7 Questions to Ask When You Feel Dizzy

By Nancy Fitzgerald |

Find out what’s behind your dizzy spells—and when to call the doctor.

dizziness and vertigo

Jimmy Stewart’s character in Vertigo needed rooftop chases and a fog-cloaked bell tower to trigger his world-turning dizzy spells. For the rest of us, however, a simple thing like skipping lunch or standing up too quickly is enough to send our heads spinning.

In fact, as many as 30 percent of people over 65 report that they’ve had an episode of dizziness in the past couple of months, according to a review in Aging and Disease. The number jumps to 50 percent of folks over 85. And multiple studies show that for people 75 and older, dizziness is a top reason for visiting the doctor.

Why? It depends, says Kathryn Boling, M.D., a family medicine specialist at Mercy Medical Center in Baltimore. "There are two possible pathways to a diagnosis," she explains. "One of those paths is dizziness-that weird, woozy feeling inside your head. The other is vertigo, where the room is spinning around you. When one of my patients complains of dizziness, the first thing I do is try to differentiate between the two."

Most episodes of vertigo and dizziness go away on their own. But they can have serious consequences. According to one study in Frontiers in Neurology, dizziness is a strong predictor of falls—the leading cause of fatal and nonfatal injuries for older adults. And even the fear of falling can lead to isolation and loneliness.

If you've had a recent dizzy spell-or if your episodes are becoming more frequent or lasting longer-it's a good idea to work with your doctor to figure out what's going on. After all, there are effective treatments, many of which are quite simple.

"Dizziness and falls are not just a normal part of aging," says Courtney Hall, Ph.D., a physical therapist who specializes in treating vertigo at the James H. Quillen VA Medical Center in Mountain Home, Tennessee. "If your doctor is telling you, 'Oh, you're just getting older, deal with it,' you really should find a new provider. Even though it's common, a lot of doctors aren't comfortable with diagnosing vertigo and dizziness."

That's likely because dizziness is one of those frustrating symptoms that pop up with a wide range of possible problems. Most are benign, but sometimes a serious condition is at root, Dr. Boling says.

Your answers to these seven questions can help you and your doctor get to the root of the problem—and find the right solution.

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Question #1: Does Your Head Feel Like It’s Spinning?

That's the number-one symptom of vertigo. Feel like you're stuck on a merry-go-round that just won't stop? That's vertigo too.

“When you have vertigo, it feels like everything seems to be moving around you,” Dr. Boling says.

Among people with vertigo, up to 42 percent of cases are caused by a condition called benign paroxysmal positional vertigo (BPPV), according to a review in Clinical Interventions in Aging. It happens when the tiny calcium crystals within your inner ear loosen and move into the ear canals. This tells your brain you’re moving—even though you’re standing still.

“Those crystals are sticky, and they sit in a sticky gel inside your ear,” explains Carol Foster, M.D., an associate professor of otolaryngology at the University of Colorado School of Medicine in Aurora and author of Overcoming Positional Vertigo. “But they lose their stickiness as the years go by.

"They're like a Post-it note," Dr. Foster says. "If you stick one on the wall, you can bet it won't still be there 60 years later. As you get older, those crystals break up and wander around your ear, and sometimes they cluster in the wrong spot and cause trouble."

Your doctor will do a neurological exam to rule out anything life-threatening, like a stroke. But if you’ve experienced vertigo like this before, chances are you’ve got BPPV.

If your doctor gives you a diagnosis of BPPV, there's a simple treatment that your doctor or a physical therapist can perform and teach you how to do on your own. It includes different head and body movements designed to get the crystals to travel out of the ear canal, Dr. Foster says.

Question #2: How Long Has It Lasted?

Most episodes of vertigo are pretty short-just a few minutes. But it's not uncommon for an episode to stretch out for a couple of hours.

