Attacks of dizziness
definition
Attacks of dizziness describe the symptom of dizziness. This is a sudden onset of dizziness that makes the patient feel like they are losing the ground under their feet.
In medical terminology, dizziness is called vertigo. More precisely defined, this is a distorted perception that can affect the environment or movement.
The frequency
Dizziness is one of the most common causes of a doctor visit. This can typically occur as a result of inner ear damage or, like headaches, be a main symptom and an indication of more complex organic damage.
Around every fifth person regularly complains of dizziness. Younger people are less prone to dizziness than older people. Most types of dizziness affect women more than men.
The introduction
The dizziness can take several forms. Spinning vertigo is one of the most common types of vertigo. It manifests itself in the sudden feeling that the environment is turning. The feeling of turning as if on a merry-go-round lasts for a few seconds to minutes. The vertigo goes hand in hand with a strong tendency to fall and therefore a high risk of falling. Many people also suffer from nausea and vomiting. In older age the vertigo can often appear as persistent vertigo and persist for several hours or even days. Those affected suffer from very severe nausea and as a result have to vomit frequently.
In addition, a clearly recognizable nystagmus occurs. This is a horizontal twitching of the eyes, such as when looking out the window of a moving train (so-called optokinetic nystagmus). The eyes initially move with the direction of rotation and then snap back to their starting position. This is quite normal when driving a train, spontaneously occurring nystagmus can indicate a disease of the balance organ in the inner ear.
Furthermore, a distinction is made between positional vertigo, which is also known as benign paroxysmal positional vertigo. It occurs when the ear stones, so-called otoliths, have loosened in the inner ear. They play an important role in the organ of equilibrium. However, when they are detached, they are randomly located in the various semicircular canals of the inner ear and thus trigger the vertigo. This type of dizziness is also accompanied by nausea, vomiting and a pronounced tendency to fall.
There is also vertigo, which is accompanied by a strong unsteady gait and stance. The symptoms of nausea and vomiting also occur here, but they usually occur less often. More often, people with vertigo go into a state of drowsiness. A phobic postural vertigo is distinguished from postural vertigo, which usually has psychological causes and is accompanied by panic attacks.
The sudden attacks of dizziness represent a very great burden for the person concerned. The patients develop a strong feeling of fear and are constantly afraid of the next attack. Vertigo that is triggered by visual stimuli is also counted as vertigo. They are also known as optokinetic motion sickness. This dizziness can be triggered, for example, in the cinema by staring at the screen or in flight simulators. The brain receives information from the eyes and from the positional organs in joints and muscles that do not match. These different pieces of information lead to a contradiction and ultimately nausea, dizziness and in some cases vomiting.
The reasons
Attacks of vertigo can have a number of different causes. One possible cause could be an increase in pressure in the inner ear. This condition of the inner ear is known as Meniere's disease. More fluid, the so-called endolymph, accumulates in the inner ear, causing dizziness due to the changed pressure in the equilibrium organ. It is not yet exactly clear why the endolymph accumulates.
In younger patients, dizziness is often associated with a migraine attack. In these cases, the migraine is known as a vestibular migraine. It begins with suddenly onset of dizziness, which is accompanied by nausea and possibly vomiting. The symptoms last a few minutes and then abruptly subside. This is followed by the typical severe headache. Migraines often show up in different ways in those affected. For example, shortly before the severe headache, some patients have a "visible aura", in other words a flicker in front of their eyes, which practically heralds the migraine attack. Dizziness occurs in a similar way in other patients.
The cause of benign positional vertigo lies in the organ of equilibrium itself. The stones in the ear, the crystals known as otoliths, are normally connected to the equilibrium sensory cells via a so-called gelatinous dome. This controls the excitation of the sensory cells. If the crystals loosen, they shift in an uncontrolled manner when the head is moved in the differently oriented semicircular canals. The hair sensory cells are stimulated and send information to certain regions in the brain. These excitations do not match the current situation, which ultimately leads to dizziness and the other typical symptoms.
Also read the article: Causes of vertigo.
Multiple sclerosis as the cause
Attacks of dizziness often occur in the context of multiple sclerosis. Multiple sclerosis is a disease that particularly affects the central nervous system and is the first to manifest itself in the optic nerve. It is a chronic inflammatory disease in which the myelin sheaths (myelin sheaths) that cover the nerves are destroyed and broken down. The nerves then lose their function and can no longer transmit any information.
