Patients describe dizziness in many different ways: “a weird feeling in my head,” “empty head,” “heavy head,” “walking on clouds or cotton,” among several other odd sensations. Although the symptom is often hard to explain, the more detailed the patient is, the faster and more accurate the diagnosis becomes.
Is it hard for you to describe your dizziness?
We know this symptom tends to be highly subjective. Many conditions and disorders can trigger this type of issue, but the patient’s interpretation and lived experience may vary greatly from one person to another.
Another point that makes the diagnosis challenging is the wide range of possibilities associated with dizziness.
Dizziness can be caused by a simple, momentary discomfort — such as a drop in blood pressure or blood sugar — or by more serious health conditions, such as the well-known labyrinthitis, which is often (and incorrectly) used as a general term for dizziness, even though it is actually a rare infection of the inner ear.
What you may not have realized is that different types of dizziness offer clues that are fundamental to the diagnosis — and in this article, my goal is to draw your attention to them.
This content is informational and does not replace an appointment with a specialist dedicated to dizziness and its related conditions.
Below, you’ll find a few simple questions whose answers will certainly help your doctor understand your case and define the most appropriate treatment. Let’s go!
- 1. What kind of strange sensation do you feel in your head?
- 2. Is your dizziness associated with other symptoms?
- 3. Are your symptoms spontaneous or triggered by something?
- 4. Does your dizziness occur in episodes or is it continuous?
1. What kind of strange sensation do you feel in your head?
The first thing you should observe is the sensations you experience during dizziness. It’s very common, for instance, for patients not to fully understand the difference between dizziness and vertigo.
In medicine, vertigo is understood as a specific type of dizziness characterized by a false perception of movement — such as feeling like everything around you is spinning — or an abnormal perception of a movement you actually made, such as turning your head and feeling the surroundings tilt or your head spin.
When we talk about dizziness, we mean any type of imbalance or spatial disorientation, which — besides vertigo — may feel like stepping on clouds, cotton, or steps, as well as a sensation of emptiness or a “floating head” that makes walking difficult.
This distinction is important because vertigo specifically may indicate changes in the labyrinth, the vestibular nerve, the vestibular nuclei, or other structures related to balance and hearing.
2. Is your dizziness associated with other symptoms?
This is the most important question for diagnosis, as it helps rule out possibilities and guide the investigation more precisely. Besides dizziness, you should pay attention to:
- auditory symptoms: hearing loss, tinnitus, or a clogged-ear sensation;
- headache: especially migraine, usually described as a throbbing pain on one side of the head;
- neck or back pain: cervical discomforts, stiffness, or soreness;
- visual changes: hazy vision or blurred sight;
- palpitations: feeling like the heart is racing;
- pallor and sweating: and check for fever;
- nausea: possibly accompanied by vomiting.
These symptoms don’t always appear together. If they don’t, you should observe whether they started around the same time.
In some conditions, such as vestibular migraine, the diagnosis may consider the patient’s migraine history even if the most recent dizziness episodes did not include headache.
In severe cases where symptoms are debilitating — especially when neurological signs appear, such as difficulty moving limbs, speech problems, or double vision — you should seek immediate medical attention.
Although it is rare, dizziness can sometimes be a sign of stroke or an aneurysm.
3. Are your symptoms spontaneous or triggered by something?
You’ll also need to answer questions such as:
- Does the dizziness or strange head sensation appear suddenly, or does it always occur during moments of tension, pain, fatigue, stress, or anxiety?
- Do the symptoms appear or worsen after long periods without eating, or when you sleep poorly?
- Is your dizziness associated with movement or changes in position?
These clues are important for understanding your condition and, in some cases, may be enough to close the diagnosis.
Postural Hypotension, for example, can cause brief dizziness when you move from lying or sitting to standing. BPPV (Benign Paroxysmal Positional Vertigo) causes spinning vertigo episodes triggered by lying down, getting up, or moving the head.
On the other hand, we also have Persistent Postural-Perceptual Dizziness (PPPD) — often known as phobic vertigo — which is a chronic dizziness condition directly linked to psychological and emotional factors.
Note that BPPV and PPPD have key differences:
– BPPV appears in episodes and causes rotational vertigo.
– PPPD causes constant dizziness, often lasting all day and improving only when lying down.
This is the next clue you need to observe.
4. Does your dizziness occur in episodes or is it continuous?
This characteristic not only helps differentiate the multiple disorders in which dizziness may appear, but also guides more effective treatment strategies based on each patient’s experience.
Pay attention to whether your dizziness or strange head sensations occur:
- in occasional episodes: long intervals (weeks, months, or years) between symptoms;
- in frequent episodes: symptoms appearing several times throughout the day or week (note the average duration of each episode);
- continuously: symptoms occur every day and remain constant.
The conditions associated with these symptoms can vary widely, which is why it’s so important to describe your experience in detail to your doctor.
In all cases, a medical evaluation is essential to rule out related problems and confirm the diagnosis. Additional tests may be requested depending on the characteristics of your symptoms and your clinical history.
Even if describing your dizziness isn’t easy, regardless of the type of strange head sensation you’re experiencing, it is crucial to see a neurotologist, the ENT doctor specialized in dizziness and tinnitus.