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Nausea and Dizziness

Woman holding her head due to nausea and dizziness

Nausea and Dizziness

Why Do People Get Nausea When They Feel Dizzy?

Nausea – feeling sick to the stomach – can be caused by many factors. In its most basic form, nausea is a very effective mechanism by which our body protects us when we ingest something toxic. The nausea prevents us from eating more of the toxic material, and – if a threshold is passed – vomiting will occur to expel the unwanted stomach contents. Nausea can also occur when the digestive system is inflamed (i.e., “gastroenteritis”) to prevent eating, which would irritate the gut.

Both of those reasons for nausea (and sometimes vomiting) make sense: the body is protecting itself from having something in the stomach that may be harmful. However, the nausea (and sometimes vomiting) that almost always accompanies dizziness doesn’t really make much sense. After all, the stomach may be totally empty, and even if food was there, what does that have to do with being off-balance?

Well, the truth is that medical science doesn’t fully understand some of the reasons that nausea occurs, or even how it occurs. However, it seems that feeling dizzy and off-balance releases certain brain chemicals – “neurotransmitters” – that act on the brain’s nausea center. The reason that this occurs is not well understood, but this is probably why nausea and dizziness occur together.

Causes of Dizziness and Nausea

There are four broad types of symptoms that people describe as “feeling dizzy:”

Lightheadedness

This is a sensation that one is “woozy,” about to faint. In medical terms, it is referred to as “presyncope,” which means that the individual may faint if the cause is not addressed. Lightheadedness is usually caused by inadequate blood and nutrient supply to the brain. Brain cells are highly metabolically active and begin failing very quickly without adequate oxygen supply. The result is presyncope, followed quickly by syncope (fainting), coma, and even death if the oxygen supply is not restored.

Similarly, the brain requires large amounts of the sugar glucose to function properly. Glucose is the primary source of energy for the entire body. Even though the brain only constitutes about 2% of the body mass, it accounts for more than 60% of the body’s glucose usage. Because of that, if the blood sugar levels go too low to support brain function (i.e., “hypoglycemia"), the same progression of presyncope-syncope-coma-death can occur as with low oxygen supply.

Water is another nutrient that the brain relies heavily on. The brain is about 73% water, and it only takes about 2% dehydration to disable its function, and cause lightheadedness.

Even if oxygen, glucose, and water levels in the blood are normal, if the circulation of blood to the brain is compromised, lightheadedness, syncope, coma and death can occur. For this reason, low blood pressure, heart problems, and low blood levels (for example from bleeding or anemia) can make people feel lightheaded.

Certain chemicals can cause lightheadedness as well, due to their effects on the brain. For example, many medications are associated with lightheadedness as a common side effect (such as sedatives, anti-seizure medications, antihistamines, and anti-depressants). As well, certain metabolic abnormalities within the body can produce lightheadedness by producing abnormal levels of chemicals required by the brain (for example, thyroid hormone, calcium, and sodium).

As well, people can feel lightheaded from plain old fainting (“vasovagal syncope”). This commonly occurs in young, healthy people, and can be brought on by stress, heat, pain, or for no apparent reason. When fainting is imminent, they will feel lightheaded and may faint if they don’t sit or lay down.

Vertigo 

This is a false sensation of spinning, whirling, swaying, or that the environment is moving. Vertigo can be caused by a disruption to the function of any part of the balance system, which is located in the inner ear and the brain. When vertigo is caused by problems in the brain’s balance circuits, it’s known as “central vertigo,” because the brain is a part of the central nervous system. When it involves the inner ear, it’s known as “peripheral vertigo.”

The most common type of vertigo is peripheral. The inner ear helps us to maintain our sense of balance through an anatomical structure known as the “vestibular apparatus.” This tiny structure senses when we are moving and when we are tilted or off-balance. When something goes wrong with this important sensory organ, vertigo occurs. This includes inflammation of the structure itself (“labyrinthitis”), inflammation of its nerve (“vestibular neuritis”), and several other causes (such as Benign Paroxysmal Positional Vertigo (BPPV), and Meniere’s disease).

