Causes of Dizziness

By Dr. Prateek Porwal, ENT Surgeon & Vertigo Specialist | PRIME ENT Center, Hardoi UP
Last Updated: February 2026 | VAI Budapest 2025 Award Recipient

In my clinic, patients often use “dizziness” and “vertigo” interchangeably, but they’re different things. Dizziness is a broader term—lightheadedness, unsteadiness, feeling faint, floating sensation. Vertigo is spinning. The distinction matters because the causes and treatments differ significantly. Let me walk through what I actually see causing dizziness in my UP practice and help you understand which category your symptoms fall into.

Dizziness vs. Vertigo: The Critical Distinction

I see patients every week who’ve been misdiagnosed because their doctor didn’t distinguish between dizziness and what is vertigo. Dizziness is any sensation of lightheadedness or feeling unsteady. Vertigo is specifically the sensation that you or the room is spinning. This matters because:

• Dizziness usually comes from cardiovascular, metabolic, or neurological causes
• Vertigo usually comes from inner ear or central nervous system problems
• Treatment approaches are completely different

The Main Dizziness Causes I Treat

1. Dehydration: The Hidden Culprit in North India

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I see this constantly in Hardoi, especially during hot months. When your body loses fluids faster than you replace them, blood volume drops, oxygen to the brain decreases, and you feel lightheaded or dizzy. This is one of the most common causes of dizziness I see, yet it’s often overlooked because it seems too simple.

Signs I look for:

• Thirst (obvious, but people ignore it)
• Dry mouth and sticky feeling
• Dark yellow urine
• Fatigue and weakness
• Headache
• Dizziness that improves within 15-30 minutes of drinking water
• Symptoms worse in afternoon and evening

Why it’s so common in UP: Heat exposure during summer months, inadequate water intake during work, diarrhea from foodborne illness, vomiting, sweating from physical labor in fields. In my practice, I’ve had farmers come in with severe dizziness that resolved completely after one glass of water.

The fix is simple: drink enough water that your urine is pale yellow. For some patients, oral rehydration solution (salt and sugar water, like you’d use for cholera prevention) works faster than plain water because it replaces electrolytes too, not just fluid.

2. Low Blood Sugar (Hypoglycemia)

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Your brain runs on glucose. When it drops too low, the brain panics and triggers symptoms. I see this especially in diabetic patients who take insulin but skip meals—a dangerous combination. It also happens in non-diabetics who fast too long, skip breakfast, or have intense physical activity on an empty stomach.

Symptoms to recognize:

• Dizziness and shakiness
• Rapid heartbeat (pounding sensation)
• Sweating (even in cool environments, which is distinctive)
• Difficulty concentrating or mental fog
• Intense hunger
• Anxiety or feeling of impending doom
• Comes on suddenly—patient is fine one moment, dizzy the next
• Improves within 5-10 minutes of eating sugar

Treatment: Eat something with quick carbs—sugar, fruit juice, fruit. If diabetic, keep glucose tablets or candy available. For diabetics, medication adjustment with their doctor is necessary to prevent recurrence. I always ask my dizzy diabetic patients: “When did you last eat?” A shocking number haven’t eaten in 12+ hours.

3. Orthostatic Hypotension (The Stand-Up Syndrome)

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This is a sudden drop in blood pressure when you stand up. Your brain temporarily doesn’t get enough oxygen. This is extremely common in the elderly and in patients on blood pressure medications.

When it happens:

• Standing up quickly from lying down or sitting
• After bed rest or lying down for extended time
• In elderly patients (very common—perhaps 30% of my elderly patients report this)
• With blood pressure medications, especially if dose is too high
• Dehydration makes it dramatically worse
• During hot weather or fever
• After large meals

How to prevent it:

• Stand up slowly, wait a moment before moving
• Sit on the edge of bed for 30 seconds before standing
• Flex your leg muscles while sitting (calf raises help pump blood)
• Stay well-hydrated
• Compression stockings can help in severe cases
• Avoid sudden position changes
• Have your blood pressure medications checked—dose might be too high

4. Anemia: The “Hidden” Cause in India

India has one of the highest rates of anemia in the world. I see anemic women—particularly in the childbearing years—with dizziness as a primary complaint. When your red blood cell count is low, oxygen delivery to the brain is reduced, causing lightheadedness.

Signs of anemia:

• Dizziness, especially with activity or exertion
• Fatigue out of proportion to activity
• Shortness of breath with normal activity
• Pale skin, pale inner eyelids
• Rapid heartbeat
• Headaches
• Difficulty concentrating
• History of heavy menstrual periods (in women)

Why it’s endemic in India: Vegetarian diet low in bioavailable iron, high burden of parasitic infections, heavy menstrual bleeding in women without access to treatment, poverty affecting nutrition. A simple blood test (hemoglobin level) diagnoses this. If anemia is the cause, iron supplementation or treatment of underlying causes (like parasites) resolves the dizziness.

5. Hypothyroidism: The Metabolic Dizziness Cause

Low thyroid function slows metabolism and can affect blood pressure regulation and brain function. This is common in both men and women but often missed because the presentation is subtle.

Associated symptoms:

• Dizziness
• Weight gain despite normal eating
• Fatigue
• Cold intolerance
• Dry skin
• Hair loss
• Slow heart rate
• Constipation
• Depression or low mood

A TSH blood test confirms this. If it’s thyroid-related dizziness, thyroid hormone replacement resolves it reliably over weeks to months.

