Our complex balance system works around the clock. If nothing is wrong, you won't be able to feel it working. However when something malfunctions a variety of symptoms alert us. Dizziness is a general term for these symptoms of wooziness, spinning or instability.

Dizziness is not a diagnosis – it is a symptom.

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 the 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.

Helpful terms to describe your dizziness include:

• Vertigo – the sensation that you or your surroundings are spinning or moving. Vertigo often gets much worse if the head is moved. It may be continuous or intermittent. It may be barely noticeable or so intense that you are unable to stay balanced on your feet. Vertigo happens when the right and left balance systems in the inner ear are out of sync – your brain thinks 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 use “vertigo” to talk about BPPV (benign positional paroxysmal vertigo).
• Light-headedness (presyncope) – 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.
• Disequilibrium – the sensation of walking on uneven ground, or the wobbly feeling you might get when you get off a boat (even though you haven't been on a boat). Another word for this feeling is imbalance.
• Spatial disorientation –  the inability to correctly determine your body position in space. Another term for this feeling is spatial unawareness.
• Rocking/swaying – the sensation of the kind of movement you feel when on a boat.

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 and may be accompanied by some of the following:

Balance issues

• falling or feeling as though you are about to fall
• difficulty walking in the dark
• staggering when you walk
• discomfort at great heights, caused by not having nearby objects to focus on and stabilize your body

Ear issues

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

Eye issues

• blurred vision (oscillopsia) - what you see appears to wobble or jump around
• 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
• 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
• 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) issues

It is little wonder that cognitive issues are a symptom of many vestibular disorders – your brain is working overtime just trying to keep you upright and the capacity for other tasks is compromised. 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 issues

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

• loss of 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
• panic attacks

Other physical issues

• 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 visit your nearest hospital emergency department:

• 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: headache; passing out; double vision; facial numbness, slurred speech or swallowing problems; weakness in one arm or leg; and difficulty walking.
  The symptoms of a brain stem stroke can be more complex and may include vertigo, dizziness and severe imbalance without weakness in one arm or leg (the hallmark of most strokes).
• Fainting or collapsing.
• Behavioural changes.
• New, different or severe headache.
• Persistent vertigo (spinning sensation) lasting more than a few minutes.
• history of stroke
• risk factors for stroke, such as diabetes and high blood pressure
• older patient