Why do I always feel dazed?

What is actually behind ... dizziness?

Numerous causes can lead to dizziness, v. a. Inner ear diseases, neurological and vascular diseases and mental disorders.

In addition, dizziness is one of the health problems that increase sharply with age. Typically, dizziness in old people cannot be traced back to a single cause, but rather is caused by a combination of various unfavorable influences, e.g. B. Fluctuating blood pressure plus poor vision plus nerve damage plus depressed mood plus medication.

How does dizziness develop?

Eyes, equilibrium organs and receptors in muscles, joints and skin constantly transmit information about our position in space to the brain. Dizziness always arises when this information contradicts each other and the brain is therefore unable to create a coherent picture. The dizziness is often accompanied by nausea, vomiting, paleness and sweating, as the nerve cells in the brain that are involved in the regulation of balance are connected to those that control vegetative reactions.

Lightheadedness. The most common is dizziness (unsystematic dizziness). Most patients say they are "dim", they feel "empty in the head", unsteady on their feet, as if they are drowsy or after drinking too much alcohol. The cause of dizziness usually does not lie in the equilibrium system.

Vertigo. Spinning vertigo can usually be described very precisely: The person affected has the feeling that their surroundings are spinning around them like in a carousel. The vertigo is often accompanied by spontaneous nystagmus (involuntary, trembling pupillary movements at rest), unsteadiness and unsteadiness, as well as nausea and vomiting.

Spinning vertigo is mainly caused by damage to the organ of equilibrium in the inner ear. Because of the close proximity to the inner ear, hearing loss is possible. More rarely, the cause lies in the processing of information by the nerve cells and pathways in the brain. Then the dizziness is usually a moderate permanent vertigo, and the nausea is not so severe either.

Staggering and lifting vertigo. With vertigo, the person concerned has the feeling that the floor is rocking like on a ship; with elevator vertigo, he is moving up or down in an elevator. The causes are manifold. The phobic postural vertigo, in which a fearful situation triggers the vertigo, is relatively common.

Positional vertigo. If the vertigo occurs only in a certain position or when changing position, one speaks of positional vertigo or positional vertigo. If turning only the head causes dizziness, there is usually a serious illness behind it.

The benign positional vertigo is common but harmless. When the head is lying sideways, the otoliths shift in the balance organ of the inner ear and lead to violent attacks of vertigo that last for seconds. They become weaker if they are provoked several times in quick succession. Even without treatment, the disease usually subsides after six to eight weeks, but it can return.

Diagnosis

The exact assignment of the cause is sometimes a real challenge. Often no exact cause can be found, but a number of causes of dizziness, especially dangerous ones, can be ruled out. The scope of the diagnostic measures therefore depends on the level of suffering of the patient and the dangerousness of the suspected cause. A typical program includes e.g. B. a neurological and - especially with vertigo - an ENT medical examination. These include a Schellong test to rule out or detect a blood pressure regulation disorder, a long-term ECG to rule out cardiac arrhythmias, Doppler sonography of the cerebral arteries to rule out arterial stenosis, if necessary an MRI to rule out a tumor and various blood tests.

 

therapy

With many forms of vertigo, gait and balance training are most effective in the long term. In the case of benign, suddenly occurring positional vertigo, positional training is the main focus. According to the motto "what does not fit is made to fit", the brain learns to recalculate the contradicting information and to correct the dizziness itself.

The understandable and, as a first measure, the correct posture for safety reasons, to lie down and take it easy, initially avoids dizziness, but has an unfavorable effect in the long run.

In the case of mentally (partly) caused dizziness, the mental disorder must be treated, for example with behavioral therapy.

In the elderly, any confounding factors that may be involved are addressed. At the same time, attempts are made to reduce the risk of falling by using aids such as walking aids and holding options in the home environment. Physiotherapy and exercise programs are at least as important as they are for younger people. But they often require considerable motivational work.

Antivertiginosa. Medicines are only used briefly in cases of severe vertigo and nausea, until the excruciating nausea has subsided. B. betahistine, dimenhydrinate, flunarizine, scopolamine and sulpiride.

All antivertiginous substances have a central nervous effect. The main side effects are tiredness and drowsiness - and thus possibly dizziness again - as well as dry mouth, visual disturbances and changes in blood pressure.

 

swell

Probst R. et al (Ed.): Hals-NasenOhren-Heilkunde, 3rd edition 2008, Thieme Verlag 2008

Schäffler, A. (Ed.): Gesundheit heute, 2nd edition. 2009, Deutscher Apotheker Verlag, Stuttgart

 

Author: Dr. med. Arne Schäffler & Kollegen, Augsburg, www.schaeffler.cc