However, if you've had vertigo for much longer, that could signal something more serious. "Constant vertigo for a couple of days is very unusual," Dr. Boling says. "If this happens, I'd send the patient for an MRI to rule out a stroke or a growth in the brain. If it's going on for a long time without any respite, that could be a sign of something very serious."

Now's a good time to remember that dizziness is not a normal part of aging. If you've had a particularly lengthy dizzy spell, don't brush it off. Contact your doctor.

If you have dizziness and any of these red flags, seek medical attention right away:

  • Headache
  • Vomiting
  • Fever over 101°F
  • Stiff neck
  • Shortness of breath
  • Change in vision or speech

Question #3: When Do You Feel Dizzy?

If it happens when you go from a sitting to standing position, a likely cause is a drop in your blood pressure.

“Maybe you’re on blood pressure medication, but you’ve lost weight and don’t need as high of a dose anymore,” Dr. Boling says. “Or you could be dehydrated and unable to maintain your blood pressure within a normal range. When you stand up, your blood pressure drops even lower, making you feel dizzy.”

Dizzy spells that follow any kind of pattern—during or after exercise, only at night, or when you’re stressed out—are like a trail of crumbs that will lead your doctor to a solid diagnosis and treatment options.

Make an appointment with your doctor. Continue taking your medication as directed unless your doctor gives you new instructions.

Question #4: What Have You Eaten—and When?

If you wake up bright and early and mow the lawn or take a walk before breakfast, you could experience low blood sugar, which can spark a dizzy spell. Eating something sweet, which could make your blood sugar rise and then quickly crash, can also make you dizzy.

Iron deficiency is another frequent food-related cause of dizziness. That's because iron deficiency can lead to anemia, a condition when you don't make enough red blood cells to carry oxygen throughout your body.

Dr. Boling suggests keeping a food diary to see if there's any link between your eating habits and your episodes of dizziness. Bring your food diary with you when you see your doctor.

Question #5: Any Tummy Troubles?

Sometimes dizziness can be caused by an electrolyte imbalance, which can happen after a bout of the "stomach flu" or other gastrointestinal illness, Dr. Boling says. Longer workout sessions that break the one-hour mark can also deplete your body's natural electrolyte stores and leave you light-headed.

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Question #6: Are You Taking Any Medications?

Your medicine list can offer important clues about your dizziness. “Some medications, like Lasix for high blood pressure or hydrochlorothiazide for fluid retention and high blood pressure, can cause you to feel dizzy, especially if you’re dehydrated,” Dr. Boling says.

“And anything that might raise your heart rate very high or slow it way down could cause dizziness,” she adds. That includes medicines used to prevent seizures, antidepressants, sedatives, and opioids.

Make an appointment with your doctor. Continue taking your medication as directed unless your doctor gives you new instructions.

When you visit the doctor, be sure to bring a list of all the prescription medications, over-the-counter drugs, and supplements you take. Sometimes, it’s the combination of medicines that may be the problem.

Question #7: How Are You Sleeping?

Do you sleep like a baby or struggle to get a good night’s rest?

“If you’re having restless sleep, or if your partner tells you that you snore or make gagging sounds, you might talk to your doctor about getting a workup for sleep apnea,” Dr. Foster says. “There’s a strong link between sleep apnea and dizziness.”

Once you have the sleep problem under control, the dizziness should go away, she says.

Take the Right Steps to Stop the Spin

The more information you bring to your visit, the easier it will be for your doctor to treat your dizziness. Bring a list of any symptoms and a list of all the medications you take.

Once your doctor has examined you and listened to all the clues you’ve provided, you’ll be on the way to putting an end to the head spinning.

Nailing the diagnosis is the first step, Dr. Boling says. "Once that's out of the way, your doctor can focus on the underlying issue that's causing the dizziness," she says.

That could mean adjusting your medications, treating an underlying condition like heart disease or low blood sugar, or suggesting changes in your diet. Your doctor might also prescribe physical therapy or give you a medication for dizziness like meclizine.

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