Dizziness in older people - causes and treatment

Dizziness is the second most common problem with which people turn to neurologists. It occurs only slightly less frequently than headaches. Moreover, the frequency of its occurrence increases proportionally with age, and women suffer from such attacks 2-3 times more often than men. But dizziness refers to quite different symptoms, from the sensation of rotation of surrounding objects or one’s body to darkening of the eyes, unsteadiness of gait, etc. And there are even more reasons for the occurrence of such disorders. One of the most commonplace is an increase or decrease in blood pressure. But if the tonometer readings are within the normal range (120/70) or close to it, you should look for the cause of dizziness elsewhere.

How to determine the cause of dizziness at normal blood pressure

Most often, finding out the cause of a patient’s health problems begins with collecting anamnesis and measuring blood pressure, since in most cases this allows you to immediately eliminate a whole range of disorders. The cause of dizziness without changes in blood pressure can be a rise to altitude, a long trip in a car or boat, or physical fatigue. In such situations, there is usually no threat to health and no need to see a doctor.

In other cases, it is necessary to differentiate systemic dizziness from non-systemic dizziness. In the first case, there is damage to the vestibular analyzer, i.e., the organ responsible for maintaining balance and adequate reactions of the body to changes in the position of the body or head. Non-systemic dizziness is caused by other diseases that are in no way related to the work of the vestibular analyzer.

With normal blood pressure levels and the absence of heart and vascular diseases, systemic (vestibular or true) dizziness is most often diagnosed. According to statistics, about 30% of people encounter it at least once in their lives.

A very important point in determining the cause of a disturbance in well-being is an accurate description of the sensations that arise during an attack. At the same time, it is important to try to avoid the word “dizziness” and talk in as much detail as possible about the feelings that arise.

Systemic vertigo is characterized by the presence of various illusions of movement. This may be a feeling:

• rotation of the body in space or vice versa of environmental objects;
• rocking the bed on which the patient is lying, rocking in a boat, falling into space;
• the ground leaving under your feet, the ceiling collapsing, etc.

With systemic dizziness, which occurs with normal blood pressure, there is no sensation of darkening in the eyes, flickering of spots, fog in the head, lightheadedness, or unsteadiness. Such symptoms indicate the non-systemic nature of the disorder and the need to search for causes in pathologies of other organs, not excluding the heart and blood vessels. After all, during an examination, blood pressure may be normal, but sharply fall or rise in response to a specific trigger.

The main distinguishing feature of systemic vertigo is nystagmus - rapid, involuntary movements of the eyeballs.

Causes of systemic dizziness

Systemic or vestibular vertigo may be central or peripheral. In the first case, the reason lies in damage to the corresponding nuclei of the brain stem and its vestibular centers, disruption of vestibular connections, which is typical for:

• circulatory disorders in the vertebrobasilar system, accompanying a transient ischemic attack or stroke, which is often observed in diseases of the spine and cervical osteochondrosis in particular;
• vestibular migraine;
• multiple sclerosis.

When the central part of the vestibular analyzer is damaged, the severity of symptoms increases smoothly. They are not very pronounced, but can persist for several days or even weeks. In such cases, headaches, visual disturbances, inability to walk and falls are also often observed.

Central vestibular vertigo accounts for 12% of all cases of patients visiting doctors with similar complaints.

In case of peripheral vestibular vertigo, the problem should be sought in damage to the vestibular analyzer or nerve. In such situations, it may consist in the development of:

• benign paroxysmal positional vertigo (BPPV);
• Meniere's disease;
• vestibular neuritis;
• bilateral vestibulopathy;
• neurovascular conflict, etc.

There is a whole range of other peripheral causes of dysfunction of the vestibular analyzer, but they are much less common - less than 0.5% of cases. But almost always, when the vestibular analyzer or nerve is damaged, the attack begins acutely and lasts no more than a day. It is characterized by a sudden onset of a pronounced sensation of rotation. This may be accompanied by nausea and even vomiting, tinnitus and hearing loss.

