Top 4 Causes of Dizziness (Table)

Dizziness is an extremely common disorder that afflicts an estimated 10-20% of individuals older than 70 years old. Even for those younger, dizziness is a not uncommon problem.

Several studies have been performed over the years to try and quantitate what are the most common causes of dizziness to help narrow the possibilities given the workup for dizziness can be long, tedious, and time-consuming which often frustrates patients.

Also frustrating is the fact that without a diagnosis, treatment can not be reliably pursued resulting in symptom persistence in spite of attempted treatment.

In any case, in rank order, the top 4 most common causes of dizziness are:

#1: BPPV

Depending on the study (see table below), accounts for ~25% of all dizziness. The symptoms of BPPV (Benign Paroxysmal Positional Vertigo) are spinning attacks that last no more than a few minutes that occur with positional changes, usually turning the head. Diagnosis is achieved by Dix-Hallpike maneuver. Treatment is positional therapy, usually Epley.

#2: Anxiety

Frequency is around 20% depending on the study (see table below). Fairly self-explanatory. Usually the dizziness is described as light-headed imbalance that lasts hours to days.

#3: Unknown

In spite of exhaustive testing and evaluation by multiple specialties, a diagnosis is never reached and treatment is symptomatic. Sadly, the cause of the dizziness can not be found in approximately 20% of patients.

#4: Orthostatic Hypotension

Orthostatic hypotension is usually described as light-headedness (vision going dark when severe) when going from a laying to standing position. Due to cardiac or blood pressure issues which when corrected, resolves this particular dizziness. Only around 5% is dizziness attributable to this condition.

Below is a table (references at end) that goes over the frequency rates for other causes of dizziness.

Variable	Study #1	Study #2	Study #3	Study #4	Study #5
# of Patients	1194	117	149	731	2556
Age of Subjects	over 70	over 50	over 65	over 70	under 70
Examiner	ENT	Neurology	Geriatrics	ENT/Neurology	ENT/Neurology
Diagnosis
BPPV	47%	26%	4%	27.6%	22.6%
Anxiety	0%	3%	32%	15.3%	33%
No Diagnosis	23%	14%	0%	15.2%	11.4%
Orthostatic Hypotension	2%	3%	1%	7.1%	1.3%
Vascular Disorder	8%	7%	70%	5.2%	0.2%
Cervical Disorder	0%	0%	66%	0%	0%
Meniere's Disease	4.05%	4%	-	5.2%	5.6%
Migraine	0.08%	-	-	1.1%	3.9%
Labyrinthitis	1.77%	3%	-	0.96%	0.51%
Brain Tumor	1.4%	3%	-	0.55%	0.24%
Medication Side Effect	-	2%	-	1.9%	0.2%
Stroke/TIA	6.34%	7%	-	5.2%	0.2%

References:
Dizziness in the elderly: Diagnosing its causes in a multidisciplinary dizziness unit. ENT Journal. 93(4-5):162-167.

Dizziness in elderly men. JAGS 42:1184-1188.

Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study. BMJ 313

Dizziness in aging: A retrospective study of 1194 cases. Otolaryngol Head Neck Surg. 1994 Mar;110(3):296-301.