Causes of dizziness

Dizziness can be caused by the following factors or diseases, among others:

Blood pressure/circulation (circulation and dizziness)
Headaches (headaches and dizziness)
Nausea (dizziness with nausea/dizziness and vomiting)
Migraine of the basilaris type
Pregnancy (dizziness during pregnancy)
Dizziness caused by fear/stress
Injury or tension of the neck muscles
Disease or injury of the cervical spine (cervical spine syndrome)
Beningner paroxysmal vertigo (BPLS) benign vertigo
Dizziness caused by diseases of the ear
Diseases of the inner ear (vestibulopathy)
Meniere’s disease
Inflammation of the vestibular nerve (neuritis vestibularis)
Thyroid gland as cause of dizziness
Perilymph Fistula
Space-consuming processes, tumors, injuries, fractures (fractures) of the inner ear
Brain Tumors
Diseases from the field of neurologyInternal Medicine
Dizziness caused by alcohol

Dizziness is not a rare symptom. More than ten percent of all visits to the family doctor are due to dizziness. Dizziness can occur more often, especially in older people.

Dizziness is a kind of alarm signal of our body, which indicates that something in the brain or our organ of balance is not functioning properly. In order for our sense of balance to function properly, our brain and our organ of balance in the inner ear must be sufficiently supplied with oxygen and nutrients, i.e. it must be supplied with blood. For this reason, too low blood pressure, for example, can cause dizziness.

Dizziness often occurs due to a neurological cause. However, medication, alcohol, other underlying diseases or psychological stress can also lead to dizziness. In the case of dizziness, one must also think of the organ of balance, which is located in the inner ear.

Disorders in the inner ear can lead to so-called Meniere’s disease, for example. The cause of this is not yet clearly understood.Typical symptoms of menière’s disease are tinnitus (beeping noises in the ear), dizziness and unilateral hearing loss. Dizziness is also a symptom of an inflammation of the vestibular nerve, the so-called neuritis vestibularis.

Typically, the dizziness of vestibular neuritis manifests itself in the form of permanent vertigo that can last from days to weeks, which is naturally very stressful for patients. In addition, there is often a pronounced tendency to fall, nausea, and insecurity of standing and walking. After four to five weeks at the latest, the dizziness subsides, either because the treatment has worked or because the healthy side has replaced the function of the sick side.

Furthermore, the dizziness can also be caused by a bilateral vestibulopathy. In this disease, the organ of balance on both sides is damaged, as well as parts of the vestibular nerves. The ultimate cause is usually unknown.

Patients may suffer from swaying and rotational vertigo, which is often triggered by certain movements. This is often accompanied by a visual disturbance (dizziness and visual impairment). The symptoms also worsen in the dark.

Patients have fewer symptoms when sitting or lying down. In addition to the organ of equilibrium, which is located in the inner ear, the ear itself can also be a possible cause of dizziness. For example, it can occur as part of an inner ear inflammation (labyrinthitis).

Inflammation of the inner ear can also be accompanied by ear pain, fever, fatigue, unilateral hearing loss or tinnitus. In most cases, inner ear inflammation is caused by viruses or bacteria. In rare cases, tumours or toxins also lead to inner ear inflammation.

In some cases, inflammation of the middle ear can also lead to inflammation of the inner ear. In the case of an inflammation of the middle ear, there is typically no dizziness; if one does occur, this is always a warning sign. In this case, the ear, nose and throat doctor should always be consulted.

Tumors of the balance nerve can also lead to dizziness. The most typical tumor is the so-called acoustic neuroma. An acoustic neuroma is a benign tumor that presents itself with the leading symptoms of unilateral hearing loss and tinnitus.

It is also often caused by a craniocerebral trauma, which is often caused by a car accident or the like. In general, a distinction is made between peripheral and central vertigo. The classification of peripheral vertigo includes, for example, Meniere’s disease and vestibular neuritis, i.e. causes that do not originate directly in the brain.

In central vertigo, on the other hand, the cause lies in the brain. This can be, for example, in the nerve nuclei responsible for the vestibular organ, vestibular center or in the cerebellum. The causes of central vertigo are mainly circulatory disorders in the brain, as in the case of a stroke.

In addition to circulatory disorders, however, inflammations in the brain, such as in multiple sclerosis and tumors, are also possible. A typical characteristic of central vertigo is that it manifests itself in a fluctuating manner and does not typically occur in the form of rotational vertigo as in peripheral vertigo. In some people who suffer from migraine attacks, a vertigo attack also occurs at the same time; this is then called vestibular migraine.