Causes of non-systemic dizziness

Dizziness while maintaining normal blood pressure levels can be provoked by:

• inflammatory processes of the ear;
• following a strict low-carbohydrate diet;
• Iron-deficiency anemia;
• taking certain medications;
• endocrine disorders, including diabetes mellitus;
• infectious diseases accompanied by a significant increase in body temperature.

But in such situations, patients are usually aware of their problem and the possibility of dizziness. The only exception, perhaps, is iron deficiency anemia, which provokes increased fatigue. But to diagnose it, it is enough to take a general blood test.

When dizziness occurs against the background of normal blood pressure, its psychogenic origin cannot be excluded. This is observed in 15% of cases and therefore deserves special attention.

Anti-dizziness medicine for older people

What drug treatment is used for dizziness in older people? Since the diagnosis is so common, there are a number of drugs that make attacks less frequent and have a beneficial effect on the brain. These are so-called nootropics, that is, drugs that accelerate neural processes in the brain. They are excellent for helping with memory loss, complications of mental activity, sclerosis and dementia. In addition, they can be prescribed to improve blood circulation, to combat prolonged fatigue, insomnia and depression.

Nootropics have a wide spectrum of action and are completely safe for the body. They can be given to children and prescribed to absolutely healthy people for whom maximum concentration at work is important. But you should not try to choose a drug for yourself; let a doctor prescribe it. The main nootropics are Glycine, Phenotropil, Piracetam, Cinnarizine, Bilobil.

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Any of these medications improves blood circulation in the vessels of the brain, strengthens the walls of blood vessels, fights hypoxia, and establishes neural connections in the central nervous system. Some drugs have a sedative effect. Medicines in this group improve cellular metabolism and activate energy processes inside cells. This increases the ability to perceive and remember information and learn. Nootropics are used to treat dizziness in older people because they improve mood and sleep, and make a person more active.

Here is a more detailed description of some nootropics:

• Piracetam is on the first step in popularity. Many people experience sleep disturbances when taking the drug, so it is not prescribed for use in the evening, only before lunch.
• Cinnarizine. It is prescribed not only as a nootropic, but also as an anti-allergy remedy. It should be borne in mind that the drug causes drowsiness, dry mouth, and disruption of the gastrointestinal tract.
• Glycine is good because it does not cause adverse reactions. A very popular drug among students, especially during study periods. The main component is gamma-aminobutyric acid, which accelerates brain function and is important for metabolic processes.
• Phenibut. Its main component is the same gamma-aminobutyric acid. This medicine may cause you to feel sleepy, especially when you first start taking it.

How else to treat dizziness in older people? Nootropics based on herbal components are also used:

• Vinpocetine. The basic component is the small periwinkle. It has a beneficial effect on brain function, improves blood circulation in areas of blood vessels susceptible to ischemia (relaxes their walls). Helps lower blood pressure.
• Bilobil. The main herbal component is ginkgo biloba. Supplies the brain with oxygen and glucose, making blood vessels more resilient in case of oxygen deficiency. Improves attentiveness, memory and learning abilities. Has a weakening effect on numbness of the limbs.

All of the above remedies and others like them should be taken for at least three months. Only after a month will the first changes be noticeable. The frequency of administration is usually one to three times a day. The treatment regimen must be prescribed by a doctor.

BPPV

BPPV is diagnosed in 17% of patients complaining of dizziness and is the most common cause of its occurrence. Moreover, the frequency of its occurrence increases in proportion to age, and in women it occurs 2 times more often. This is a disease in which otoliths move into the semicircular canals of the inner ear.

Otoliths are calcium carbonate crystals normally located in the otolithic membrane of the inner ear.

With BPPV, attacks are usually triggered by head movements, especially at night, when the patient cannot control himself. There are frequent situations when dizziness occurs after turning in a dream or getting up/getting out of bed. In this case, dizziness begins acutely, but lasts less than a minute, although it may be accompanied by nausea and vomiting, nystagmus. It is not associated with hearing loss, noise, or ringing in the ears.

