Some spells come on out of the blue with no warning at all. Others can be set off by something you do, or something you encounter—a trigger. Spells with triggers are more likely to be benign, meaning that they often do not harm the ear. Spells that come on without any warning are more likely to be damaging.
Let’s look at some of the most common causes of dizziness that have triggers. Benign paroxysmal positional vertigo (BPPV) is a very frequent cause of seeing the room spin, usually for less than a minute at a time. It’s a mechanical problem in the ear caused by gravity-sensor crystals that have fallen into a spinning sensor by mistake. It is called positional because the spells are set off by moving too quickly into certain positions—lying down, sitting up from lying down, rolling over in bed, and tipping the head up or down. The triggers are so reliable that it feels almost machine-like; every time you make the movement, you get a few seconds of dizziness. Since the disease is just a mechanical error in the ear, it can be resolved by doing exercises that remove the crystals (see the orange treatment video and handouts on our main page). Although it can feel very violent, it usually does not cause permanent damage to the ear.
Migraine headaches are another very common trigger of dizziness. A person who has headaches that are nauseating, or that are made worse by bright lights or loud noises, may have migraine. The dizziness can come at the same time as the headache. In some people with migraine the dizziness comes a short time before the headache, but it’s the underlying migraine tendency that is triggering the dizziness. In other people dizzy spells and headaches seem to alternate but both become more frequent when a migraine flareup is happening. If you suffer from this, treating the migraine headaches with preventative medications can also help control the dizziness.
Many older people have dizziness that comes on only when walking. They feel fine when sitting or lying down. This is a strong symptom of multisensory imbalance, the imbalance of aging. This floating, off balance sensation is caused by aging of the balance system combined with loss of sensation in the legs or feet, and deterioration of vision. All of these systems are needed for good balance, so if none are working perfectly, balance is no longer as reliable. Most find using support aids like trekking poles, a walker or even a grocery store cart can greatly improve balance and reduce the dizziness.
A less common trigger for dizziness is hearing a very loud sound. In people who have a malformation of the inner ear resulting in a leak of fluid within the skull, semicircular canal dehiscence, a loud sound, a cough or a sneeze can make the room appear to tilt or make them fell as if they are about to fall. This can be corrected with surgery.
When you are already dizzy, you might feel worse when making a quick head movement. This doesn’t help narrow down the cause of the dizziness, because quick head movements when in the midst of a dizzy spell always make it feel worse, no matter what the underlying cause is.
The sensations you experience during a recurrent dizzy spell can help narrow down the cause. We’ll cover this in our next post.