In addition to many other symptoms, there are various forms of dizziness associated with the disease. The disease progresses in phases and more and more inflammatory foci develop, which can lead to sensory and motor deficits all over the body. Dizziness is a concomitant symptom and on the one hand can occur permanently through old foci and on the other hand, as an acute vertigo attack, it can be an indication of the development of a new inflammatory focus. In general, most people with multiple sclerosis feel dizzy on a permanent basis. It is no longer possible to tell exactly whether it is, for example, vertigo or vertigo. The occurrence of dizziness can vary greatly in its intensity and regularity.
Find out all about the topic here: Multiple sclerosis.
The stress as the cause
Professional or daily pressure and tension can not only affect the psyche, but also affect the body over a longer period of time. Many people have stress on their stomachs. A common symptom of overwork can also be dizziness. Attacks of dizziness can then occur acutely in a stressful situation or during periods of rest. Especially the attacks at rest give an indication that the body is unbalanced and overloaded. The dizziness should be perceived as a warning sign.
If the body reacts to stress with such complaints, it is an indication that it needs rest and relaxation. It should be clarified whether there is an organic cause for the dizziness, otherwise appropriate measures can be taken against the stress. The person concerned should try to reduce the stress and allow himself enough rest periods.
Sport, relaxation exercises and autogenic training can be helpful. Treating yourself to a massage or physiotherapy for muscle tension from time to time can improve the dizziness. In extreme cases, psychotherapy may also be necessary.
How can you reduce stress? Read on here.
The stroke as the cause
Dizziness can also be related to strokes. They can appear in different ways. Sudden attacks of dizziness can also occur before a stroke and thus indicate a problem in the brain. They are often accompanied by nausea and vomiting. Those affected are usually so bad that they are hardly able to both stand and sit. In addition, there is an increased risk of falling due to a pronounced tendency to fall.
Furthermore, dizziness can also occur permanently as a result of a stroke. In this case, one speaks of central dizziness because the cause lies in the brain, i.e. in the central nervous system. Similar to a stroke, dizziness can occur with other brain injuries, such as injuries to the brain stem in particular.
Learn more about: The consequences of a stroke.
Menopause as a cause
A woman's body goes through some hormonal changes during menopause that the woman has to cope with. The physical change can cause some discomfort. For example, dizziness attacks can occur more frequently during hormone fluctuations. These, if safely caused by the hormonal change, are usually harmless.
Attacks of dizziness can be very uncomfortable for women and are often accompanied by nausea and vomiting. The dizziness attacks can be relieved with various drugs, including many herbal substances. The side effects of nausea and vomiting can also be reduced with medication.Generally speaking, the patient should still have the vertigo attacks that occur during the menopause examined by a doctor. The dizziness can also be caused by other causes.
In order to avoid later complications, such as permanent chronic dizziness or damage to the inner ear, an organic cause should be excluded through suitable examinations.
Further information on this topic can be found at: Menopausal dizziness.
The drugs as the cause
Attacks of dizziness can also be caused by taking various medicines. The dizziness is particularly often triggered by drugs that have an influence on the body's circulatory system. These include, for example, drugs to lower blood pressure such as beta blockers and so-called ACE inhibitors (angiotensin converting enzyme inhibitors). If the blood pressure is too low as a result of these medications, dizziness attacks can occur and the person concerned usually has to sit or even lie down until the blood pressure has regulated itself again. But it can also lead to dizziness when lying down.
Other drugs that can cause dizziness include various antibiotics and, very often, pain medication. Some drugs also work through the circulatory system, while other drugs can influence various regulating ion channels in the inner ear. If the symptoms are too severe, the patient should consult the attending physician. The medication may need to be replaced. This is particularly advisable if the drug actually has a damaging effect on the balance organ. Most patients feel an improvement in their symptoms the longer they take the medication. After a while, the body gets used to the active ingredient and adjusts the body's functions accordingly.
The psyche as the cause
The physical well-being and the psyche are closely related. Therefore, psychological problems such as stress, personal crises or overwork are not infrequently the causes of physical suffering. Dizziness attacks can also be psychosomatic. The dizziness generally has an underlying organic cause, but psychological problems such as depression have a significant influence on their development and also worsening. The psyche can help ensure that the dizziness remains permanent. This can worsen the patient's condition, since the vertigo attacks represent an additional problem in addition to the causal psychological stress. In addition to dizziness, most patients also suffer from unsteady gait and fear of falling.