Central vertigo can occur with any brain dysfunction that happens to involve the parts that are involved in equilibrium. This includes such conditions as stroke, brain inflammation (“encephalitis”), migraine headaches, multiple sclerosis, brain tumors, and exposure to toxins.

Vertigo is associated with nausea and vomiting, excessive sweating, and blurry vision, often with a sudden onset. Depending on the cause, the nausea and dizziness from vertigo can come and go, lasting seconds, minutes, or hours, or it can be chronic, lasting days, weeks, or even months. Together, the symptoms make affected individuals miserable, as they are often unable to walk or keep down food.

Psychophysiological dizziness 

This is a kind of dizziness that is related to various psychological disorders, such as anxiety. The dizziness can involve a variety of sensations, such as being out of body, spinning, or floating.

Disequilibrium 

This type of dizziness is associated with “sensory conflict,” where the visual cues don’t align with what the individual feels. They feel unsteady of off-balance because their vision sees them as being tilted of moving, but their sense of touch tells them they are not. The cause is usually in the eyes or the parts of the brain involved in interpreting vision. With motion sickness, the visual system is working fine, but the seeing movement while the body is at rest creates sensory conflict, and the individuals feel nausea and dizziness.

Cervical Dizziness 

This is less commonly discussed, but your neck can make you dizzy.  Like vertigo and dysequilibrium, when there is a sensory conflict between your neck with your vision and vestibular systems, you can develop a sensory mismatch leading to dizziness symptoms, with motion sickness being one of the symptoms.

Lightheadedness and Fatigue

Some conditions cause fatigue as well as lightheadedness. Lightheadedness is usually caused by inadequate supply of the brain’s three main metabolic requirements: glucose (sugar), oxygen, and water. Inadequate supply of these three important energy requirements can also cause feelings of fatigue. This can occur when there is:

  • Inadequate blood supply to carry nutrients to the brain – this can happen with low blood pressure, heart abnormalities, autonomic nervous system irregularities, and blockages of the blood circulation (such as blood clots and atherosclerosis (cholesterol build-up narrowing the arteries)), and
  • Inadequate nutrients in the blood – this occurs with low blood sugar (hypoglycemia), dehydration, when there’s inadequate blood in the circulation (“anemia” from low iron or low vitamin B12, or other causes), malnutrition, and inadequate breathing or lung function.

As well, some of the medications that cause lightheadedness are also known to cause fatigue. Medications that are well known to cause both side effects include:

  • Older antidepressant medications (“tricyclic” antidepressants),
  • Anti-seizure medications,
  • Blood pressure medications,
  • Heart medications (“anti-arrhythmias”), and
  • Anti-psychosis/mood stabilizer medications.

The brain is among the most metabolically active tissues in the body, so it usually experiences symptoms before other body parts. However, if the inadequate supply of any of these energy requirements gets profound enough, other body parts will also feel fatigue. For example, the muscles will tire faster, causing the individual to feel fatigued much sooner than usual.

Headache and Dizziness and Nausea

Depending on the cause of dizziness, headache may also be present. In some cases, the headache will bring on vertigo, and in others the vertigo causes the headache. Vertigo and headaches can each cause nausea, so the three symptoms will often occur together.

Headaches are caused by a variety of factors, ranging from muscle tightness in the scalp and neck (tension headaches), poor blood flow associated with autonomic nervous system dysfunction, to sinus congestion (sinus headaches) to brain issues (such as migraines). There are over 200 types of headaches.

One of the more common causes of dizziness and headache is vestibular migraine, which occurs in about 7-10% of people with recurrent vertigo. These types of dizziness-headaches typically include the following symptoms:

  • Bouts of moderate to severe vertigo dizziness lasting between five minutes and 72 hours,
  • A headache that is on one side of the head,
  • The headache is pulsating, and moderate to severe in intensity,
  • The headache and dizziness are worsened by physical activity,
  • Visual aura (seeing moving shapes or pulsating lights), and
  • Intolerance of noise and light.

Dizziness itself, especially vertigo, may trigger headache although the mechanisms are poorly understood. The most likely cause is a mixture of nerve dysfunctional and blood vessel dilation and inflammation. Because of the association between nausea and headaches (nausea is a common symptom of headaches, especially migraines), there may be an association between the nausea that is brought on by dizziness and headaches.