If it is not the vestibular organ or an underlying disease or the like that is responsible for the dizziness, but the psyche, it is called non-organic, psychogenic or even somatoform dizziness. This occurs for example in the context of anxiety disorders. If the dizziness is accompanied by drowsiness and visual disturbances in the form of blurred or double vision, it can also be caused by incorrectly adjusted glasses.

Sometimes this is accompanied by headaches and a feeling of pressure in the eyes. This is then called ocular dizziness. Dizziness can also occur as a side effect of medication.

Typical of these are sedatives and sleeping pills. Furthermore, dizziness also occurs with drugs such as antidepressants, antiepileptic drugs, muscle relaxants, antibiotics, diuretic drugs and drugs for the cardiovascular system. A frequent cause of temporary dizziness is of course alcohol (dizziness and alcohol).This is because alcohol has an influence on our cerebellum, which plays an important role in the (fine) coordination of movements in our body.

Therefore, excessive alcohol consumption leads to increasing insecurity in standing and walking. At some point, the alcohol also reaches our organ of balance, causing us to suffer from vertigo. Vertigo can also occur in the context of other underlying diseases, such as polyneuropathy, which can occur in an advanced stage of a sugar or alcohol disease.

Increased sugar concentrations in the blood increasingly attack the peripheral nerves, causing our sense of touch to suffer. In addition, our brain receives less information about the position of our joints and muscles from these nerves, which is important for targeted movements and our coordination. All in all, polyneuropathy can also lead to insecurity in standing and walking, which is accompanied by dizziness.

In addition to polyneuropathy, too low or too high blood pressure can also lead to dizzy spells. This is typical for a too low blood pressure, for example, if one has drunk too little or gets up too quickly from a sitting position, so that the brain is supplied with too little blood for a short time, because a lot of blood has accumulated in the legs due to sitting. In technical terms, this is known as orthostatic hypotension.

Since the cerebellum is our organ for coordination and planning of movements, it is therefore logical that dizziness also occurs in diseases that affect the cerebellum, such as cerebellar atrophy, i.e. tissue loss of the cerebellum. This then usually manifests itself in a fluctuating and not rotating manner. In addition to the causes already mentioned, there are also causes that are much more harmless and usually occur only for a short time.

These include, for example, vertigo caused by fear of heights or the dizziness that occurs after a merry-go-round. Also with a sea sickness or nausea during a car trip (motion sickness), a vertigo often occurs. Disorders in the circulation, such as too high or too low blood pressure, can cause dizziness.

The dizziness can be accompanied by nausea, fainting, headaches and many other symptoms. Beningne paroxysmal positional vertigo is caused by a disorder in the organ of equilibrium (vestibular organ). Here, particles (canalolithiasis) are deposited in the archway system (see anatomy ear) of the organ of equilibrium.

The dorsal canal is most frequently affected. When the head is moved, the particles, which move freely in the archway system, are shifted in the direction of the archway and deflect the cupula there. The cupula is a gelatinous structure that is responsible for the perception of head movements.

If it is incorrectly deflected by the particles, it will send incorrect information about the head position to the brain. Due to the contradictory information between the affected and the healthy organ of balance on the other side, unpleasant attacks of rotational vertigo occur during head and body movements, which can last up to one minute. In addition, the patient suffers from eye movement disorders (nystagmus) and often nausea and vomiting.

In the case of positional vertigo, special exercises can also provide relief at home. Diseases of the inner ear include inflammations that either occur locally or have been passed on via other organs. Inflammation of the middle ear (otitis media), inflammation of the bones (e.g. mastoiditis) and diseases of the meninges can spread to the inner ear and irritate the organ of equilibrium there to such an extent that dizziness attacks can occur.

You can find more information on our website:

Otitis media
Mastoiditis
Vertigo caused by the inner ear

Menière’s disease predominantly affects middle-aged men. It is conspicuous that in vegetatively unstable patients it often occurs after psychological stress, changes in the weather, alcohol, caffeine and nicotine abuse or after banal infections. In these cases, severe rotational vertigo occurs at intervals, which is additionally accompanied by ringing in the ears (tinnitus) and a diffuse, cotton wool-like feeling of pressure in the ear.

After repeated attacks, a hearing loss can be detected during a hearing test (audiogram, tone audiometry, hearing test). Such seizures last from minutes to hours.The cause is still unclear, but it is suspected to be a disturbance in the fluids of the organ of equilibrium (endolymph/perilymph) and its composition (electrolyte shift). Inflammation of the nerve responsible for the transfer of information from the organ of equilibrium to the brain (vestibular nerve) can cause permanent vertigo with a tendency to fall to the opposite side.

