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 (balance system) disorder. Most causes of non-vestibular dizziness are temporary and not life threatening. Treatment options depend on the underlying condition.
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
The following blood (haematological) disorders are known to cause dizziness:
Anemia is the most common blood disorder. It happens when you do not have enough red blood cells or when they malfunction. Anemia secondary to gastrointestinal bleeding may also cause dizziness.
More information: American Society of Hematology: Anemia
- Hyperviscosity syndrome
Hyperviscosity syndrome is a condition in which the blood is unable to flow freely through the arteries. As well as dizziness, symptoms may include hearing loss and diplopia (double vision).
More information: Cancer Therapy Advisor: Hyperviscosity Syndrome
- Pernicious anemia
Pernicious anemia is an autoimmune disease in which the body does not produce enough red blood cells. This leads to Vitamin B12 deficiency. As well as dizziness, symptoms of pernicious anemia may include imbalance and difficulty walking.
More information: Pernicious Anemia Society
- 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 go to the nearest hospital emergency department.
- Celiac disease
About 25% of people with celiac disease have damage to the nerves that control involuntary body functions (this is called 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)
CVS is 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
These conditions related to the heart and blood circulation are known to include dizziness as a symptom:
- 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 go to the nearest hospital emergency department.
- 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 go to the nearest hospital emergency department.
- Heart valve disease – happens when one or more of the heart valves do 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 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
- bacterial infections of the middle ear (acute otitis media)
Dizziness may also be a symptom of infections that affect the brain. These can be generally divided by cause:
- Bacterial, including:
- Viral, including:
- Fungal, including:
- Fungal meningitis
More information: Meningitis Research Foundation of Canada
- Fungal meningitis
- Protozoal, including:
- Prionic, including:
- Creuzfeldt-Jacob disease
More information: Alzheimer Society: Creutzfeldt-Jacob Disease
- Creuzfeldt-Jacob disease
Marijuana, alcohol and nicotine use
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
Tetrahydrocannabinol (THC), the principal 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 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 stop after the medication is no longer taken. Common problems include vision changes, dizziness, light-headedness, drowsiness, and impaired judgment. Over 1,000 medications list vertigo (spinning sensation) and 2,000 list dizziness (light-headedness) as a side effect.
Sometime the problem isn't caused by a single medication, but a combination 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 vestibular weakness).
- Anti-inflammatories (both prescription and over-the-counter) including NSAIDS such as ibuprofen (Motrin®), naproxen (ALEVE®); acetylsalicylic acid (ASA – aspirin) and acetaminophen (Tylenol®).
- Anti-malarials such as Malarone®. The quinolone class of anti-malarials may be vestibular toxins.
- 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: BC Cancer Agency
- Sleep aids (both prescription and non-prescription).
- Tricyclic antidepressants such as amitriptyline and nortriptyline.
The endocrine system helps the body function properly by communicating and coordinating vital processes through hormones. Endocrine system conditions cause problems with metabolism (meaning the physical and chemical processes of the body). This may bring on dizziness. Metabolic conditions include:
- Electrolyte or fluid disturbances
Electrolytes are important minerals involved in many essential body processes. Common electrolytes include sodium, calcium, magnesium and potassium. When the amount of electrolytes is too high or too low, you may be dizzy and have difficulty standing or walking. An electrolyte imbalance may be caused by severe water loss (dehydration) as well as an illness that causes vomiting, diarrhea or fever, kidney problems, diabetes, malnutrition, hormone disorders, heart disease, and side effects of chemotherapy. Severe symptoms include mental confusion, seizures or an irregular heart rate. Get immediate medical help - call 911 or go to the nearest hospital emergency department.
More information: Dieticians of Canada: Guidelines for Drinking Fluids to Stay Hydrated
- 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.
Pancreatic Neuroendocrine Tumors: Insulinoma
- Kidney disorders
Anemia related to kidney failure can lead to feeling faint, dizzy or weak.
More information: BC 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
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 are not usually the only symptoms. Movement, posture and speech will likely also be compromised. Neurological conditions that may cause dizziness and imbalance include:
While the term "ataxia" usually describes the symptom of loss of full control of body movements, it also describes a group of specific degenerative diseases of the central nervous system. Symptoms may include stumbling, falling, poor balance, and dizziness. These symptoms are caused by damage to the cerebellum, the part of the brain responsible for coordinating movement.
There are 8 recognized episodic ataxia syndromes. Episodic ataxia type 1 (EA1) is characterized by brief attacks of unsteadiness and dizziness with involuntary muscle quivering (myokymia). Episodic ataxia type 2 (EA2) is characterized by sudden attacks of ataxia, vertigo (spinning sensation) and nausea typically lasting minutes to days.
