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Non-vestibular Causes of Dizziness and Imbalance

This information is intended as a general introduction to this topic. As each person is affected differently by balance and dizziness problems, speak with your health care professional for individual advice.

Most people with dizziness and imbalance do not have a vestibular (inner-ear balance system) disorder. Most causes of non-vestibular dizziness are temporary and not life-threatening. Treatment options depend on the underlying condition.

Non-vestibular causes of dizziness and imbalance include problems related to:

Allergies

Light-headedness and dizziness are sometimes associated with airborne and food allergies. Allergy-related sinus congestion can lead to vertigo (spinning sensation).
More information: Canadian Society of Allergy and Clinical Immunology

Blood conditions

Blood (haematological) disorders known to cause dizziness include:

Digestive system

  • Anemia secondary to gastrointestinal (GI) bleeding
    GI bleeding is a sign of a problem in the digestive tract. Complications can cause anemia. Symptoms include light-headedness and fainting. GI bleeding suggests a serious medical condition. Get immediate medical help - call 911 or other emergency services right away.
  • Celiac disease
    About 25% of people with celiac disease have damage to the nerves that control involuntary body functions (autonomic neuropathy). Celiac disease may disrupt regulation of blood pressure and heart rate, leading to episodic vertigo and fainting.
    More information: Canadian Celiac Association
  • Cyclic Vomiting Syndrome (CVS)
    Characterized by intermittent episodes of severe vomiting that have no apparent cause. People with CVS may be dizzy during a vomiting episode.
    More information: Cyclic Vomiting Syndrome Association
  • Liver disorders
    The liver acts as the body’s detoxification system. Dizziness is among the symptoms of acute liver failure, cirrhosis of the liver and other liver disorders.
    More information: Canadian Liver Foundation

Heart and circulatory (cardiovascular) system

Conditions related to the heart and blood circulation that are known to have dizziness as a symptom include:

  • Arrhythmia – heart rhythm problems. Arrhythmia can be a medical emergency or harmless - visit your doctor for a complete evaluation.
  • Atherosclerosis – build up of plaque (fats, cholesterol and other substances) in and on the artery walls.
  • Brain aneurysm – a bulge that forms in a blood vessel in the brain. Get immediate medical help - call 911 or other emergency services right away.
  • Carotid sinus syndrome (CSS) – external pressure on the carotid artery (a small bundle of nerve endings in the side of the neck) causes a brief blackout and light-headedness. A brief blackout may result in falling without warning and for no obvious reason.
  • Heart attack (myocardial infarction) – happens when blood flow to part of the heart decreases or stops, damaging the heart muscle. Get immediate medical help - call 911 or other emergency services right away.
  • Heart valve disease – happens when one or more of the heart valves does not open or close properly.
  • Vascular dementia – a decline in thinking skills caused by cerebrovascular disease. Blood vessels in the brain are damaged and brain tissue injured. The brain cells are deprived of vital oxygen and nutrients. Vascular dementia may cause dizziness and result in loss of balance.
  • Vertebrobasilar insufficiency (VBI) - insufficient blood flow to the back (posterior) parts of the brain. Risk factors include diabetes, high blood pressure (hypertension), obesity, high cholesterol, smoking, and advanced age as well as an inactive lifestyle.
  • Low blood pressure (hypotension) may result in not enough oxygen getting to organs in the body. It can make you feel light-headed or dizzy. Conditions that can cause low blood pressure include: pregnancy, heart problems, endocrine problems, dehydration, blood loss, severe infection (septicaemia), severe allergic reaction (anaphylaxis), lack of dietary nutrients, and some medications.
    A drop in blood pressure on standing (orthostatic or postural hypotension) and after eating (postprandial hypertension) mainly affects those over age 65.