In connection with mental illness, the phobic dizziness occurs very often. A form of psychogenic attacks of vertigo in which people suffer from anxiety disorders and depression. In addition, the stressful experience of a vertigo attack gives you considerable fear of the next attack. In these patients, basic problems such as mental overload or depression must be treated so that the symptoms of dizziness subside.
The cervical spine as the cause
The cervical spine (cervical spine) is an endangered part of the body in the event of sudden sharp changes in direction, as it is not a particularly strong structure and has to compensate for the movement of the relatively heavy head. This leads to strong tension in the neck muscles. The muscles in the cervical spine are also often affected when the back is tense. This tension is transmitted directly to the head and, in addition to tension headaches, can also trigger symptoms such as dizziness and nausea.
Sudden attacks of dizziness caused by the cervical spine are more likely to occur in acute stressful situations of the cervical spine. In addition to the muscles, the nerves that originate in the cervical spine can also cause dizziness if they malfunction. In addition, important vessels run along the cervical spine that supply the brain with blood. If there are circulatory disorders in the cervical spine, this can lead to an insufficient supply of the brain and thus blood pressure-related dizziness.
The iron deficiency as the cause
Iron deficiency is particularly noticeable in the body through its important function in transporting oxygen. Iron is needed to produce the red blood pigment (hemoglobin). This molecule is found in the red blood cells (erythrocytes) and binds oxygen in the blood. With the help of hemoglobin, oxygen can be transported from the lungs to the other organs of the body.
If insufficient hemoglobin can be formed due to an iron deficiency, this leads to an insufficient supply of the organs. The brain in particular is dependent on a constant supply of oxygen. In case of insufficient supply. An iron deficiency can also accelerate the pulse, as the body tries to maintain oxygen despite the deficiency. The increased pulse can, in turn, cause blood pressure fluctuations and thus sudden attacks of dizziness.
Read more on this topic at: Iron deficiency dizziness?
The accompanying symptoms
When it comes to the symptoms of dizziness, a distinction is made between different types of dizziness. Most of the time, vertigo (like a carousel) or vertigo (like on a ship) occurs. But elevator dizziness, which feels like you are taking an elevator, can also occur. Such attacks of dizziness are often accompanied by nausea or vomiting and headaches.
An attack of vertigo can also lead to acute hearing loss, a sudden deterioration in hearing. In general, dizziness is also used as a term when the affected person becomes a little "dizzy" due to circulatory problems. In this context, nausea and vomiting can also occur. In addition, complaints such as cold sweat, turning black in front of the eyes or a fainting attack are associated with such blood pressure-related vertigo.
The nausea as an accompanying symptom
Nausea and vomiting are common symptoms associated with vertigo attacks. When you feel dizzy, there is sudden confusion in the brain, as the information from various sensory organs usually does not match.
For example, the organ of equilibrium perceives movement while the eye sees that the body is not moving. These different sensory impressions suddenly lead to severe dizziness - this also triggers discomfort or nausea. In the case of particularly pronounced attacks of dizziness, the nausea can be so severe that the affected person has to vomit.
Also read the article: Dizziness with nausea - that's behind it.
The appearance of the vertigo attack
While getting up
Many people experience morning dizziness that requires them to stand up slowly to avoid falling over. These dizziness attacks occur when the person concerned tries to stand up from a lying or sitting position. These symptoms are based on a natural effect. Getting up suddenly and too quickly causes a relatively large part of the blood to sink into the lower half of the body. The blood vessels that normally ensure constant blood pressure cannot react quickly enough at such a moment. For a brief moment there is a lack of blood in the head and in the upper half to keep blood pressure up and oxygen to the brain. The result is dizziness.
Corresponding countermeasures that the body automatically takes, such as narrowing the blood vessels, increase blood pressure. After a short time, the person concerned should no longer feel dizzy. These dizziness attacks are particularly common in tall, slim and elderly people. However, permanently too low blood pressure (hypotension) can trigger a brief attack of dizziness when standing up.
You can find more information on this topic at: The dizziness on getting up.
At night
Dizziness at night can have a number of causes. In some cases, it may be caused by Meniere's disease. This disease of the inner ear is accompanied by an increase in pressure due to water accumulation. This dizziness therefore occurs independently of movement and can therefore also occur at night.
Another cause can be positional vertigo. This form of vertigo is triggered by detached ear stones (otoliths), which move freely in the semicircular canals of the organ of equilibrium and thereby irritate it in an uncontrolled manner. Especially at night, when the person concerned turns and changes the position of the head, a sudden, uncomfortable attack of dizziness can occur.