Such inflammations are caused by viruses or occur spontaneously and without a detectable cause (idiopathic). The so-called neuritis vestibularis, the labyrinth failure, is an acute event that can usually be centrally compensated after weeks at the latest. Here, due to inflammatory processes of the vestibular nerve (vestibular balance nerve), the sense of balance fails on one side.

This leads to rotational vertigo, sweating, a tendency to fall and involuntary eye movements (spontaneous nystagmus). In acute situations, a lot of bed rest helps here. Medication for dizziness relieves the symptoms.

Good results are achieved with the glucocorticoid methylprednisolone. Furthermore, therapy with infusions with vasodilators (vasodilating drugs) is possible. However, whether the infusion therapy achieves significant success is somewhat controversial.

These two forms of therapy are also used to treat tinnitus. This is a connection between the inner ear and the middle ear with the discharge of the so-called perilymph, a fluid of the inner ear. This can be caused by infections, trauma or even malformations.

Surgery is rarely performed here. In most cases, a therapy of the underlying disease, for example an infection, and a wait-and-see approach are sufficient. In general, bed rest and raising the head helps.

Children are more frequently affected by perilymph fistulas than adults. This special form of migraine is more common in children and young adults. It gets its name from the fact that involvement of the large basilar artery leads to its development.

This migraine is characterized by symptoms such as speech disorders, visual disturbances, dizziness, ataxia, hearing loss and disturbances of consciousness. In the context of this disorder, it can lead to the so-called locked-in syndrome. This is the complete lack of movement while fully conscious.

Only vertical eye movement may be possible. This condition lasts about 2 to 30 minutes. Here too, the therapy consists of migraine prophylaxis.

The neck is a very sensitive region of the body. It can quickly be overstretched or incorrectly strained and must withstand many stresses and strains in everyday life. After all, it carries the head, which is in motion virtually around the clock.

Damage to the cervical spine can easily lead to headaches and dizziness. Very common are simply tensions of the neck muscles, which cause these unpleasant symptoms. The neck can be slightly tense, especially if there is a lack of exercise or an uncomfortable head position, for example when working in an office.

Relief can be achieved through simple exercises that relax the neck. In most cases, the family doctor can show you how to do these exercises. In the case of severe tension, the physiotherapist can help with massages.

In order to protect the neck, you should avoid working overhead. A suitable neck pillow can also do very good. Warmth generally provides good relief in the case of tensions, as well as neck complaints.

Finally, a tense neck can also occur in very stressful situations, where relaxation techniques can help to eliminate the discomfort. The cervical spine comprises the vertebrae between the head and the thoracic vertebrae. There are seven vertebrae, of which the first two, the Atlas and the Axis, are different from the other vertebrae.

Together with the skull bone, they form the upper and lower cervical joints and allow the head to move against the spine. The cervical spine is very mobile and can easily be injured in accidents. It is secured by various ligaments, the most important of which are the aliar ligaments.

These so-called wing ligaments secure the head joint in its position and limit movement. Traumatic injuries of the cervical spine are quite common and lead to dizziness in those affected. Especially whiplash injuries, which happen for example in road traffic accidents, can lead to this.

The ligamentous apparatus of the head joint is injured by a so-called whiplash movement.This leads to an instability in this area, which then causes dizziness. This instability results from a rupture or overstretching of the ligamentous structures between the base of the skull (Os occipitale) and the first two vertebrae (Atlas and Axis). The aforementioned aliar ligaments, the wing ligaments, are particularly frequently affected.

If the joint capsule also ruptures, the movement of the head against the spinal column is no longer adequately limited. This results in a displacement of the head against the cervical spine or, in the worst case, a subluxation between the atlas and axis. This is an incomplete dislocation of the joint.

This subluxation may cause a so-called basilar impression. A basilar impression is a displacement of the cervical spine upwards towards the base of the skull. In this process, the first vertebrae can exert pressure on the brain stem and thus trigger a typical symptom of the brain stem.

This stem-brain symptomatology usually includes dizziness, visual disturbances and vigilance disorders (ranging from dazed to somnolent). In addition to palpation (palpation by the doctor), CT and MRI are suitable for examining the cervical spine. In rare cases, other diseases of the cervical spine can also cause dizziness.

Metastases in the cervical spine can damage them and cause dizziness. Chronic diseases such as herniated discs of the cervical spine, osteoporosis and osteomalacia can also be reasons for dizziness. However, this is less frequently the case.

