FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

SOLVING ENGLISH PUZZLE FIRST KEY TO READER'S DIZZINESS PROBLEM

Question: About two months ago I started getting real dizzy at bedtime and in the morning. If I try to get up during the night or in the morning, I fall back on the bed. I’m then okay all day, but at bedtime it’s back again. It went away for two weeks and now is back. I have no other symptoms -- no ringing in the ear, no problems with my eyes and no heart problems. It’s just the dizziness. What could be causing this problem?

Answer: Before I answer your specific question, I need to give you some background on dizziness. The first issue to look at is more a matter of English usage than strictly a medical question. The common term “dizziness” often means different things to different people -- including doctors. One of the first challenges in evaluating someone who says they are feeling “dizzy” is to determine exactly what they mean by this term.

Some people use “dizzy” to mean a lightheaded or unsteady feeling, but others use it to describe the sensation that the room is spinning. Physicians tend to use “vertigo” to denote the spinning-room feeling.

Dizziness is not a disease in itself, but can be a symptom of many different disorders. Generally, very mild dizziness or light-headedness is not a significant medical problem. It can be caused by getting blood drawn, by pain or by standing up too quickly after lying down. Many times, the cause of a mild temporary spell of dizziness is never found. Stress and fatigue also cause the light-headed type of dizziness.

The inner ear is the “balance center” for the body, and frequently disease in that organ system can be responsible for dizziness. When the ear is the problem, the dizziness is usually of the “vertigo type.” This type of dizziness is more severe, lasts longer and can be associated with nausea and vomiting. Commonly a change of head position will make the vertigo form of dizziness worse.

Vertigo can also be a symptom of trauma to the ear from an accident or injury, bacterial infection in the ear or sinuses, or tumors in the ear. An inner-ear condition called Menière’s disease often produces not only vertigo but also hearing loss.

Another cause of vertigo is an underlying, or systemic, disease. Common examples include atrial fibrillation, stroke, tumor, anemia or slow heart rate due to heart block. Finally, some medications can cause severe vertigo.

So, as you can see, there are many possible causes of the dizziness that you are experiencing. It’s not possible for me to assess the exact nature of your dizziness from what you say in your e-mail. If, by the time you read this column, your symptoms have gone away, there’s probably no reason to seek medical attention. Perhaps, your problem was nothing more than an on-again, off-again dizzy spells due to psychological stress, transient pain or a minimal injury. However, if your episodes of dizziness are becoming more severe, you should see your family physician for an evaluation. Severe dizziness can be a sign of a serious medical condition.

Your physician will probably take a complete medical history, give you a physical exam and request blood tests and imaging (X-rays or CT scans) to arrive at a diagnosis. If your dizziness is due to a problem in the ears, it can probably be treated easily with rest and medication. If the cause turns out to be something more systemic, then it will be necessary to treat whatever underlying disease is causing your symptoms.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.