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Dizziness and Vertigo

Dizziness is a very distressing symptom which can be difficult to diagnose as it can be caused by abnormalities in various parts of the body eg ears, eyes, brain, nerves, heart and neck.

Dizziness is an abnormal sensation of movement, usually spinning, but some patients describe feeling faint, unsteadiness on walking and feeling fuzzy headed.

When attending the clinic you may not be actually suffering with dizziness at that time. The diagnosis of your condition will therefore depend on the symptoms you can recall. It would therefore be very useful if you could think about your symptoms by asking yourself the following questions:

  1. What were you doing when the first attack of dizziness came on?
  2. What time of day was it?
  3. What did it feel like?
  4. Did you notice any other symptoms which came on before, with or soon after the dizziness? (e.g. tinnitus, hearing loss, nausea, vomiting, headache, blurred vision, racing heartbeat or fainting).
  5. Does lying, sitting or standing make the dizziness worse or better?
  6. Since your first attack of dizziness have the symptoms been improving, getting worse or staying the same?
  7. Do you have any other medical problems? Eg high blood pressure, heart problems, arthritis, neck injury, migraine or dizziness before.
  8. Have you had previous surgery on your ears, brain or heart?
  9. Do you take any regular medication?
  10. Have you had any remedies for dizziness in the past, which have helped?

Emergency Treatment of Dizziness:

If you suffer an attack of dizziness it is always best to sit or lie down. You may be more comfortable with the lights on or off. If you are not vomiting then it is best to swallow a travel sickness tablet like Prochlorperazine (Stemetil) 10mg or Cyclizine 50mg. If you are vomiting then the Prochlorperazine tablet (Buccastem) can be held against the gum under the upper lip where it will be absorbed effectively in about 20 minutes. If this is ineffective, call your doctor who may be able to give you an injection to stop the vomiting.

Although patients often go to casualty with dizziness this is unnecessary unless they have other symptoms eg chest pain.

If you do have to move about make sure you use a stick or a frame for support to prevent you falling.

Common causes of dizziness are:

Labyrinthitis (Vestibular Neuronitis)

A severe attack of spinning dizziness, accompanied by vomiting, which settles over a few days but often, does not fully resolve for about three months. It is usually preceded by a viral infection which can itself be mild. It can occur at any age and it does not usually happen again.

Benign Paroxysmal Positional Vertigo (BPPV)

Turning to one side while lying in bed causes spinning dizziness which lasts for about 30 seconds. This annoying condition can follow labyrinthitis and can last for years. It is simply treated with a head positioning manoeuvre: The Epley Manoeuvre. When carried out properly this manoeuvre cures 80% of patients.

Migraine

The headache in some migraine attacks is replaced by dizziness as the main symptom. Some patients do not have a headache at all. Other symptoms of migraine are usually present. Treatment is usually medication depending on the frequency of the attacks.


Postural Hypotension

Poor blood pressure control may cause a sensation of blackout or dizziness when standing up. This can come on gradually and the symptom can vary from day to day. This will make instant diagnosis at the clinic difficult and further specialist tests may be required. Treatment includes reduction of blood pressure medication and/or increasing salt intake.

Meniere's Disease

This rare condition causes recurring episodes of labyrinthitis (see above). It is caused by an imbalance in the two fluids in the inner ear. Patients often have a sensation of pressure in the ear as well as tinnitus and hearing loss with each attack. This can be a very disabling condition, which can cause long-term hearing loss. Treatment includes medication and even surgery in extreme cases.

Dizziness and Driving

Most patients with dizziness do not have to stop driving as they will still be able to maintain control of the car. If however your feel that the frequency or severity of your attacks of dizziness is impairing your driving ability, then you should not drive. The questionnaire DIZ1 specifically deals with fitness to drive in drivers with disabling dizziness. It can be found at http://www.direct.gov.uk/en/Motoring/DriverLicensing/MedicalRulesForDrivers/DG_10010623 .


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