Postural defects of the spine, especially the cervical spine, can irritate arteries to the head (Aa. Intervertebrales, Aa. Carotides) to such an extent that a lack of oxygen in the area of the central nervous system (CNS brain) results.

As accompanying symptoms, patients also describe headaches (cephalgias), neck stiffness and pain in the area of the cervical spine. The cervical spine syndrome often develops as a result of degenerative changes in the cervical spine. Other causes include whiplash injuries, tumors, muscular tensions, operations on the cervical spine or even herniated discs in the cervical spine.

A cervical spine syndrome primarily causes pain in the neck and shoulder area, which radiates into the arms and can lead to numbness there. However, a cervical spine syndrome can also be accompanied by other symptoms such as headaches, impaired vision or dizziness. Dizziness in cervical spine syndrome is the result of a conflict in the processing of information sent to the brain from different parts of the body.

In the area of the neck muscles, there are sensory cells that transmit information for the adjustment of the body balance. If there is tension in the neck area or due to degenerative changes, malpositions and postural changes can occur. The sensory cells then transmit incorrect information to the brain regarding the spatial position and posture, which is in conflict with the information from the organ of equilibrium and the visual organ.

The result is dizziness and insecurity. Patients describe the occurring dizziness as uncertainty, which occurs mainly when standing and walking. The dizziness triggers a feeling of swaying and a slight, persistent state of drowsiness.

In many cases, this dizziness is permanent, sometimes a little more and sometimes less, and is not dependent on certain movements or activities. Often accompanied by headaches, dizziness can severely limit the patient with a cervical syndrome, as the ability to pay attention and concentrate can also be impaired. Changes in the cervical vertebrae or even tumorous changes in tissue can compress or constrict the vessels that carry the blood of the body’s circulation to the brain.

This reduces the blood flow to the brain and results in an undersupply of oxygen to the brain. This can also lead to dizziness and discomfort. Patients suffering from a cervical spine syndrome due to muscular tension of the cervical spine often also develop dizziness resulting from acute stress in everyday life.

In such situations, dizziness attacks can also occur. In order to relieve the dizziness, physical activity and physiotherapeutic exercises are particularly useful. In this way, possible tensions can be relieved and any existing malpositions can be compensated.A space-occupying process (tumor) in the area of the auditory and vestibular nerves (acoustic neuroma) can lead to irritation or even loss of balance information.

A diagnosis is made with a computer tomogram (CT) of the skull. Accidents involving the skull can lead to a fracture of the petrous bone (skull bone surrounding the inner ear). This causes mechanical damage to the vestibular system.

A reliable diagnosis can be made by explaining the cause of the accident, the symptoms and a computer tomography. Severe fluctuations in blood pressure and cardiac dysrhythmia can in the long term lead to an oxygen deficiency in the brain, the vestibular organ and vestibular nerves. The same effect is caused by drugs for high blood pressure (antihypertensives, antihypertensive drugs) and drugs for depression (antidepressants) as well as certain sleeping pills (benzodiazepines).

A severe metabolic imbalance (hypoglycaemia/hyperglycaemia) as a result of untreated diabetes (diabetes mellitus) can disturb the electrolyte balance (balance of ions in the body e.g. sodium, potassium, calcium) in the body, resulting in dizziness symptoms. In addition, in diabetes mellitus (diabetes), a disturbance of sensation in the extremities can lead to a perceptual disturbance of the ground and joint positions (polyneuropathy with proprioceptive disorders). In multiple sclerosis (MS, encephalitis disseminata), an inflammation of the vestibular nerve can also cause dizziness symptoms.

Migraine patients (migraine) also report dizziness and drowsiness in addition to severe headaches. Whether dizziness can only be caused by stress or fear cannot be said with certainty. Just because one does not always find an organic cause for the stress, it does not mean that the cause is of a purely psychogenic nature.

However, it is true that very stressful and stressful situations can trigger a feeling of dizziness or vertigo. Often symptoms such as shortness of breath or the feeling of impending powerlessness are added to this. However, these are acute events that are mainly triggered by hyperventilation.

Certain mental illnesses such as panic attacks and anxiety disorders are associated with a very high level of stress. Such panic attacks or anxiety disorders often lead to a vicious circle of anxiety, stress, dizziness and shortness of breath. However, what the exact causes are is not known in detail.

It can help in such situations not to flee from the situation, but to get through it in peace. One must not develop avoidance behavior out of fear. It is important to pay attention to regular and calm breathing. One should try to relax as much as possible. In this way you can reduce your stress level and prevent symptoms such as dizziness and shortness of breath.