Dizziness and Nausea

Dizziness and nausea are common complaints that frequently go together and lead a person to seek a medical consultation. There is a wide range of causes of these symptoms, and most of them are not serious. However, these may cause a very uneasy feeling which can interfere with one's daily activities.

Dizziness is a feeling of lightheadedness or a spinning sensation that is often accompanied by nausea, or a sick feeling like one is about to vomit. When one is experiencing dizziness and nausea, other symptoms may also be experienced, such as sweating, faintness, shortness of breath and chest pains. There may be a feeling of weakness and loss of balance which may be accompanied by palpitations (irregular or fast heart beats) and blurring of vision. Although one person may just feel nauseated, others may actually vomit.

Causes of Dizziness and Nausea

Benign Paroxysmal Positional Vertigo (BPPV) - This condition accounts for about 20% of all causes of dizziness and it is more common in older adults. People who have this condition often feel lightheaded with a sense of imbalance and nausea. It is usually experienced during a change in the position of the head, such as when getting out of bed, rolling over in bed or bending over a sink to shampoo the hair. An affected person usually tips the head up and backward to relieve the feeling of spinning. This symptom may occur intermittently, sometimes lasting for a few weeks.

Most cases of BPPV have no known causes, but possible causes include head trauma, whiplash injury, migraines, inner ear problems, Meniere's disease and vestibular neuritis.

Many cases of this type of vertigo are self-limiting and get better without treatment. Patients are advised to avoid sudden movements that can cause vertigo. They may also be trained to get up slowly in the morning and use two pillows under their heads while sleeping. Special exercises may also be taught to patients by health care providers to relieve dizziness.

Motion Sickness - One of the most common causes of dizziness accompanied by nausea and vomiting is motion sickness, which is a normal reaction to head motion. Symptoms usually start with paleness of the skin, followed by yawning, sweating and restlessness. These are also accompanied by fatigue, drowsiness and upset stomach. Finally, the affected individual experiences nausea and vomits.

The cause of motion sickness is an imbalance in head movement, visual stimulation, inner ear stimulation and other sensory disturbances. It can happen to a person at any age, but those who have migraines are at greater risk.

Motion sickness can be treated with medications such as antihistamines, sedatives and migraine medications. However, it can be prevented by behavioral interventions such as repeated exposure to travel, avoiding ship travel, sitting on the front seat or by the window and by staying out of confines spaces.

Meniere's Disease - This is a disorder in the inner ear which leads to episodic vertigo, tinnitus or ringing in the ears, a sensation of fullness and pressure in one ear, variable hearing loss, nausea and vomiting. Symptoms occur as an attack which may last for hours and may lead to a feeling of exhaustion. During an attack the eyes move and there is a great sensitivity to visual stimulus. However, attacks may also be mild or severe enough to cause a fall. Attacks may occur in clusters and there may be long periods without any attacks. Usually the condition begins in one ear and may later involve the other ear.

The exact cause of Meniere's disease is unknown but possible causes include head trauma, viral infection of the inner ear, allergy, migraine and hereditary factors.

There is no definite treatment for Meniere's disease, but medications such as lorazepam may be prescribed to control symptoms. During an attack, patients are advised to lie down and stay still, with eyes focused on an object until the episode ends. They are also told not to suddenly get up or take anything by mouth right after an attack.

Pressure Sensitivity - Fluctuation of pressure inside or outside the ears may cause a feeling of dizziness and nausea. Straining in the bathroom changes pressure in the inner ear and can cause dizziness. An increase in middle ear pressure occurs during scuba diving or riding an airplane, causing dizziness and nausea. One can usually clear one ear but not the other. Sticking a finger into the ear causes outer ear pressure changes and leads to lightheadedness.

Treatment depends on the cause, and it may involve medical or surgical treatment. People who are sensitive to pressure may also use ear plugs to avoid sensing fluctuations in pressure.

Transient Ischemic Attacks (TIA) and Strokes - These neurological conditions involve a decrease in blood supply to the brain, leading to dizziness. They usually occur suddenly, although the duration may differ - TIAs last only a short time while strokes are long lasting. Accompanying symptoms include visual changes, weakness, unsteadiness/ lack of coordination, confusion, headaches, loss of hearing, numbness, speech changes, hearing abnormal noises and numbness around one's lips.

Risk factors that may lead to a blockage in blood supply to the brain include high blood pressure, high cholesterol levels, obesity, sedentary lifestyle, smoking, advanced age, family history, heart disease and diabetes.

Diagnosis depends on the physician's clinical judgment and laboratory analysis, including radiographic examinations. Treatment includes blood thinners, anticoagulants, and medications to lower blood cholesterol and control heart rate abnormalities.

Cervical Vertigo - Dizziness associated with certain neck postures is called cervical vertigo. Aside from being associated with neck movements, this type of dizziness is often not accompanied by other symptoms like hearing disturbances or ear pain, making it difficult to diagnose. It is common among females and people who are 30-50 years old.

Causes of cervical vertigo include migraines, neck trauma, abnormal sensory input in neck receptors and compression of the vertebral artery in the neck. Its diagnosis is usually made after excluding other possible causes of vertigo and lab work-up may include radiographic scans of the neck.

Low Blood Pressure - Any factor that can cause a drop in blood pressure may cause dizziness, weakness, sweating, nausea and vomiting, shortness of breath and chest pains. Common causes of low blood pressure are anemia, bleeding, dehydration, heat exhaustion, alcohol intake, pregnancy and use of some medications. The treatment will depend on the specific cause, and this will usually relieve the symptoms.

High Blood Pressure - Many people do not have symptoms of high blood pressure but this condition may also be associated with dizziness, nausea, headaches, neck pain, and chest pains. The cause of elevated blood pressure is usually unknown, although risk factors associated with it include high cholesterol, atherosclerosis, obesity and diabetes. Treatment of high blood pressure includes medications and lifestyle modifications like diet and exercise.

Diabetes - Either high blood sugar levels or low blood sugar levels may induce dizziness and nausea. These are due to the lack of blood sugar control which may be related to genetic factors, diet, obesity and sedentary lifestyles. Symptoms may be accompanied by sweating, fainting and body weakness. Treatment involves control of blood sugar levels using medications and improvement in diet and exercise.

Hyperventilation - Breathing too fast can result in dizziness accompanied by nausea. This is a common condition that occurs during episodes of emotional distress and may be recognized by the tingling sensation felt in the hands, feet and mouth, and seen as clawing of the hands and feet. The affected individual's rapid breathing causes a decrease in his carbon dioxide levels and produces these symptoms. Treatment involves encouraging the individual to calm down and breathe slowly into a paper bag.

Early Pregnancy - In the early weeks of pregnancy women commonly experience dizziness and nausea and these are usually accompanied by a missed period, tiredness and moodiness. A pregnancy test will confirm the diagnosis. No treatment is necessary unless symptoms are severe.

Tumors - Tumors that develop anywhere in the ear or brain can lead to dizziness. Symptoms usually include nausea, tinnitus, imbalance and hearing problems, depending on the location of the tumor. Diagnosis depends on clinical assessment and laboratory work-up which includes brain scans. Treatment also depends on the location and size of the tumor, which may need surgical removal.

In summary, dizziness and nausea are symptoms that usually go together and are commonly experienced by people of all ages. Most of the causes of dizziness with nausea are not serious and may be self-limiting. However there are some conditions where the cause is unknown. If you experience dizziness that is accompanied by other serious symptoms like chest pains or difficulty in breathing you may need medical help. Furthermore, if the symptoms interrupt your normal activities or occur more often than usual, it is best to seek medical consultation for proper diagnosis and treatment.

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