More information: Heart and Stroke Foundation

Illness and infections

Illnesses or infections that may cause light-headedness or dizziness include:

  • sinus conditions
  • tooth infections
  • diarrhea
  • bacterial infections of the middle ear (acute otitis media)
  • influenza (flu)

Dizziness may also be a symptom of infections that affect the brain. These can be generally divided by cause:

Marijuana, alcohol and nicotine use

  • Alcohol
    Consuming excessive amounts of alcohol, either through binge drinking or long-term alcohol misuse, may cause dizziness and balance problems.
    More information: Government of Canada: Problematic Alcohol Use
  • Marijuana
    Tetrahydrocannabinol (THC), the main psychoactive component of marijuana, tends to expand blood vessels. This results in decreased blood pressure and an increased heart rate - dizziness may result. In addition, heightened sensory perception while using marijuana makes it more challenging for the brain to keep the body balanced while in motion.
    More information: Government of British Columbia: Cannabis
  • Nicotine
    Nicotine ingested from tobacco products decreases the blood supply to the inner ear by narrowing blood vessels. Side effects from using tobacco products may include dizziness, nystagmus (rapid involuntary eye movement) and unsteadiness.
    More information: Government of Canada: Smoking, Vaping and Tobacco

Medication side effects

One or more side effects of many prescription and over-the-counter medications may affect balance. Some medications suppress the vestibular system and may do so in a way that causes dizziness and imbalance. Others lower blood pressure and may cause light-headedness.

The side effects usually stop after the medication is no longer taken. Common problems include vision changes, dizziness, light-headedness, drowsiness, and impaired judgment. Over 1,000 prescription medications list vertigo (spinning sensation) and 2,000 list dizziness (light-headedness) as a side effect.

Sometime the problem is not caused by a single medication, but by several medication taken together. Several medications are known to cause vestibular toxicity (poisoning of the vestibular system) when used in combination with some antibiotics.

Older adults are particularly at risk as drugs are metabolized differently with age. Talk to your doctor or pharmacist if you think a medication may be causing or aggravating your dizziness and/or imbalance.

Medications that may cause dizziness and imbalance include:

  • Aminoglycoside antibiotics such as gentamicin, streptomycin, tobramycin and viomycin (may cause bilateral vestibulopathy).
  • Anticonvulsants.
  • Anti-inflammatories (both prescription and over-the-counter) including NSAIDS such as ibuprofen (Motrin®), naproxen (ALEVE®), acetylsalicylic acid (ASA – aspirin) and acetaminophen (Tylenol®).
  • Antifungals.
  • Antihistamines.
  • Anti-malarials such as Malarone®. The quinolone class of anti-malarials may be vestibular toxins.
  • Anti-psychotics.
  • Benzodiazepines such as alprazolam (Xanax®) and lorazepam (Ativan®). One study suggests unsteadiness leading to falls as a side-effect of taking this class of anti-anxiety medication may be connected to a third of all hip fractures in people over 85 years of age.
  • Cholesterol-lowering drugs.
  • Loop diuretics such as furosemide (Lasix®) and bumetanide (Burinex®). These medicines help rid the body of salt (sodium) and water. They are often used to treat high blood pressure but are used for other conditions as well.
  • Mucolytics (used to thin mucus).
  • Parkinson’s disease medications
  • Platinum-based chemotherapy drugs such as cisplatin may cause permanent damage to the balance structures in the inner ear as well as vision. This may increase falls risk. Some chemotherapies damage nerves and may also damage the central nervous system, causing chemically induced peripheral neuropathy.
    More information: Canadian Cancer Society
  • Sleep aids (both prescription and non-prescription).
  • Tricyclic antidepressants such as amitriptyline and nortriptyline.

Metabolic conditions

The endocrine system helps the body function properly by communicating and coordinating vital processes through hormones. Endocrine system conditions cause problems with metabolism (the physical and chemical processes of the body). This may bring on dizziness. Metabolic conditions include:

  • Electrolyte imbalance
    Electrolytes are electrically charged minerals and compounds involved in many essential body processes. Common electrolytes include sodium, calcium, magnesium, phosphate, and potassium. When the level of one or more of these electrolytes is too high or too low, you may have a variety of symptoms including dizziness and difficulty standing or walking.
    Severe symptoms include mental confusion, seizures or an irregular heart rate. Get immediate medical help - call 911 or other emergency services right away.
    Causes of an electrolyte imbalance include: severe fluid loss (dehydration) as a result of persistent vomiting, diarrhea, sweating or or fever; kidney problems; diabetes; malnutrition; hormone disorders; higher-than-normal blood pH (metabolic alkalosis); side effects of some medications such as steroids, diuretics and laxatives; and chemotherapy.
    More information:
    Dieticians of Canada: Guidelines for Drinking Fluids to Stay Hydrated
    Healthline: All About Electrolyte Disorders 
  • Fabry disease
    A rare inherited metabolic disorder that results from the buildup of a type of fat, called globotriaosylceramide (GL-3), in blood vessel walls throughout the body. Hearing loss, tinnitus, dizziness, and vertigo are common in adult patients.
    More information:
    Fabry Support & Information Group
  • High and low blood sugar levels
    Diabetes is the most common condition associated with high blood sugar (hyperglycemia). Low blood sugar (hypoglycemia) is associated with diabetes, alcohol consumption, hepatitis, kidney disorders, not eating enough, problems with the adrenal or pituitary glands and some medications as well as insulin producing tumours (insulinomas) and non-islet cell tumours in the pancreas. If you have diabetes and your blood sugar continues to be below 4.0 mmol/L despite treatment and you are getting more sleepy and less alert, get immediate help - call 911 or other emergency services right away. If possible, have someone stay with you until your blood sugar is above 4.0 mmol/L or until emergency help arrives.
    More information:
    Diabetes Canada
    Cancer Research UK: What Are Insulinomas?
  • Kidney disorders
    Anemia related to kidney failure can lead to feeling faint, dizzy, or weak.
    More information: Kidney Foundation
  • Overactive thyroid
    An overactive thyroid (hyperthyroidism) is relatively common and may develop from a number of conditions. It may cause light-headedness.
    More information: Thyroid Foundation of Canada
  • Addison’s disease
    Also called primary adrenal insufficiency, Addison’s disease is an uncommon disorder that arises when the adrenal glands do not produce enough of certain hormones. Light-headedness or fainting may be one of the early symptoms.
    More information: Canadian Addison Society

Neurological conditions

Studies suggest that about 25% of patients who see a doctor about dizziness have an underlying neurological condition. When areas of the brain that coordinate balance are not working properly, dizziness and imbalance usually are not the only symptoms. Movement, posture and speech will likely also be compromised.

Neurological conditions that may cause dizziness and imbalance include:

  • Brainstem and cerebellum tumours and cysts
    Benign (non-cancerous) or malignant (cancerous) cysts on areas of the brain controlling coordination and movement may cause dizziness, imbalance, and increased falls risk.
    More information: Brain Tumour Foundation of Canada: Information Sheets
  • Cerebellar degeneration
    Refers to deterioration of nerve cells (neurons) in the area of the brain that controls muscle coordination and balance (cerebellum). In general, cerebellar degeneration is characterized by decreased muscle tone and loss of coordination that gets worse over time (progressive). Patients usually have a wide-legged, unsteady gait and are at increased falls risk.
    More information: NIH Genetic and Rare Diseases Information Center: Cerebellar DegenerationRisk factors and causes of cerebellar degeneration include:

    • Cerebellar cortical atrophy (CCA), multi-system atrophy and olivopontocerebellar degeneration (OPCA).
    • Multiple sclerosis (MS) and other demyelinating conditions of the nervous system.
      More information: Multiple Sclerosis Society of Canada
    • Ataxia, a degenerative disease of the central nervous system. Symptoms include slurred speech, stumbling, falling, imbalance/incoordination and dizziness/vertigo.
      There are different causes for ataxia. Some are hereditary (genetic), some are acquired and some have no known clear cause (idiopathic).
      More information:
      Ataxia Canada
      National Ataxia Foundation (American)The word "ataxia" is also used to describe the symptom of loss of full control of body movements. This lack of coordination can be associated with some infections, injuries, other diseases or degenerative changes to the central nervous system. These conditions or risk factors include autoimmune disorders, ischemic or hemorrhagic stroke, chronic alcohol abuse, poor diet, vitamin B12 or vitamin E deficiency, use of some sedatives, and some tumours. Ataxia is also part of a rare disorder called CANVAS Syndrome.
    • Transmissable spongiform encephalopathies (such as Creuzfeldt-Jacob disease) in which abnormal proteins cause inflammation in the brain, including the cerebellum.
      More information: Alzheimer Society: Creutzfeldt-Jacob Disease
  • Chiari malformation
    A congenital defect in the base of the skull and the part of the brain that controls muscle coordination and balance (cerebellum). Symptoms include balance problems and dizziness.
    More information: NINDS: Chiari Malformation Fact Sheet
  • Dysautonomia
    An umbrella term for several conditions causing a malfunction of the autonomic nervous system (the part of the nervous system that controls and regulates the internal organs without any conscious recognition or effort). Symptoms include light-headedness and fainting. There are different types of dysautonomia:

    • Neurocardiogenic syncope (NCS) is the most common type. Also called vasovagal neurocardiogenic syncope, it is a fainting spell that happens when the body overreacts to certain triggers. These include intense emotion, the sight of blood, extreme heat, dehydration, a long period of standing, or intense pain.
    • Postural orthostatic tachycardia syndrome (POTS) is a condition in which a change from lying to standing causes an abnormally large increase in heart rate. It is estimated to impact 1 out of 100 teenagers.
      More information: Dysautonomia International
  • Fainting (vasovagal syncope)
    The most common type of fainting. It is caused by a sudden drop in blood pressure resulting in less blood flow to the brain. Just before fainting, symptoms include light-headedness and nausea. It is also called neurocardiogenic syncope. Fainting can be a sign of a more serious condition – get medical advice.
    More information: BCHealthLink: Fainting
  • Migraine with brainstem aura
    This condition has similar symptoms to vestibular migraine. However, migraine with brain stem aura has additional symptoms seen during the early, or aura, phase coming from the brainstem deep in the brain, such as clumsy movements or confusion. These occur most commonly 5 minutes to an hour before the headache. It is also called basilar migraine.
    More information: American Migraine Foundation
  • Paraneoplastic Syndrome
    A rare complication of cancer. Symptoms may include rapidly progressive imbalance and uncontrollable eye movements (nystagmus).
    More information: Canadian Cancer Society
  • Parkinson’s disease
    Dizziness is a frequent symptom of this neurodegenerative disease. The risk of falling increases with disease severity.
    More information: Parkinson Canada
  • Peripheral neuropathies
    Result from damage or disease of the nerves that carry messages to and from the central nervous system to the rest of the body. Loss of nerve function in the legs or feet leads to increased unsteadiness and falls risk. If the autonomic nerves are affected, changes in blood pressure may cause dizziness or light-headedness. The most common cause of peripheral neuropathy is diabetes. Others include: chemotherapy; infections, including Lyme disease and HIV; inherited disorders such as Charcot-Marie-Tooth; trauma; and vitamin deficiency.
    More information:
    Foundation for Peripheral Neuropathy
    Canadian Lyme Disease Foundation
    Canadian AIDS Society
  • Stroke and TIA affecting the back of the brain
    Dizziness, vertigo (spinning sensation), nystagmus (uncontrollable eye movements), gait disturbance, ataxia (loss of full control of body movements), hearing loss and tinnitus (ringing in the ears) can be symptoms of reduced blood supply to the back of the brain (vertebrobasilar insufficiency or VBI). Stroke and TIA (transient ischemic attack) are medical emergencies – call 911 or other emergency services right away.
    More information: Heart and Stroke Canada
  • Vestibular epilepsy
    Benign temporo-parieto-occipital junction epilepsy with vestibular disturbance is a rare form of epilepsy. Its symptoms include short bouts of vertigo (spinning sensation) and nystagmus (rapid uncontrollable eye movement).
    More information: Epilepsy Canada

Mental health conditions

Occasional anxiety, stress, fatigue, or irritability are part of almost everyone’s life. Sometimes these feelings provoke dizziness or a sense of imbalance. And people with balance and dizziness conditions are often anxious about their conditions. An anxiety disorder may be the cause when these feelings become intense and overwhelming and interfere with everyday activities.