While sitting
Sudden attacks of dizziness, which mainly occur while sitting, can be caused by strong tension in the muscles. The muscles of the neck, the jaw, the entire back and the area around the eyes can be constantly exposed to tension due to poor posture while sitting, which in the long term can no longer be released properly. Such tension can also be the reason for dizziness attacks.
The symptoms can be relieved by targeted muscle exercises. The vertigo attacks should be clarified by a doctor so that the correct therapy can be initiated. In the case of muscle tension, the muscles can be loosened. The person affected should also ensure an upright and straight sitting posture so that the incorrect posture does not lead to further complaints.
The diagnosis
As part of the anamnesis, the doctor can initially receive information about the occurrence of the dizziness. He will want to know when the dizziness attacks occur, how the dizziness expresses itself exactly, what other symptoms occur and how the symptoms improve again. Various tests are then carried out to help define the exact cause and type of dizziness. These tests include, for example, those that check the organ of equilibrium. The patient should stand straight with his eyes closed. This attempt, known as the Romberg test, would be positive if the patient is unable to maintain balance and begins to sway.
Following this, the Unterberger stepping attempt can be carried out. The patient should step on the spot. Sick patients turn around 45 degrees, which means that the test is positive and indicates a disorder. The index finger test can also be carried out. Here, the patient should lead his outstretched index finger to the tip of his nose with his eyes closed. This tests the coordination ability of the cerebellum.
Another important examination is done by rinsing the ears with cold and warm water. This checks involuntary rhythmic twitching of the eyes, which is known as nystagmus. The change in temperature in the ear stimulates the organ of equilibrium and triggers nystagmus, which normally occurs, for example, when turning quickly. During this examination, the patient wears special glasses, the Frenzel glasses, which enable precise observation of the eyes and prevent disturbances such as fixing the eyes on a point in the environment.
The nystagmus can also be checked using the swivel chair. The patient sits on a chair that is turned in one direction for half a minute. The experiment is then carried out in the opposite direction. Both times the movements of the eyes are registered and compared with each other.
A hearing test is also carried out for further diagnosis. It can provide clues to various disorders of the middle or inner ear that can cause dizziness.
In a dizziness clinic, a special consultation hour for the symptom of dizziness, many different examinations can be carried out to find the focus and cause of the dizziness.
Also read the article: Vertigo without findings.
The treatment
The therapy for a vertigo attack depends to a large extent on the disease underlying the symptoms. Some types of vertigo can be treated with medication and the accompanying symptoms can also be alleviated with medication. For example, so-called antihistamines and anticholinergics are used against attacks of vertigo. If you have severe symptoms, you can also use sedating (depressant) medication. However, finding the right balance between sedation and dizziness is not always easy.
Special exercises help with acute attacks of vertigo in the context of so-called benign positional vertigo. With the disease, small crystals dissolve in the organ of equilibrium, which swim around and cause dizziness. With the positioning maneuvers one tries to let the crystals come to rest again. Further physiotherapy exercises can help to cope with everyday life despite the occasional dizziness. This includes measures such as gait training and balance training. You can also learn to avoid certain movements that trigger dizziness. Additional treatment measures such as heat applications and massages are used as a support. If necessary, light muscle building training can also help.
This article might also interest you: Treatment of vertigo.
The duration
Individual dizziness attacks can last a few seconds to usually several minutes, depending on the triggering cause. For example, rapid turning movements of the head can trigger threshing attacks lasting around thirty seconds. However, if you keep your head still afterwards, the symptoms will quickly subside.
However, a vertigo attack rarely comes alone. In most cases, the affected person is affected by attacks of dizziness for several days or even weeks. Here, too, the total duration of the complaints strongly depends on the underlying cause. In addition, dizziness attacks can become chronic, especially if there are special triggers that cannot be treated well.
The consequences
The consequences of increasing dizziness attacks manifest themselves primarily in restrictions in everyday life. In the acute case of the vertigo attack, those affected must first sit down and wait until the vertigo disappears. If necessary, the ability to walk may be restricted for a long time, as the dizziness recurs when moving. In addition, attacks of dizziness are often accompanied by a tendency to fall, which can lead to injuries.
As dizziness particularly often affects older people, who are also more prone to injuries such as broken bones, fractures are not uncommon as a result of dizziness attacks. In particular, the forearm bones, which are used when supporting, and occasionally the thighbones can break in older people when they fall.
