Dizziness, Fainting & Seizures: Causes, Symptoms & When to Seek Help

What Is Dizziness and What Causes It?

Dizziness is a sensation of unsteadiness, lightheadedness, or feeling faint. It can be caused by inner ear problems, blood pressure changes, anxiety, medication side effects, or neurological conditions. Most dizziness is not a sign of serious illness and improves with simple treatments or lifestyle changes.

Dizziness is one of the most common reasons people visit their doctor, affecting up to 30% of adults at some point in their lives. The term "dizziness" is actually an umbrella word that describes several different sensations, and understanding exactly what type of dizziness you're experiencing can help identify the underlying cause.

When you describe feeling dizzy, you might be experiencing one of several distinct sensations. Vertigo is a specific type of dizziness where you feel like you or your surroundings are spinning or moving when nothing is actually moving. This is often caused by problems in the inner ear balance system. Lightheadedness is a feeling that you might faint, often accompanied by weakness or unsteadiness. Disequilibrium is a sense of being off-balance or unsteady on your feet, particularly when walking.

The causes of dizziness vary widely depending on the type of sensation you're experiencing. Understanding these causes is crucial for proper treatment and knowing when to seek medical attention.

Common Causes of Dizziness

Benign Paroxysmal Positional Vertigo (BPPV), also known as crystal disease, is one of the most common causes of vertigo. It occurs when tiny calcium crystals in your inner ear become dislodged and move into the semicircular canals, where they interfere with the normal fluid movement that tells your brain about head movements. This causes brief but intense episodes of vertigo triggered by specific head movements, such as turning over in bed, looking up, or bending down. BPPV is typically not dangerous and can often be treated with simple repositioning maneuvers performed by a healthcare provider.

Blood pressure changes are another frequent cause of dizziness, particularly the lightheaded variety. When you stand up quickly from sitting or lying down, your body needs to adjust your blood pressure to maintain blood flow to your brain. If this adjustment happens too slowly (called orthostatic hypotension), you may feel dizzy or lightheaded. This is more common in older adults, people taking blood pressure medications, and those who are dehydrated.

Vestibular neuritis is an inflammation of the vestibular nerve that connects your inner ear to your brain. It typically causes sudden, severe vertigo that can last for days, often accompanied by nausea, vomiting, and difficulty walking. This condition is usually caused by a viral infection and, while very unpleasant, typically resolves on its own over several weeks.

Meniere's disease is a chronic inner ear condition that causes episodes of vertigo lasting 20 minutes to several hours, along with hearing loss, tinnitus (ringing in the ears), and a feeling of fullness in the affected ear. The exact cause is unknown, but it's related to abnormal fluid buildup in the inner ear.

Anxiety and stress can significantly contribute to dizziness. When you're anxious, your body's fight-or-flight response activates, causing rapid breathing (hyperventilation), increased heart rate, and muscle tension. Hyperventilation reduces carbon dioxide levels in your blood, which can cause lightheadedness and a sensation of unreality. Additionally, chronic anxiety can make you more sensitive to normal body sensations, causing you to notice and worry about slight imbalances you would otherwise ignore.

Medications and Dizziness

Many medications can cause dizziness as a side effect. Blood pressure medications, particularly when doses are being adjusted, can cause orthostatic hypotension. Sedatives, anti-anxiety medications, and some antidepressants can affect balance and cause lightheadedness. Certain antibiotics, particularly aminoglycosides, can damage the inner ear and cause vestibular problems. If you're experiencing new dizziness after starting a medication or changing doses, speak with your healthcare provider.

What Causes Fainting and When Is It Dangerous?

Fainting (syncope) occurs when blood flow to the brain temporarily decreases, usually due to a sudden drop in blood pressure. While most fainting is harmless and caused by triggers like standing too quickly, heat, or strong emotions, some cases can indicate serious heart conditions that require immediate medical evaluation.

Fainting, medically known as syncope, is a temporary loss of consciousness caused by reduced blood flow to the brain. It's remarkably common—approximately 40% of people will faint at least once in their lifetime. When blood pressure drops suddenly, the brain doesn't receive enough oxygen, causing you to lose consciousness. When you fall or lie down, blood flow returns to the brain and you regain consciousness, usually within a minute.

Understanding why fainting happens helps distinguish between harmless episodes and those that might indicate a serious underlying condition. The vast majority of fainting episodes are caused by vasovagal syncope, a harmless reflex that causes your heart rate and blood pressure to drop suddenly.

Types and Causes of Fainting

Vasovagal syncope is the most common type of fainting, accounting for about half of all cases. It's triggered by the vagus nerve overreacting to certain stimuli, causing your heart rate to slow and blood vessels to dilate, which drops blood pressure rapidly. Common triggers include standing for long periods, heat exposure, seeing blood, intense emotional distress, pain (especially sudden pain), and straining during bowel movements. Before a vasovagal faint, you might notice warning signs like feeling warm, nauseous, lightheaded, having tunnel vision, or hearing sounds becoming distant.