  • Anxiety disorder
    Anxiety disorders are the most common mental health issue. There are many types of anxiety disorder. One commonality is persistent, excessive fear or worry in situations that are not threatening. Symptoms of anxiety disorders may include light-headedness, dizziness, or faintness.
    More information: Anxiety Canada
  • Anorexia
    The medical term for this eating disorder is anorexia nervosa. Severe food restriction may lead to dizziness.
    More information: Eating Disorder Association of Canada
  • Panic attacks
    Feeling dizzy and unsteady are among the symptoms of a panic attack or panic disorder.
    More information: Anxiety Canada: Panic Disorder

Musculoskeletal conditions

  • Cervical spondylosis
    A type of osteoarthritis. It causes deterioration in the vertebrae, discs and ligaments in the neck or cervical spine. Sometimes these changes can affect blood supply to the brain, possibly causing dizziness and even blackouts.
    More information: Arthritis Canada
  • Osteoporosis
    People with osteoporosis have low bone density and are up to three times as likely to have BPPV. This may be caused by a problem with calcium metabolism.
    More information: Osteoporosis Canada

Respiratory conditions

Breathing (respiratory) problems leading to low levels of oxygen in the blood (hypoxia), as well as those with reduced carbon dioxide in the blood (hypocapnia), may cause dizziness.

Conditions leading to low blood oxygen levels (hypoxemia) include:

  • Carbon monoxide (CO) poisoning
    CO is a colourless, odourless, tasteless gas produced by improperly ventilating burning gas, wood, propane, charcoal, and other fuel. Research suggests CO poisoning can permanently damage the balance processing centres of the brain. Symptoms of high-level CO poisoning include imbalance and dizziness. Very high levels of exposure may be lethal.
    More information: Canada Safety Council: Carbon Monoxide
  • Congenital heart defects in children
    More information: Children’s Heart Network: CHD Fact Sheet
  • Congenital heart disease in adults
    More information: Canadian Congenital Heart Alliance
  • High altitude sickness
    Travelling above 2500m increases the risk of having 1 of 3 forms of mountain sickness. Dizziness is a hallmark symptom of all forms. In addition to confusion, fever, a fast heart rate (tachycardia), confusion and severe headache, worsening coordination and imbalance is a sign of the least common form, high altitude cerebral edema (HACE). HACE comes on quickly and is a life-threatening condition. Get immediate medical help - call 911 or other emergency services right away.
    More information: Altitude.org
  • Hyperventilation
    Hyperventilation refers to breathing in excess of what the body needs. It results in a low level of carbon dioxide in the blood. Hyperventilation might happen when exercizing strenuously or holding your breath under stress.
    More information: HealthLinkBC: Hyperventilation
  • Lung disease and chronic respiratory issues may increase falls risk more than other chronic conditions. Conditions include:
  • Obesity
    Research suggests obese people have a higher rate of dizziness and falls than the general population.
    More information Obesity Canada
  • Sleep apnea
    Obstructive sleep apnea syndrome may be related to chronic dizziness. Research suggests those with sleep apnea have abnormal vestibular (inner-ear balance system) responses.
    More information: American Sleep Apnea Association

Visual system conditions

Eye movement disorders (also called functional vision disorders) are related to how the eyes work together as well as how visual and vestibular information is process and integrated by the brain. They may cause dizziness and increase risk of falling.

Eye movement disorders include:

Other common visual dysfunctions that may play a part in dizziness and balance problems include:

  • Aniseikonia
    Meaning “unequal images,” this is an eye condition where there is a significant difference in the perceived size of images from one eye to the other.
  • Vertical imbalance
    With this dysfunction, one eye will aim higher than the other. To try to adjust to the vertical misalignment of the eyes, the person will often tilt their head to help align the eyes.

Women’s health issues

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Page updated January, 2021.