Our complex balance system works around the clock. If nothing is wrong, we do not feel it working. However, a variety of symptoms alert us when it malfunctions.

Dizziness is a broad umbrella term without medical meaning. Dizziness is not a diagnosis; it is a symptom. The word "dizziness" is used to describe sensations such as spinning, wooziness or instability.

It is important to try to describe your symptoms with as much detail and accuracy as possible to healthcare providers. They need this information to help figure out where your problem is coming from. With this knowledge, a diagnosis and treatment strategy can be made to help you work towards recovery.

There is no right or wrong way to describe your symptoms to your doctor. The balance system is complex and there is much variability between what people experience.

Sometimes the symptoms can be difficult to put into words – “I can’t explain it, I just feel something’s wrong” can be an important and very helpful thing to tell a health professional. It is also helpful to use gestures. Using analogies is also useful – for example, “I feel like I’m on a merry-go-round” or “I feel like I’m on a boat on the high seas."

Symptoms can range from mild, fleeting sensations to severe spells that last for hours or more.

Helpful terms to describe your dizziness include:

Vertigo

Vertigo is the false sensation that you or your surroundings are spinning or moving. Most of us have experienced this sensation as children when we spun ourselves round and round in circles until we could no longer stand up.

Vertigo often gets much worse with head movement. It may be continuous or intermittent (off and on). It may be barely noticeable or so intense that you are unable to stay upright on your feet.

Vertigo happens when the vestibular system in one ear or both ears is out of sync – your brain receives the false message that your head is moving when it is not. This is why many types of dizziness are triggered or made worse by head movement.

Vertigo is not a diagnosis, even though some doctors may seem to use the word as such, especially when talking about BPPV (benign positional paroxysmal vertigo). Vertigo is symptom of a number of possible underlying vestibular disorders and other conditions.

Light-headedness

Light-headedness is the sensation of being woozy and about to faint. Light-headedness is the feeling you get when you stand up too quickly, hold your breath for a long time, or after drinking a glass of wine too many. You may also feel light-headed if you are dehydrated, anemic, or have low blood pressure. The medical term for light-headedness is presyncope.

Most people have experienced light-headedness when standing up after bending over for a long time. This sensation is related to how blood circulates to the brain. It is not a problem with the inner-ear balance mechanism (vestibular system). If your head is positioned below your heart, your heart senses that it does not need to pump very hard because gravity is helping move blood to your brain. When you stand back up, however, your heart suddenly has to work harder to get blood to your brain. You feel light-headed during the brief moment when not enough blood flows to the brain.

Imbalance

Imbalance is the sensation of walking on uneven ground, or the wobbly feeling you might get when you get off a boat (even though you have not been on a boat). Another word for this feeling is disequilibrium.

If you feel off balance, you may fall or feel as though you are about to fall. You may stagger when walking and have difficulty walking in the dark.

You may be uncomfortable at great heights because you do not have nearby objects to focus on and stabilize your body.

Spatial disorientation

Spatial disorientation is the inability to determine accurately your body position in space. Another term for this feeling is spatial unawareness.

Rocking or swaying

This is the sensation of the kind of movement you feel when on a boat.

Dizziness may be accompanied by some of the following symptoms:

Hearing problems

• hearing loss
• distorted hearing
• feeling of pressure in the ears (aural fullness)
• ringing or buzzing in the ears (tinnitus)
• sensitivity to everyday sounds (hyperacusis)
• sound-induced vertigo  (Tullio phenomenon)

Vision problems

• Blurred vision (oscillopsia) - what you see appears to wobble or jump around. It is most likely to occur with bilateral vestibulopathy, but may also occur with other vestibular disorders including vestibular migraine, concussion, vestibular paroxysmia, semicircular canal dehiscence, vestibular toxicity and CANVAS syndrome.
• Double vision (diplopia) or feeling as though you see a "ghost image"
• Light sensitivity (photophobia)
• Rapid involuntary eye movements (nystagmus)
• Rapid involuntary eye movements caused by pressure changes in the external auditory canal (Hennebert sign)
• Sensitivity to some types of digital screens and the flicker of fluorescent lights
• Difficulty focusing on objects or tracking objects as they move
• Skipping, re-reading, or substituting words while reading
• Avoiding near tasks, such as reading and writing
• Experiencing an illusion of instability or movement when watching moving objects or things that give a sense of movement such as patterned floors – this is called visually induced dizziness
• A sensation that the what you are seeing takes just a fraction longer to catch up with your head movement - this is called visual lag
• Poor ability to focus near-to-far or far-to near quickly.
• Challenges with visual-spatial tasks such a reduced eye-hand coordination or altered depth perception

Cognitive (thinking) changes

When you have a vestibular disorder, your brain is working overtime just trying to keep you upright and the capacity for other tasks is compromised. It is little wonder, then, that cognitive issues are a symptom of many vestibular disorders. It can be helpful to develop coping strategies to deal with cognitive issues such as:

• forgetfulness and short-term memory problems
• difficulty recalling words
• confusion and disorientation
• sensation of being “foggy” or “fuzzy” in the head
• feeling “spaced out” (dissociation)
• problems concentrating or focusing on tasks
• decreased or slowed processing
• problems with following directions or instructions
• challenges with executive functioning (the automatic process of organizing thoughts and making plans and decisions)
• difficulty tracking printed words
• difficulty handling sequences, such as mixing up spoken words and syllables or transposing letters or numbers
• challenges with following conversations, especially when your surroundings are noisy or busy
• reduced mental stamina
• impaired ability to learn new concepts
• difficulty multi-tasking (monitoring and paying attention to more than one thing at a time)
• decreased ability to grasp big-picture concepts, for example getting the general idea of a newspaper article

Psychological changes

It can be helpful to develop coping strategies and cognitive behavioural therapy (CBT) strategies to deal with psychological issues such as:

• losing self-confidence and self-reliance
• experiencing a wide range of feelings including anxiety, despair, hopelessness, anger, frustration, persecution, and loss of control
• isolating yourself from social situations
• having panic attacks

Other symptoms include:

• slurred speech
• nausea, vomiting, or cold sweats caused by the brain’s influence on the body’s glands and hormonal response
• feeling as though you have a hangover or are seasick
• neck and jaw (temporomandibular joint, also called TMJ) issues

When to seek immediate help

Some symptoms are “red flag” signs of a possible serious or life-threatening condition. If you are dizzy and have any of these red flag signs, get immediate medical help - call 911 or other emergency services right away:

• fever of 39.4°C (103°F) or greater
• chest pain/heart racing or symptoms of a stroke – stroke symptoms are treated as a medical emergency and usually include:
  • weakness in one arm or leg (hallmark symptoms of most strokes
  • headache
  • passing out
  • double vision
  • facial numbness, slurred speech, or swallowing problems
  • weakness in one arm or leg
  • difficulty walking
  • brain stem strokes usually have more complex symptoms that may include vertigo, dizziness, and severe imbalance without weakness in one arm or leg
• fainting (syncope) or collapsing
• behavioural changes
• new, different, or severe headache
• persistent vertigo (spinning sensation) lasting more than a few minutes
• stroke history
• having risk factors for stroke, such as diabetes and high blood pressure
• older patient