The duration of the attack usually does not exceed several minutes.

In most cases, the causes of BPPV cannot be determined. Only in certain situations is its development associated with head injuries, ear surgeries, or previous diseases of the inner ear.

But on the other hand, BPPV does not require specific treatment and, as a rule, goes away on its own in a few weeks or months. Patients are only taught special maneuvers to facilitate the release of particles from the affected semicircular canal to eliminate dizziness. But before they are carried out, it is imperative to consult a doctor who will confirm or deny the presence of BPPV and determine its type. Otherwise, as well as if the technique is violated, your condition may worsen.

There are more than 5 different maneuvers to relieve an attack of dizziness due to BPPV. The choice of which one will be most effective for an individual patient depends on which part of the labyrinthitis his otoliths move to. In most cases, the Eple maneuver is recommended. Its essence is as follows:

• turn the head 45° towards the affected ear and lie on your back (this may be accompanied by increased dizziness);
• the head is turned sharply towards the healthy ear so that it is at an angle of 45°;
• continue turning to the healthy side with the whole body so that at the end point the face is directed downward;
• rise to a sitting position, maintaining a head tilt of 45°.

You should remain in each position for about 1 minute, and change them as abruptly as possible.

In half of the cases, correct implementation of therapeutic maneuvers allows for long-term elimination of BPPV symptoms. Although 25-50% of patients experience relapses. In such situations, repeated maneuvers are indicated.

Treatment of dizziness in older people with folk remedies

Along with drug treatment, it is permissible to use traditional medicine recipes. It is better to consult a doctor first so that the effect does not turn out to be the opposite. Some simple remedies:

• Sage. Brew 4 tbsp in 0.5 liters of boiling water. l. sage flowers. Leave for half an hour, you can mix with honey. Drink before meals. The decoction is a good tonic.
• Common parsley. Grind the seeds of the plant in a coffee grinder, brew 1 tsp in a glass of boiling water. crushed mass, leave overnight. In the morning, strain and take four times a day in equal parts, before meals. It stops dizziness well in older people.
• A collection of peppermint leaves, lemon balm, linden flowers and mistletoe. The herbs need to be brewed with boiling water and allowed to brew. It helps well with a weakened vestibular apparatus.
• Red clover. Brew 1 tsp in half a glass of boiling water. dried flowers, let it brew. Take 50 ml twice a day 40 minutes before meals. Helps cleanse the walls of blood vessels, activates life processes, and reduces dizziness.
• Elecampane root. Brew a pinch of crushed root in a glass of boiling water, let it brew for half an hour and strain. Take 4 times a day in equal parts. Tones, destroys infections and parasites, has a beneficial effect on the vestibular system and stops dizziness.
• Simple kelp (sea kale). Eat 1 tsp once a day. dried plant with water. Strengthens the immune system, helps cleanse toxins, normalizes the central nervous system, and stops dizziness.

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• Veronica grass. Brew 1 tbsp in 250 ml boiling water. l. dried plant, infuse. Take the infusion warm, 80-100 ml before meals. Acts as a sedative and relieves dizziness.
• Onion. Scroll it through a meat grinder. The dizziness goes away if you breathe over the resulting mush. Mix chopped onion and honey in a glass jar in equal parts and leave in a cool place for 5 days. The remedy stops severe dizziness in older people and gives strength.

Basically, soothing herbal decoctions are used as herbal remedies:

• Chamomile tea with mint. Brew a tablespoon of dried herbs in a glass of boiling water and strain after 15 minutes. If you are not allergic to honey, you can add one teaspoon to your tea.
• Calming drink. Brew chamomile, mint and valerian (one teaspoon each) in 0.5 liters of boiling water and leave in a thermos for 12 hours. The best option is to prepare the decoction overnight, strain it in the morning, add honey and apple cider vinegar (one teaspoon each). Drink before meals.
• Dried ginger root is an excellent folk remedy for treating dizziness in the elderly. The root is taken in powder form three times daily before meals. Dry, powdered garlic is also a good tonic. You can take both remedies at once.
• Hawthorn relieves spasms and has a strengthening effect on the walls of blood vessels. A self-prepared infusion is much more effective than a pharmaceutical alcohol preparation. To prepare, brew one tablespoon of dry herb in 200 ml of boiling water and leave for half an hour.
• Dizziness stops after two weeks of taking plantain infusion.