6. Inner Ear Disorders Causing Dizziness (Not Vertigo)

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Sometimes dizziness (not true vertigo or spinning) comes from inner ear problems. The symptoms are milder than true BPPV—unsteadiness rather than spinning sensation.

Presentation:

• Unsteadiness, especially in darkness or with eyes closed
• Balance problems walking in straight line
• Difficulty with stairs or uneven ground
• May have hearing changes or tinnitus
• Feeling of instability, not spinning

These often benefit from vestibular rehabilitation exercises that retrain the brain’s balance compensation. Some patients also benefit from treating underlying conditions like vestibular migraine.

7. Anxiety and Stress: The Psychological Component

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I see a lot of anxiety-causing dizziness in my practice. Stress triggers fight-or-flight response, which changes breathing (hyperventilation), heart rate, and blood pressure. This causes real dizziness, not imaginary.

The pattern I recognize:

• Dizziness comes during stressful periods or times of anxiety
• Racing heart and rapid, shallow breathing
• Feeling of impending doom
• Muscle tension in neck, shoulders
• Improves with relaxation or reassurance
• No physical exam findings suggesting inner ear or cardiac disease
• Patient’s stress level clearly correlates with symptom severity

My approach: I never dismiss anxiety-related dizziness as “just in your head.” It’s real physiology. But it requires ruling out medical causes first (physical exam, maybe simple tests). Then address the anxiety—breathing exercises, meditation, sometimes medication. Cognitive behavioral therapy is very effective.

8. Medication-Induced Dizziness: A Very Common Cause

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Many drugs cause dizziness as a side effect. Blood pressure meds, antidepressants, antihistamines, pain meds, antibiotics—the list is long. Every time I see a patient with dizziness, I review their medication list carefully.

Common culprits I see frequently:

• Blood pressure medications (especially if dose too high)—patient’s BP drops too much
• Antihistamines for allergies—cause drowsiness and dizziness
• Antidepressants (SSRIs, tricyclics)—can lower blood pressure
• Sleep medications—leave person groggy and unsteady next day
• Pain medications with sedation—impair balance and coordination
• Anticonvulsants—cause dizziness as known side effect
• Antibiotics, particularly aminoglycosides (like gentamicin for infections)—can cause ototoxicity and damage inner ear
• Betahistine for vertigo—ironically, some patients get worse dizziness

If dizziness started after starting a new medication, don’t stop it without talking to your doctor, but mention the side effect. Often dose adjustment or switching to a different drug helps. I’ve had patients on blood pressure meds for years at doses that were too high for them—small adjustment fixed the dizziness.

9. Cervicogenic Dizziness: The Neck Connection (Or Lack Thereof)

I need to address this because I see cervical vertigo misdiagnosis constantly. Patients come in convinced their dizziness is from cervical spondylosis (neck arthritis) because they have neck pain, and somewhere they read that the neck can cause dizziness.

The controversy: Yes, the neck has balance-related nerves and sensors. Can severe neck problems cause some balance issues? Theoretically yes. But is this actually a common diagnosis? No. And most “cervical chakkar” diagnosed by non-specialists is actually BPPV, anxiety, or vestibular migraine.

Signs of actual cervicogenic dizziness (rare):

• Dizziness specifically triggered by neck movement in certain directions
• Associated with significant neck pain and limited range of motion
• Dizziness reproduced by positioning neck in specific way
• Imaging shows severe cervical pathology

The problem: Many doctors X-ray the neck, see some arthritis (common in anyone over 40), and blame that for dizziness without considering other causes. Result: patients waste money on neck treatments that don’t help, miss the real diagnosis, and remain dizzy. If true BPPV is present, it continues untreated.

Red Flag Causes Requiring Urgent Assessment

Most dizziness is benign, but some causes need urgent medical evaluation:

• Dizziness with chest pain or shortness of breath – Could be cardiac
• Sudden severe dizziness with weakness, numbness, or speech problems – Could be stroke
• Dizziness after head injury with loss of consciousness – Head trauma
• Persistent dizziness with high fever – Infection
• Dizziness with loss of consciousness or syncope – Cardiac issue
• New dizziness in elderly patient on new medications – Often medication-induced, needs urgent review

Diagnostic Approach: How I Sort Out The Cause

When a patient comes to my clinic with dizziness, here’s roughly how I think through it:

First: History (5 minutes of questions)

• Onset: Sudden (more likely cardiovascular/neurological) vs. gradual (more likely metabolic)
• Duration: Seconds (BPPV) vs. minutes (anxiety) vs. hours (migraine)
• Character: Spinning (vertigo) vs. lightheadedness (non-vertigo)
• Associated symptoms: Hearing loss (inner ear)? Chest pain (cardiac)? Anxiety (psychological)?
• Medications: Any started recently?

Second: Examination (10 minutes)

• Blood pressure: Sitting and standing – check for orthostatic drop
• Heart rate and rhythm
• Balance tests
• Neurological exam
• Dix-Hallpike test (if vertigo suspected)

Third: Testing (if needed)

• Blood tests: Hemoglobin, glucose, thyroid, electrolytes
• ECG: If cardiac cause suspected
• VNG: If inner ear pathology suspected

Usually this diagnostic process resolves most cases.