Understanding Dizziness: Vertigo vs. Lightheadedness

This week, neuro-otologist David Kaylie of Duke Health will help us understand how balance disorders disrupt patients’ lives and what doctors can do to help. If you have felt lightheaded or been bothered with vertigo, call in your questions between 7 and 8 am EDT on Saturday, April 12, 2025, at 888-472-3366. Or you can send us email: radio@peoplespharmacy.com. Find out why you feel dizzy and what you can do about it.

You could listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on April 14, 2025.

Why You Feel Dizzy:

One possible cause of dizziness is Menière disease. People with this condition often have unpredictable episodes in which they feel like they are spinning. They may also have hearing loss or tinnitus that comes and goes at first. Menière disease happens when fluid builds up in the inner ear, but doctors don’t know the underlying reasons for that.

Another reason many people feel dizzy is benign paroxysmal positional vertigo, or BPPV. This produces a spinning sensation whenever the person moves their head. It occurs when little pieces of calcium carbonate get dislodged from their normal position and move into the semicircular canals. As these inner ear structures are crucial for balance, disrupting them with wandering crystals can cause vertigo.

The inner ear is also the source of some other balance problems. An inner ear infection could cause trouble. Inflammation of the labyrinth, which includes the semicircular canal along with the otolith organs, can disrupt balance, as can inflammation of the nerves.

For some people, dizziness can be a symptom of migraine. The headache may follow later, or there may not be any actual pain, just lightheadedness or dizziness. Dehydration might trigger the attack, but not everyone can identify a recurrent trigger.

Medications can occasionally cause lightheadedness that can be troubling. If they lower blood pressure too much, an individual may need to be careful about standing up too quickly. Doctors call this reaction “orthostatic hypotension.” Another condition that can throw people off balance is “postural orthostatic tachycardia syndrome,” or POTS for short. In addition to lightheadedness–feeling as if they might faint–people with POTS may find that their heart rates zoom when they stand up.

What Can You Do About Dizziness?

The steps to overcome dizziness will depend on the source of the problem. If it is a reaction to medication, a change in the prescription might make a difference.

On the other hand, if it is due to migraine, preventive medication might be helpful. Experts may recommend avoiding caffeine or dehydration to reduce the risk of this form of migraine.

The compounded medication that Dr. Kaylie prescribes for people with Menière disease is betahistine.

Describing Your Symptoms:

The doctor will find it easier to diagnose why you feel dizzy if you can be precise about the symptoms. When do they happen? Does anything make them stop? Do you feel like you are spinning, or is the sensation more like you are about to faint? Nausea is common with balance disorders, so reporting it won’t help much with the diagnosis but it will help the doctor understand your experience.

Call in Your Questions:

Dr. David Kaylie will be in our studio to answer your questions about balance disorders from 7 to 8 am on April 12, 2025. Have you been diagnosed with otoliths? Do you take a medication such as gentamycin that can cause dizziness? Give us a call to learn what you can do about dizziness: 888-472-3366 or email us: radio@peoplespharmacy.com

This Week’s Guest:

David M. Kaylie, MD, MS, is Professor and Vice Chairman for Clinical Operations in the Department of Head and Neck Surgery & Communication Sciences at Duke Health.

Dr. Kaylie is a neuro-otologist who manages the whole range of disorders of the ear, hearing and balance. He is particularly interested in the impact balance disorders have on patients’ perceptions of their well-being and interactions with the world. Why are balance disorders so disruptive to patients’ lives and what can doctors do to better understand their condition?
https://www.dukehealth.org/find-doctors-physicians/david-m-kaylie-md-ms

Listen to the Podcast:

The podcast of this program will be available Monday, April 14, 2025, after broadcast on April 12. You can stream the show from this site and download the podcast for free.

Download the mp3.