You can also prepare tinctures:

• From garlic. Pour half a liter of alcohol into 300 g of garlic in a glass container and leave in a cool place for 15 days. Method of administration: add 20 drops of tincture to half a glass of milk. The product cleanses the body of toxins, fights infections, improves the functioning of the heart muscle, and relieves dizziness.
• From chestnut. Crushed chestnut buds are poured with half a liter of Cahors (preheated to 70 degrees) and kept for 15 minutes in a water bath. When it cools down, add two tablespoons of honey and a little vanilla powder. Take 50 ml before meals. Improves general condition and activates the activity of brain vessels.

Juice treatment:

• Carrot. Drink 0.5–1 glass three times a day before meals. Strengthens the immune system, relieves dizziness. An excellent remedy is a mixture of carrot, pomegranate and red beet juices (in a ratio of 3:2:2). Take the same way, 0.5–1 cup three times a day before meals. Improves the overall well-being of older people.
• Pineapple. Pineapple is a very strong antioxidant, rich in minerals and vitamins. Its juice rejuvenates the body and has a strengthening effect on the walls of blood vessels. Relieves dizziness in older people and is good for anemia.
• Juice from salad. Drink 25 ml 4 times a day if dizziness occurs due to heart failure or disorders of the central nervous system.
• Juice of young zucchini (possibly with the addition of carrot). It is taken in cases where dizziness occurs due to cardiac problems or high blood pressure.

Meniere's disease

According to statistics, Meniere's disease is diagnosed in 10% of patients who complain of dizziness. This is a disease of the inner ear, in which there is an increase in the volume of labyrinthine fluid and an increase in pressure within the labyrinthitis. Most often it occurs after 30 years.

Meniere's disease is characterized by episodes of systemic dizziness, which is associated with a progressive decrease in hearing acuity, tinnitus, and unsteady gait. Often there is also a feeling of stuffiness in the ear. In this case, hearing impairment manifests itself to a greater extent directly during an attack of dizziness, which can last from several minutes to a couple of hours. This is associated with nausea and vomiting.

A characteristic feature of Meniere's disease is the possibility of a so-called aura immediately before an attack. It may manifest itself:

• increasing noise in the affected ear;
• ear congestion;
• hearing impairment.

But the aura is not observed in all cases. Therefore, in its absence, the possibility of dizziness at normal pressure due to Meniere’s disease cannot be excluded.

When the pathology manifests itself, attacks occur frequently and initially their frequency increases. Over time, the trend reverses and dizziness bothers patients less and less.

During the disease there are 3 stages:

• Stage 1 – tinnitus is observed only periodically and is accompanied by a feeling of fullness and congestion, which leads to a decrease in hearing acuity. But at this stage, hearing between attacks is restored.
• Stage 2 – noise and congestion in the ears are constantly present, attacks become more frequent and occur almost daily. In this case, the dizziness is very intense, and hearing between attacks is practically not restored and can completely disappear.
• Stage 3 – the interval between attacks gradually increases, although hearing loss persists and is irreversible. There is also a constant feeling of unsteadiness and instability.

Initially, with Meniere's disease, only one ear is affected, but in 50% of patients, within several years, the second ear is also involved in the pathological process.

When diagnosing Meniere's disease, the main priority of treatment is to prevent the occurrence of attacks, since suddenly appearing intense dizziness significantly reduces the patient's quality of life, and in the early stages can deprive him of his ability to work due to the high frequency of episodes. For this purpose, patients are prescribed a salt-restricted diet, as well as individually selected drug therapy.

Other treatments for dizziness in older people

Dizziness in older people is best treated by a combination of medications, folk remedies and the following methods:

• Physiotherapy. Properly selected exercises strengthen the spine and stimulate the functioning of blood vessels. Regular exercise can sometimes give more significant results than taking medications.

