When suddenly everything starts spinning around you

What is dizziness?

Dizziness, also referred to as vertigo, describes the sensation of disturbed spatial orientation or a false perception of movement, even though neither the body nor the surroundings are actually moving. This perceptual disorder occurs when the brain cannot properly process the various sensory inputs, for example from the balance organ in the inner ear and from the eyes. The result is that the environment is perceived as unstable — it appears to sway, rotate or tilt.

There are different types of dizziness. With unsteadiness dizziness you feel as if the ground beneath your feet is swaying. With rotational vertigo you have the sensation of spinning, as if on a carousel. With elevator‑type dizziness you feel as if you are moving up and down like in a lift. There is also lightheadedness dizziness, where the sensation is diffuse and hard to describe.

Dizziness can occur suddenly and last for varying lengths of time, from a few seconds to several hours. It can be triggered by certain movements, physical exertion or stress. In many cases the symptoms resolve on their own. For some people, however, dizziness can persist for days or months.

What can cause dizziness?

Dizziness can have many causes and often arises when the brain receives conflicting signals from the sensory organs or does not process them correctly. Physical and psychological conditions can be triggers, as can head injuries, for example concussions. In general, a distinction is made between vestibular and non‑vestibular dizziness.

Vestibular dizziness is due to a disorder of the balance system. Inner ear conditions such as Ménière’s disease or inflammation of the balance nerve (vestibular neuritis) often cause rotational vertigo. A common form is benign paroxysmal positional vertigo, where small crystals in the inner ear irritate sensory cells. Migraine, circulatory disturbances in the brain or benign tumours such as acoustic neuroma can also trigger vestibular dizziness attacks. This form of dizziness is often accompanied by unsteadiness when walking, nausea or tinnitus.

Non‑vestibular dizziness occurs in people whose balance organs are intact but who experience dizziness for other reasons. These include cardiovascular problems such as high or low blood pressure, anaemia or heart rhythm disorders. Changes in blood sugar levels such as hypoglycaemia and neurological conditions like diabetic polyneuropathy can also cause dizziness. Consumption of alcohol, certain medications or drugs can lead to dizziness. Psychological triggers such as anxiety disorders, depression or panic attacks play a role particularly in chronic dizziness. This so‑called psychogenic dizziness often occurs in social situations and is associated with lightheadedness and a risk of falling.

Other causes include orthopaedic problems such as cervical syndrome, where muscle tension in the neck area can trigger dizziness. Pregnant women also more frequently experience dizziness caused by circulatory fluctuations. Finally, motion sickness (kinetosis) can occur when the brain overreacts to unfamiliar movements. Older people are particularly susceptible to age‑related dizziness, caused by delayed processing of stimuli or circulatory disorders.

Could my dizziness come from the cervical spine (HWS)?

Dizziness can originate from the cervical spine (HWS). The neck is a particularly sensitive area of the body, heavily stressed due to its high mobility and mechanical loads such as poor posture or injuries. Such problems can lead to a variety of symptoms, including dizziness.

Cervical syndrome is often associated with pain in the neck and shoulder area, which can radiate into the arms. Many patients report dizziness or unsteadiness when walking, lasting from a few minutes to several hours. These complaints can be triggered by a range of factors, such as muscle tension, degenerative changes with age or post‑traumatic issues after accidents.

Of particular note is vertebrogenic dizziness, which can be caused by functional restrictions of the cervical spine. The sensory cells that transmit information from the neck muscles and tendons to the balance centre in the inner ear can be affected. A whiplash injury, for example, can lead to such damage.

If there is suspicion that the dizziness originates from the cervical spine, a medical assessment is advisable. Treatment varies depending on the cause and usually consists of a combination of medication and physiotherapeutic measures to relax the muscles and improve mobility.

When should you see a doctor for dizziness?

Dizziness can be an annoying symptom, often related to a harmless positional vertigo that usually disappears after a few days or weeks. However, there are situations where a medical consultation is strongly recommended. If you experience recurrent and sudden dizziness without an obvious cause, it should be evaluated medically. It is particularly concerning when dizziness attacks are severe or when certain head movements repeatedly trigger dizziness.

Associated symptoms such as nausea, vomiting, headache, ringing in the ears, persistent dizziness, visual disturbances or shortness of breath are important warning signs that should not be ignored. If dizziness occurs during an infection with or without fever or worsens in specific situations such as driving or in crowded places, it is advisable to see a doctor. Stress can also trigger dizziness, so medical advice should be sought in these cases as well.

In older people, dizziness is often dismissed as a normal part of ageing. This is a mistake, as serious conditions that require treatment may lie behind the symptoms. It is important that older people do not become inactive out of fear of falling but seek medical assessment to clarify possible causes and reduce the risk of falls.

How does the doctor examine dizziness?

To determine the cause of dizziness, the doctor starts with a detailed medical history, asking about symptoms, their onset, accompanying complaints and lifestyle. Keeping a dizziness diary can also be helpful.

This is followed by a physical examination, during which pulse and blood pressure are measured. An electrocardiogram (ECG) may be performed if necessary. The doctor conducts specific tests, for example the nystagmus test, which observes uncontrolled eye movements. Balance tests such as the Romberg test are also done to check the function of the balance system.

Hearing tests may be required in addition, as hearing and balance are closely linked. Depending on the suspected diagnosis, further investigations such as imaging studies or blood tests may be necessary.

What you can do about dizziness: practical tips

• If possible, sit down and bend your head forward or lie down and raise your legs. This promotes blood flow to the brain and quickly relieves dizziness.
• For positional vertigo, move your head slowly to the side and avoid sudden head movements.
• Perform specific positioning manoeuvres, e.g. the Brandt‑Daroff exercises: sit upright, lie down on your side and remain in that position for 30 seconds before slowly sitting up again.
• Drink enough water to prevent dehydration, which can worsen dizziness.
• Sleep with your head slightly elevated to avoid morning positional vertigo. An extra pillow can help.
• Avoid excessive heat and stuffy rooms, as lack of oxygen or heat can intensify dizziness.
• Breathe deeply and evenly if dizziness is triggered by stress. This calms the nervous system and can ease dizziness.
• When standing for long periods, have something to hold on to, especially if dizziness occurs unexpectedly.
• Avoid getting out of bed too quickly. Sit on the edge of the bed first and wait a few seconds before standing up.
• Ventilate your living areas regularly to avoid oxygen shortage that can trigger dizziness.
• Avoid alcohol and nicotine, as these substances affect circulation and can exacerbate dizziness.
• Chew a piece of ginger or drink ginger tea to relieve nausea associated with dizziness.
• Essential oils such as peppermint or lavender can have a calming effect and relieve symptoms.
• Ensure regular intake of medications if dizziness is caused by an underlying condition and medicines can help.

Dizziness can have many causes, but early diagnosis is the key to taking targeted action. The right treatment can significantly improve quality of life and restore balance.