Health Insights · Neurology
Dizziness: working out the cause
Dizziness is a word covering at least three different experiences with entirely different causes. Describing which one you have — the room spinning, feeling faint, or being unsteady on your feet — is the most useful thing you can bring to an appointment, and usually narrows it down immediately.
Call 999 if dizziness comes with
- face droop, arm weakness or speech difficulty — act FAST
- double vision, difficulty swallowing or slurred speech
- sudden severe headache, or the worst headache of your life
- numbness or weakness on one side of the body
- chest pain, palpitations or collapse
- new unsteadiness with a severe headache after a head injury
Sudden vertigo with any neurological symptom — particularly double vision, slurred speech or one-sided weakness — may be a stroke affecting the brainstem or cerebellum, which is frequently mistaken for an inner ear problem. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
Which kind is it?
- Vertigo — a false sense of movement, usually the room spinning. Points to the inner ear or, less often, the brain.
- Presyncope — feeling faint, light-headed, about to black out, often with greying vision and clamminess. Points to blood pressure, heart rhythm or anaemia.
- Disequilibrium — unsteadiness on the feet without spinning or faintness. Points to nerves, joints, vision, medication or neurological conditions.
- Non-specific dizziness — a floating, foggy or detached feeling, often associated with anxiety or hyperventilation.
Vertigo — the common causes
- BPPV — brief, intense spinning triggered by turning over in bed, looking up or bending down. Lasts seconds to a minute. The commonest cause, and it is cured in one appointment with a repositioning manoeuvre.
- Vestibular neuritis — sudden severe vertigo lasting days, often after a viral illness, with nausea and unsteadiness but normal hearing.
- Ménière's disease — attacks lasting 20 minutes to hours, with hearing loss, tinnitus and a sense of fullness in one ear.
- Vestibular migraine — vertigo with or without headache, often light and sound sensitivity. Commonly missed.
Feeling faint — the common causes
- Postural hypotension — blood pressure dropping on standing. Very common, especially with age, dehydration and blood pressure medication.
- Medicines — antihypertensives, diuretics, antidepressants, prostate tablets, opioids.
- Anaemia, low blood sugar, and dehydration.
- Heart rhythm problems — particularly if it happens without warning, while sitting or lying, or during exertion. This combination needs prompt cardiac assessment.
- Vasovagal episodes — triggered by standing for a long time, heat, pain or the sight of blood.
Two questions that narrow it down fast
How long does an episode last? Seconds to a minute suggests BPPV. Minutes to hours suggests migraine or Ménière's. Days of constant vertigo suggests vestibular neuritis. Constant for weeks suggests something other than the inner ear. And what brings it on? Turning in bed points to BPPV; standing up points to blood pressure; nothing at all, particularly while sitting, points towards the heart.
What assessment involves
- Lying and standing blood pressure — simple, and frequently diagnostic
- ECG, particularly for faintness or if episodes occur without warning
- Examination of the ears, eyes and balance, including specific positional tests
- Blood tests — full blood count, ferritin, glucose, kidney function, thyroid
- Medication review, which is one of the highest-yield steps
- Imaging only where the history or examination suggests a central cause
Staying safe meanwhile
Do
- Sit or lie down immediately when it starts
- Stand up slowly, in stages, especially from bed
- Keep well hydrated and avoid long periods standing still
- Move the head deliberately rather than avoiding movement entirely
- Remove trip hazards and improve lighting at home
Avoid
- Driving until the cause is established
- Ladders, heights, swimming alone and machinery
- Prolonged bed rest with vertigo — it delays recovery
- Alcohol, which worsens balance
- Long-term vestibular sedatives such as prochlorperazine, which prevent adaptation
Why come to us. Dizziness is frequently dealt with by a prescription for prochlorperazine and no diagnosis — and for BPPV, the commonest cause, that is exactly the wrong treatment when a two-minute manoeuvre would cure it. We take a proper history, perform lying and standing blood pressure, ECG and positional testing on site, take bloods in-house with results the same visit, and review your medicines. ENT and cardiology are available without a referral, 7 days a week.
Private assessment for dizziness in East London
Dizziness has many causes — inner-ear problems, blood pressure, medication and, less often, neurological or heart conditions — so assessment guides treatment. A private GP in East London can examine you, check your blood pressure and arrange blood tests or an ECG, involving our ENT or specialist medicine team where needed. Sudden dizziness with slurred speech, weakness or a severe headache needs emergency care — call 999. Tower Bridge Hospital is on Whitechapel Road in East London, a short journey from Canary Wharf and the City, with same-day appointments and no referral required.
Dizziness in London: common questions
What causes dizziness?
Common causes include inner-ear problems, low blood pressure, dehydration and medication; heart and neurological causes are less common.
When is dizziness an emergency?
Dizziness with slurred speech, facial or limb weakness, double vision, or a sudden severe headache needs emergency care — call 999.
What tests might I need?
Depending on the likely cause: blood pressure checks, blood tests, an ECG, and sometimes ear or neurological assessment.
Can I be seen the same day?
Yes — same-day private GP appointments are available most days.
The kind of dizziness identified, not just sedated
ECG, BP testing and bloods on site. 7 days a week.