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• Physiotherapy. Modern technologies in this area are multifaceted; water, sound, light, magnetic, and laser treatments are available. Regular implementation of these procedures has a very beneficial effect on the nervous system.
• Reflexology, in particular acupuncture. It normalizes the functioning of the central nervous system, relaxes muscles and activates blood circulation.
• Psychotherapy. The likelihood of dizziness in older people is significantly reduced if measures are taken to relieve nervous tension and anxiety.

Entering into old age will be much easier if you take care of your health in advance. The physical capabilities of the body directly depend on compliance with the daily routine, proper nutrition, intensity of exercise, and abuse of bad habits. Think about what is easier - to prevent the disease or to treat it later? Provide your body with normal functioning, do not neglect examinations if you are already about sixty. Be active, walk more, look at the world positively. Then you definitely won’t have to deal with bouts of dizziness.

Vestibular neuronitis

Vestibular neuronitis or neuritis means inflammation of the vestibular root of the 8th pair of cranial nerves, i.e., the vestibular-cochlear nerve. It has not yet been reliably determined what exactly provokes the development of this disease. According to research, it is assumed that herpes virus infection type 1 is involved in this. This theory is also supported by the fact that most often neuritis manifests itself after suffering from an acute respiratory infection.

The disease is characterized by a sudden onset of severe dizziness with a sensation of rotation of surrounding objects, which tends to gradually weaken over time. But head movements or changes in body position provoke a deterioration in health. The attack is accompanied by nausea, vomiting, and nystagmus. In this case, the oscillatory movements of the eyes are directed towards the healthy ear. There is also an imbalance, with falls more often occurring on the side of the healthy ear. But vestibular neuritis is not accompanied by hearing impairment or neurological disorders.

Dizziness may last for hours or days, and unsteadiness may persist for a week or longer.

When diagnosing vestibular neuronitis, symptomatic therapy is indicated to alleviate the patient’s well-being. It is designed to eliminate nausea, vomiting and reduce the severity of dizziness. Specific drugs are selected by a neurologist individually, taking into account the characteristics of the patient’s condition and the nature of concomitant diseases. As a rule, the course lasts no more than 3 days.

It is also recommended to perform special visual exercises, head movements, walking and balance exercises. They need to be performed daily, devoting at least half an hour to exercise.

In most cases, the measures taken are sufficient to eliminate the disease and normalize the patient’s condition. Within a few weeks, central vestibular compensation occurs, which leads to the elimination of the symptoms of neuritis. But instability and difficulty maintaining balance, especially when moving the head, can persist for a long time. But in 15% of patients, after the symptoms of vestibular neuronitis subside, the development of BPPV is observed, and psychogenic dizziness often occurs.

general characteristics

Severe dizziness is an intense sensation of movement (rotation or displacement) of the patient himself or the space surrounding him in the objective absence of such changes.
Can be short-term, long-term, permanent. It is divided into systemic and non-systemic. Systemic vertigo, in turn, is divided into central (with the involvement of the inner ear, vestibular nerves and ganglia) and peripheral (due to damage to the cerebellum, brain stem). Severe systemic dizziness is characterized by a feeling of movement in space, falling through, swaying on the waves, instability or displacement of the support under your feet. Non-systemic dizziness occurs due to inconsistency of vestibular, visual and proprioceptive perception. Accompanied by a feeling of instability and difficulty maintaining a pose.

Bilateral vestibulopathy

Bilateral vestibulopathy refers to bilateral deficits in vestibular function, which is clinically manifested by:

• attacks of dizziness while moving with the illusion of rotation of the environment;
• instability;
• imbalances, especially severe in the dark and when walking on uneven surfaces;
• decreased visual acuity while walking and making head movements.

But all the symptoms are observed only when the person is in an upright position. If he sits or lies, there are no such violations.

Most often, bilateral vestibulopathy occurs as a result of taking medications, especially aminoglycoside antibiotics, as well as after suffering from infectious and inflammatory diseases of the brain and some other pathologies.

