting seconds to a few minutes, triggered by head movements such as lying down, turning over in bed, or looking upward.
Circulation
Blacking out or seeing spots when standing up, often due to low blood pressure, dehydration, or after lying down for a long time.
Inner ear
Inflammation of the vestibular nerve (vestibular neuritis) causes spinning vertigo lasting for days, along with nausea. In Menière's disease, vertigo attacks occur together with hearing loss and tinnitus.
Vestibular migraine
Vertigo attacks lasting minutes to hours, often with sensitivity to light or noise and sometimes without headache — a common and often late-recognized cause.
Medications
Blood pressure and sedative medications, diuretics, certain antibiotics, and combinations of several drugs can trigger or worsen dizziness.
Brain and nerves
Less commonly, the cause lies in the brain. This is suggested by double vision, difficulty speaking or swallowing, gait disturbances, numbness, or dizziness that starts suddenly and persists.
Typical steps at the doctor's office
- 1The doctor distinguishes spinning vertigo from unsteadiness, asks about duration, triggers, and accompanying symptoms, and checks circulation, eye movements, and gait.
- 2If positional vertigo is suspected, a positional test is performed (Dix-Hallpike manoeuvre); if confirmed, it can usually be treated directly with a repositioning manoeuvre, such as the Epley manoeuvre.
- 3The list of medications is reviewed, since dizziness is a common side effect.
- 4Depending on the suspected cause, an ENT or neurological assessment follows; if there are signs of a cause in the brain, this is done as an emergency.
What makes serious causes more likely
- With increasing age, positional vertigo and circulation-related dizziness become more common, and several causes often occur together.
- Taking several medications at the same time significantly increases the likelihood of medication-related dizziness.
- High blood pressure, diabetes, atrial fibrillation, smoking, and previous strokes are reasons to have newly occurring, persistent dizziness assessed by a neurologist promptly.
- A history of migraine makes vestibular migraine more likely.
What typically happens next?
Benign paroxysmal positional vertigo usually responds to repositioning manoeuvres within a few sessions, but returns in some affected individuals over the years. Inflammation of the vestibular nerve improves over days to weeks as the brain compensates for the loss of function; targeted balance exercises support this process. Circulation-related dizziness improves once the underlying cause is treated or a triggering medication is adjusted. If dizziness persists for weeks or changes in character, a repeat assessment is advisable.
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