The Mayo Clinic describes dizziness as a range of sensations, such as feeling faint, woozy, weak or unsteady. When dizziness gives you the false sense that you or your surroundings are spinning or moving, it is called vertigo.1 That sensation of spinning or whirling is sometimes associated with balance problems.2,3 The feeling of imbalance when standing or walking, or the sense of motion, can be caused by problems in the inner ear and/or a lack of mental clarity.4
Dizziness and vertigo are not unique to Parkinson’s disease (PD).3 There can be multiple causes and determining an effective treatment depends on good reporting of the symptoms and the ability to identify a cause. Additionally, symptoms may be less notable in the early stages of Parkinson’s.3 As with most aspects of Parkinson’s, the experience of symptoms is unique; you may not ever experience these.
A loss of balance often resulting in falling affects many with Parkinson’s. This is due in part to general motor dysfunction caused by the disorder. Falling can depend on each person’s symptoms and how they respond to medication. This should be monitored for any pattern noted at the time of these changes or fluctuations.5 Syncope (passing out) is one of the most commonly overlooked causes of dizziness in people with Parkinson’s.2
Common contributing causes
Medication-induced dizziness or vertigo
Drugs used to treat Parkinson’s and other medical conditions, such as high blood pressure, can potentially cause dizziness or make dizziness worse. If you are dieting, or having difficulty eating and drinking these symptoms can worsen. Dopamine agonists are the most likely drugs associated with dizziness or vertigo in PD.6
Medication-induced dizziness is typically treated by reducing dosage and over time discontinuing the trigger drug(s). Other common drugs that can cause dizziness include anticonvulsants, antihypertensives, antibiotics, antidepressants, antipsychotics, pain medications, and anti-inflammatories. Always consult your physician before stopping or altering prescribed medications. The Parkinson’s Foundation stresses that taking your medication on time, every time, can help best manage your condition while avoiding dizzy spells.5
The medical definition of orthostatic hypotension (OH) is a drop in systolic blood pressure of 20mmHg, or a drop in diastolic blood pressure of 10mmHg within three minutes of standing, when compared to blood pressure in sitting or supine position.2,7 A drop in blood pressure that significant can result in feeling light-headed, a loss of color in the face, weakness, fatigue, blurry vision or cognitive impairments. This can result in a loss of balance if you stand up too quickly. If you experience severe OH, you are at risk for fainting that can result in a fall.
With a sudden change in position, the blood vessels in your lower extremities may not be able to pump enough blood up through the body. When this happens blood pools in the vessels of the legs and limits the return of the blood supply back to the heart and brain (decreased cerebral perfusion).7
Older people who have had Parkinson’s for a long time are at increased risk for developing OH. Anywhere from 15-50% of people will experience this kind of dizziness.7 One easy management technique is to increase hydration by drinking 6-8 glasses of water each day. Your doctor may suggest wearing compression stockings, increasing your intake of salt and caffeine, and if needed, they can prescribe certain medications that can help you retain water and increase standing blood pressure.2
Deep brain stimulation
DBS is a surgical procedure generally performed to alleviate motor symptoms of Parkinson’s not adequately controlled with medication. It has also been associated with the onset of dizziness or vertigo. It typically develops soon after the surgical implantation. Always remember to note if the dizziness is present when the device is activated or if it is off. To evaluate the cause, try turning off the device and monitor to see if the sensation subsides. If it resolves, talk with your doctor about the positioning and programming of the device.
Benign paroxysmal positional vertigo
Benign paroxysmal positional vertigo (BPPV) is a sense of spinning when turning in bed. It may last only a few seconds but can be scary or make you feel nauseated.2 A doctor can diagnose BPPV by performing a physical examination using a diagnostic maneuver such as the Dix Hallpike. To improve this problem there are exercises to do at home, such as the Epley or Semont maneuvers, that can help resolve and restore balance in your ear. It’s achieved by putting your head in different positions, which moves crystal debris out of the semicircular canal of the ear and resolves the symptoms of vertigo.
Some who experience migraine headaches can also develop dizziness or vertigo. Generally, treating the headache resolves the dizziness. It can be referred to as migraine-induced vertigo.
Transient ischemic attack or stroke
When dizziness comes on quickly, along with additional neurological symptoms, a transient ischemic attack (TIA) or stroke is possible. If you care for someone who appears to be having a stroke, call 911 immediately.
Common management strategies
Effective strategies for managing dizziness can improve your quality of life. Take your time when changing positions to allow your blood pressure to adjust, stay hydrated, and elevate your head when sleeping. Make sure to keep a record of the times and circumstances you experience dizziness or vertigo, to share with your healthcare team.
Dizziness. Available at: https://www.mayoclinic.org/diseases-conditions/dizziness/symptoms-causes/syc-20371787. Accessed 11.3.18.
What’s Hot in PD? Tips for Patients and Families on the Diagnosis and Treatment of Dizziness, Vertigo and Parkinson’s Disease. Available at: http://parkinson.org/blog/whats-hot/Parkinsons-Disease-Dizziness-Vertigo-Treatment-Tips. Accessed 11.4.18.
Vertigo and Dizziness. Available at: https://www.parkinson.org/Understanding-Parkinsons/Symptoms/Non-Movement-Symptoms/Vertigo-Dizziness-Parkinsons?gclid=EAIaIQobChMIifG4wuex3gIVy4CfCh2vOALrEAAYASAAEgKIJvD_BwE. Accessed 11.4.18.
How can I prevent dizziness? Available at: https://nwpf.org/stay-informed/blog/how-can-i-prevent-dissiness. Accessed 11.3.18.
Falls and Parkinson's. Available at: https://www.parkinsons.org.uk/information-and-support/falls-and-dizziness. Accessed online 11/3/18.
What's Hot in PD? If you are Dizzy or Passing Out, it could be Your Parkinson’s Disease or Parkinson’s Disease Medications. Available at: http://www.parkinson.org/blog/whats-hot/dizzy-passing-out. Accessed 11.4.18.
Kraus, A. Dizziness/Light headed Sensations with Parkinson’s Disease: Is it Orthostatic Hypotension? Available at: https://movementdisorders.ufhealth.org/2017/01/18/dizzinesslight-headed-sensations-with-parkinsons-disease-is-it-orthostatic-hypotension/. Accessed 11.4.18.