It is impossible to completely eliminate the disorder, but by performing a special set of exercises selected separately for each patient, it is possible to achieve the development of central vestibular compensation.

Definition and Features

It is necessary to distinguish between true dizziness, in which there is a feeling of objects moving in space. Such symptoms may be normal if they occur after prolonged rotation around its axis (on a carousel), but in other cases they indicate a malfunction of the vestibular apparatus. The difficulty in diagnosing this condition is that the doctor has to rely only on the patient’s testimony. Many people also mean other symptoms by this term: impaired visual acuity, headaches and others. In reality, dizziness should be understood as a feeling of movement of environmental objects in relation to a person, while the body position is felt as stable. Most often these are circular movements (objects rotate around a person’s axis), but they can also be linear (a feeling of falling or rising in height, various shocks).

Neurovascular conflict

In neurovascular conflict, episodes of dizziness are caused by compression of the 8th pair of cranial nerves by an abnormally located blood vessel. As a result, the myelin sheath of the nerve becomes thinner, which leads to its constant stimulation by the vessel and overexcitation of the vestibular nucleus.

This is accompanied by short attacks of dizziness, which usually occur with a certain position of the head. This is often associated with tinnitus and hearing loss. In this case, episodes of dizziness can bother the patient several times a year, or 2-3 times a day.

For frequent, severe attacks, patients are prescribed specific drug treatment. If in response to it there is a decrease in the number of attacks, a decrease in their severity and duration, this serves as additional confirmation of the presence of a neurovascular conflict. In such situations, MRI is highly recommended. If its results confirm the diagnosis, it is worth performing surgery to decompress the vestibular-cochlear nerve as early as possible before hyperactivity of the vestibular nucleus develops.

What to do?

It is almost impossible to independently determine the causes of frequent attacks of dizziness. Therefore, those who regularly experience vertigo are advised to go to an appointment with a therapist, or a neurologist. The specialist will carefully examine the patient’s complaints and prescribe diagnostic tests. If necessary, the doctor will refer the patient for consultations with an ENT specialist, an ophthalmologist, a cardiologist, or an endocrinologist.

To identify the causes of vertigo, the patient may be prescribed the following tests:

1. Neurological tests. They allow you to assess the functionality of the vestibular apparatus.
2. MRI or CT. Such brain studies reveal various disorders (hemorrhages, tumors, vascular pathologies).
3. Ultrasound Doppler. Using Doppler ultrasound, the condition of the vessels of the head and neck is studied.
4. Audiometry. Diagnostics allows us to assess hearing function.
5. EEG. To study the activity of the cerebral cortex, the doctor will prescribe electroencephalography.

To quickly cope with dizziness (of course, if it is not caused by dangerous reasons), you can sit on any surface, relax a little and take 5-6 deep breaths. Be sure to open the window (if you are indoors) to provide fresh air. If the causes of vertigo are harmless, then such actions are quite enough for the dizziness to disappear without a trace.

Vestibular migraine

Migraine is a widespread disease, the manifestations of which are very diverse. Most often, in addition to dizziness at normal blood pressure, migraine is accompanied by a severe headache. As a rule, it is one-sided, pulsating and can persist for several minutes, hours, or several days. Often during an attack there is increased sensitivity to light and sounds.

Some patients notice the appearance of an aura before the onset of a migraine. In most cases, it consists of the occurrence of visual disturbances: loss of visual fields, flickering of spots in front of the eyes, luminous lines, etc. The aura usually appears an hour or less before the onset of the attack, and then disappears without a trace.

Migraines are more often diagnosed in women, and episodes of dizziness may be directly related to the phase of the menstrual cycle.

Treatment is carried out with medication. Usually, to eliminate pain and dizziness, the same medications are prescribed as for classic migraine. If attacks occur frequently, basic therapy is selected that is appropriate to the situation. All patients are also advised to avoid stress, eat right, normalize their work and rest schedule, and regulate the amount of physical activity.