Doctor, Please Explain
Dizziness and Motion Sickness
Insight into causes and prevention
• What is dizziness?
• What causes dizziness?
• How will my dizziness be treated?
• and more…
Feeling unsteady or dizzy can happen due to poor
circulation, vertigo, injury, infection, allergies, or
neurological disease. Dizziness is treatable but it is
important for your doctor to help you determine the cause so
that the correct treatment is used. While each person will
be affected differently, symptoms that warrant a visit to
the doctor include a high fever, severe headache,
convulsions or ongoing vomiting, chest pain, heart
palpitations, shortness of breath, inability to move an arm
or leg, a change in vision or speech, or hearing loss.
What is dizziness?
Dizziness can be described in many ways, such as feeling
lightheaded, unsteady, or giddy. Vertigo is a type of
dizziness experienced as an illusion of movement of self or
the environment and is usually unpleasant. Others experience
dizziness associated with motion sickness, a nauseating
feeling brought on by the motion of riding in an airplane,
on a roller coaster, or aboard a boat. Dizziness, vertigo,
and motion sickness all relate to the sense of balance and
equilibrium. Your sense of balance is maintained by a
complex interaction of the following parts of the nervous
• The inner ears (also called the labyrinth), which monitor
the directions of motion, such as turning, rolling,
forward-backward, side-to-side, and up-and-down motions.
• The eyes, which monitor where the body is in space (i.e.,
upside down, right side up, etc.) and also directions of
• The skin pressure receptors in the joints and spine, which
tell what part of the body is down and touching the ground.
• The muscle and joint sensory receptors, which tell what
parts of the body are moving.
• The central nervous system (the brain and spinal cord),
which processes all the bits of information from the four
other systems to make some coordinated sense out of it all.
The symptoms of motion sickness and dizziness appear when
the central nervous system receives conflicting messages
from the other four systems.
What causes dizziness?
Circulation: If your brain does not get enough blood flow,
you feel lightheaded. Almost everyone has experienced this
on occasion when standing up quickly from a lying down
position. But some people have light-headedness from poor
circulation on a frequent or chronic basis. This could be
caused by arteriosclerosis or hardening of the arteries, and
it is commonly seen in patients who have high blood
pressure, diabetes, or high levels of blood fats
(cholesterol). It is sometimes seen in patients with
inadequate cardiac (heart) function, hypoglycemia (low blood
sugar), or anemia (low iron).
Certain drugs also decrease the blood flow to the brain,
especially stimulants such as nicotine and caffeine. Excess
salt in the diet also leads to poor circulation. Sometimes
circulation is impaired by spasms in the arteries caused by
emotional stress, anxiety, and tension.
If the inner ear fails to receive enough blood flow, the
more specific type of dizziness occurs, that is, vertigo.
The inner ear is very sensitive to minor alterations of
blood flow and all of the causes mentioned for poor
circulation to the brain also apply specifically to the
Vertigo: Benign paroxysmal positional vertigo (BPPV),
labyrinthitis, and Ménière’s syndrome (fluctuating hearing
usually in one ear, pressure in the ear, ringing in one ear,
and attacks of spinning), and some forms of migraine are all
causes of vertigo. BPPV occurs when you change the position
of your head (typically lying down or sitting up), while
inner ear infections can cause labyrinthitis.
Injury: A skull fracture that damages the inner ear produces
a profound and incapacitating vertigo with nausea and
hearing loss. The dizziness will last for several weeks, and
then slowly improve as the normal (other) side takes over.
Infection: Viruses can attack the inner ear and its nerve
connections to the brain. This can result in severe vertigo,
but hearing is usually spared. However, a bacterial
infection such as mastoiditis that extends into the inner
ear will completely destroy both the hearing and the
equilibrium function of that ear. The severity of dizziness
and recovery time will be similar to that of a skull
Allergy: Some people experience dizziness and/or vertigo
attacks when they are exposed to foods or airborne particles
(such as dust, molds, pollens, dander, etc.) to which they
Neurological diseases: A number of diseases of the nerves
can affect balance, such as multiple sclerosis, syphilis,
tumors, etc. These are uncommon causes, but your doctor will
think about them during the examination.
When should I seek medical attention?
Call 911 or go to an emergency room if you experience:
• a head injury,
• fever over 101°F, headache, or very stiff neck,
• convulsions or ongoing vomiting,
• chest pain, heart palpitations, shortness of breath,
weakness, a severe headache, inability to move an arm or
leg, or change in vision or speech, or
• fainting and loss of consciousness for more than a few
Consult your doctor if you:
• have never experienced dizziness before,
• experience a difference in symptoms you have had in the
• suspect that medication is causing your symptoms, or
• experience hearing loss.
How will my dizziness be treated?
The doctor will ask you to describe your dizziness and
answer questions about your general health. Along with these
questions, your doctor will examine your ears, nose, and
throat. Some routine tests will be performed to check your
blood pressure, nerve and balance function, and hearing.
Possible additional tests may include a CT or MRI scan of
your head, special tests of eye motion after warm or cold
water or air is used to stimulate the inner ear (ENG—electronystagmography
or VNG—videonystagmography), and in some cases, blood tests
or a cardiology (heart) evaluation. Your doctor will
determine the best treatment based on your symptoms and the
cause of them.
• Avoid rapid changes in position.
• Avoid rapid head motion (especially turning or twisting).
• Eliminate or decrease use of products that impair
circulation, e.g., tobacco, alcohol, caffeine, and salt.
• Minimize stress and avoid substances to which you are
• Get enough fluids
• Treat infections, including ear infections, colds, flu,
sinus congestion, and other respiratory infections
If you are subject to motion sickness:
• Do not read while traveling.
• Do not sit in a seat facing backward.
• Do not watch or talk to another traveler who is having
• Avoid strong odors and spicy or greasy foods immediately
before and during your travel.
• Talk to your doctor about medications.
Remember: Most cases of dizziness and motion sickness are
mild and self-treatable. But, severe cases and those that
become progressively worse deserve the attention of a doctor
with specialized skills in diseases of the ear, nose,
throat, equilibrium, and neurological systems.
© 2007 Stefan Kieserman, M.D.
Any information provided on
this Web site should not be considered medical advice or a
substitute for a consultation with a physician. If you have a
medical problem, contact your local physician for diagnosis and