More information: Ataxia Canada
- 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
Cerebellar degeneration refers to the deterioration of nerve cells (neurons) in the area of the brain controlling muscle coordination and balance (cerebellum). Patients have increased falls risk. More information: Genetic and Rare Diseases Information Center: Cerebellar Degeneration
- Chiari malformation
A Chiari malformation is a congenital defect in the base of the skull and the cerebellum. Symptoms include balance problems and dizziness.
More information: NINDS: Chiari Malformation Fact Sheet
Dysautonomia is 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 of dysautonomia. 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)
Vasovagal syncope (pronounced "vay-zoh-VAY-gul SING-kuh-pee") is 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
- Multiple sclerosis (MS)
MS and other demyelinating conditions of the nervous system may result in episodes of dizziness contributing to balance problems and risk of falling.
More information: Multiple Sclerosis Society of Canada
- Migraine with brainstem aura
Symptoms of migraine with brainstem aura include vertigo (spinning sensation), ringing in the ears (tinnitus), sound sensitivity (hyperacusis) and loss of balance.
- Paraneoplastic Syndrome
Paraneoplastic cerebellar degeneration is 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 neuropathy
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.
Foundation for Peripheral Neuropathy
BC Centre for Disease Control: Lyme Disease
HealthLink BC: HIV (Human Immunodeficiency Virus) Infection
- 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 go to the nearest hospital emergency department.
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: BC Epilepsy Society
Mental health conditions
Occasional anxiety, stress, fatigue or irritability is 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
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
- Cervical spondylosis
Cervical spondylosis is 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
People with low bone density (osteoporosis) are up to three times as likely to have BPPV. This may be caused by a problem with calcium metabolism.
More information: Osteoporosis Canada
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: Carbon Monoxide Awareness
- Congenital heart defects in children
More information: Children’s Heart Network: CHD Fact Sheet
- Congenital heart disease in adults
More information: Heart Centre Providence Health Care: Congenital Heart Disease
- 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.
Unsteady gait and fluid in the lungs (pulmonary edema) are acute signs of the least common form, high altitude cerebral edema (HACE). HACE comes on quickly and is a life-threatening condition. Get immediate medical help - 911 or go to the nearest hospital emergency department.
More information: Altitude.org
Breathing in excess of what the body needs results in a low level of carbon dioxide in the blood. This is called hyperventilation. It 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:
- Chronic obstructive pulmonary disease (COPD)
More information: Canadian Lung Association: COPD
More information: National Emphysema Foundation
More information: Asthma Canada
- Acute respiratory distress syndrome (ARDS)
More information: HealthLinkBC: Acute Respiratory Disease Syndrome (ARDS)
- Interstitial lung disease
More information: Pacific Lung Health Centre: Interstitial Lung Disease
More information: HealthLinkBC: Pneumonia
- Pneumothorax (collapsed lung)
More information: HealthLinkBC: Collapsed Lung (Pneumothorax)
- Pulmonary edema
Pulmonary edema is caused by excess fluid in the lungs. It makes it difficult to breathe. It usually occurs with congestive heart failure. Light-headedness or dizziness due to a significant drop in blood pressure is an acute symptom and a medical emergency. Get immediate medical help - call 911 or go to the nearest hospital emergency department.
More information: HealthLinkBC: Learning About Pulmonary Edema
- Pulmonary embolism
A pulmonary embolism is a blockage in an artery in the lung. It is usually caused by blood clots that travel to the lungs from the legs (deep vein thrombosis). It can be life-threatening. Get immediate medical help - call 911 or go to the nearest hospital emergency department.
More information HealthLinkBC: Pulmonary Embolism
- Chronic obstructive pulmonary disease (COPD)
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:
- Post trauma vision syndrome (PTVS)
Vision problems after brain injury are referred to as post trauma vision syndrome. The eyes are unable to work together properly (binocular vision dysfunction).
- Visual midline shift syndrome (VMSS)
Some dizzy people have problems perceiving their position in space. This may make them think their body midline has shifted to one side or the other.
Other common visual dysfunctions that may play a part in dizziness and balance problems include:
- Aniseikonia – meaning “unequal images,” 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
Dizziness during menopause is common. Changes in fertility hormones may trigger a number of conditions, leading to dizziness. These include: insomnia, hot flashes, tinnitus and migraines as well as anxiety and stress.
More information: North American Menopause Society
Causes of temporary dizziness during the menstrual cycle may include: anemia due to heavy bleeding (menorrhagia); hormonal changes; low blood sugar (hypoglycaemia); and migraine.
More information: YourPeriod.ca
Up to 75% of pregnant women may be affected by dizziness from as early as 8 weeks into the first trimester.
American Pregnancy Association: Pregnancy and Dizziness
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Page updated September, 2019.