How to Stop Feeling Dizzy 

Dizziness and nausea are very uncomfortable to deal with, so people understandably seek relief when they experience these symptoms. Both have been associated with reduced quality of life and overall well-being. As well, dizziness presents a significant safety hazard, as the falling risk is very high. Dizziness and nausea are typically associated with a sudden onset, which worsens the danger of falls or other accidents. Often the dizziness, sweating, and feeling nauseous seem to arise out of nowhere, and can unexpectedly disrupt an individual’s ability to walk or drive.

The most important factor in stopping dizziness is safety. Getting to a safe place and sitting or laying down, pulling the car over if driving, or stopping other activities that require concentration and balance is urgent. Often simply sitting or lying down will help with the dizziness and may even stop it. However, people who experience dizziness should see their doctor to be properly assessed and – if needed – to receive treatment.

Dizziness Treatment 

The most important part of the treatment of dizziness is identifying and correcting the underlying cause. This underscores the importance of diagnosis, because if the cause is not properly diagnosed then it is unlikely that an effective treatment will be found.  You also need to understand that you might feel worse before you get better with treatments. 

Because there is such a long list of causes of dizziness, it is sometimes difficult to narrow down the cause. Besides a good history and physical examination, the health care provider may need to order tests, such as blood tests, or imaging studies.

Most cases of lightheadedness can be treated by identifying and correcting the underlying cause. However, when the cause is more difficult to treat, such as heart or lung dysfunction, the dizziness may become chronic and recurrent. When people are taking medications that cause dizziness, stopping or switching the medication may resolve the dizziness. However, some individuals may not have a choice but to continue on the medication and put up with the side effects.

Psychophysiological dizziness can often be effectively stopped or reduced by treating the underlying psychological cause. For example, if the dizziness occurs during panic attacks, treating the anxiety and preventing the panic attacks is usually effective at relieving the dizziness.

Disequilibrium may be more difficult to treat, because the vestibular problems may be chronic. As such, people affected by this type of dizziness may have to learn to live with it, but physical therapy can greatly reduce their symptoms and risk of falls.

Vertigo can be a unique issue – some cases like benign vertigo associated with debris can be easy to treat by your therapist while other form like central and peripheral vertigo is generally more difficult to treat.  This is because medications for this type of vertigo (such as steroids, diuretics, and antihistamines) are generally not very effective. Unfortunately, many of these medications are also very sedating. Some cases of vertigo are self-limited – meaning that they resolve on their own after a period of time – while others persist longer. Physical therapy specifically designed to treat vertigo – known as “vestibular rehabilitation” – is in most cases the most effective treatment.

When dizziness is chronic – as many cases are – an important part of treatment includes balance and gait therapy, so as to prevent injury from falls. In such cases, access to a physical therapist with expertise in diagnosing and treating dizziness becomes important.

Physical therapists are trained to assess each patient’s dizzy symptoms in order to customize the optimal treatment approach for that individual’s specific type of dizziness. This is important because different types of dizziness respond to different types of treatment. This is why expertise in treating vertigo and other types of dizziness is important when selecting a physical therapist.

FYZICAL® Therapy & Balance Centers provide specialized physical therapy for a wide variety of musculoskeletal, neurological, visual, and inner ear conditions that cause dizziness and poor balance.

The dizziness treatment program at FYZICAL uses established proprietary treatment and recovery protocols that include specialized cutting-edge equipment that is not available at other physical therapy centers. This makes the specialized physical therapists at FYZICAL an excellent choice for those seeking relief from dizziness of any kind.

FYZICAL offers free assessments to diagnose dizziness and to determine each individual’s falling risk. The physical therapists at FYZICAL will then create a recovery program tailored to each patient’s specific condition and needs.

FYZICAL offers a wide variety of physical therapy services by qualified providers across the U.S. To find a FYZICAL Therapy & Balance Center near you, visit our website at FYZICAL.com. Our highly skilled therapy providers are 100% focused on your optimal health so you can Love Your Life®!

To learn more about how FYZICAL Therapy & Balance Centers can help you, download our free e-book.