Orthostatic hypotension occurs when blood pressure drops significantly upon standing. Normally, your body compensates for position changes by constricting blood vessels and slightly increasing heart rate. When this mechanism fails, blood pools in your legs and less reaches your brain. This is more common in older adults, people who are dehydrated, those taking certain medications (particularly blood pressure medicines, diuretics, and some antidepressants), and individuals with conditions affecting the autonomic nervous system.

Cardiac syncope is caused by heart conditions that temporarily reduce blood flow. This can include arrhythmias (abnormal heart rhythms), structural heart problems like aortic stenosis, or other conditions affecting the heart's pumping ability. Cardiac syncope is more concerning because it can indicate life-threatening conditions and has a higher risk of sudden death. Warning signs that fainting might be cardiac-related include fainting during exercise, while lying down, or while sitting; family history of sudden cardiac death; and fainting without warning symptoms.

Breath-holding spells are a type of fainting seen in young children, typically between 6 months and 5 years old. During intense crying or after a minor injury, some children hold their breath until they turn blue or pale and briefly lose consciousness. While extremely frightening for parents, breath-holding spells are not harmful and children outgrow them. However, the first episode should always be evaluated by a healthcare provider to rule out other causes.

Warning Signs Before Fainting

Many people experience warning signs (called prodromal symptoms) before fainting. Recognizing these can help you take action to prevent falling and injuring yourself. Common warning signs include feeling warm or hot, nausea, sweating, pale skin, lightheadedness, tunnel vision or vision going gray or black, hearing sounds becoming distant or muffled, and feeling generally weak.

If you recognize these signs, try to sit or lie down immediately with your legs elevated. If you're standing in a situation where you can't sit (like in a crowded space), cross your legs and tense your leg and abdominal muscles to help maintain blood pressure. Drinking water and getting to a cooler environment can also help.

What Are Seizures and How Does Epilepsy Work?

Seizures are sudden electrical disturbances in the brain that cause changes in behavior, movements, feelings, or consciousness. Epilepsy is a brain disorder characterized by recurrent seizures. Approximately 1% of the world's population has epilepsy, and over 50% can become seizure-free with medication.

A seizure occurs when there is a sudden surge of abnormal electrical activity in the brain. This disrupts the normal communication between brain cells and can cause a wide variety of symptoms depending on which part of the brain is affected. Seizures can range from brief lapses in attention to full convulsions with loss of consciousness.

Epilepsy is diagnosed when a person has had two or more unprovoked seizures occurring more than 24 hours apart, or after one seizure with a high risk of more. Approximately 1% of the world's population—about 65 million people—have epilepsy, making it one of the most common neurological disorders. The good news is that with proper treatment, over 50% of people with epilepsy can become seizure-free, and many more can significantly reduce their seizure frequency.

Types of Seizures

Seizures are classified into two main categories based on where the abnormal electrical activity begins in the brain: generalized seizures (affecting both sides of the brain from the start) and focal seizures (starting in one area of the brain).

Generalized tonic-clonic seizures (formerly called grand mal seizures) are what most people picture when they think of epilepsy. During the tonic phase, the body stiffens, and the person may fall and lose consciousness. This is followed by the clonic phase, where muscles jerk rhythmically. The person may stop breathing briefly and turn bluish around the lips. After the seizure (the postictal period), the person typically feels confused, tired, and may have muscle soreness. These seizures usually last 1-3 minutes.

Absence seizures (formerly called petit mal seizures) cause brief lapses in consciousness, typically lasting 5-15 seconds. The person may stare blankly, blink rapidly, or make small movements like lip smacking. They're unaware of what's happening and don't remember the episode afterward. Absence seizures are most common in children and may occur many times a day. They can be mistaken for daydreaming or not paying attention.

Focal aware seizures (formerly simple partial seizures) affect consciousness minimally or not at all. The person remains aware but may experience unusual sensations, emotions, or movements. Symptoms depend on which part of the brain is affected and might include twitching in one part of the body, unusual sensations (strange smells, tastes, or feelings), or an "aura"—a warning feeling that a bigger seizure might be coming.

Focal impaired awareness seizures (formerly complex partial seizures) do affect consciousness. The person may appear confused, make repetitive movements like lip smacking or hand rubbing, and not respond to others. They typically don't remember the seizure afterward. These seizures usually last 1-2 minutes.

What Causes Seizures?

Seizures can have many causes, and in about 50% of people with epilepsy, no specific cause can be identified. Known causes include genetic factors (some types of epilepsy run in families), brain injuries from trauma, stroke, or surgery, brain tumors, infections affecting the brain (meningitis, encephalitis), developmental disorders, and prenatal brain damage.

In people with epilepsy, certain triggers can make seizures more likely. Common triggers include lack of sleep or disrupted sleep patterns, stress and anxiety, alcohol consumption (particularly withdrawal), missed anti-epileptic medication doses, hormonal changes (some women have more seizures around their menstrual period), and flashing or flickering lights (in a subset of people with photosensitive epilepsy).

When Should You Seek Medical Care?

Seek immediate emergency care for seizures lasting more than 5 minutes, loss of consciousness that doesn't resolve quickly, fainting with chest pain or during exercise, or if symptoms suggest stroke. For ongoing dizziness affecting daily life, persistent vertigo, or first-time seizures, contact your healthcare provider promptly.

Knowing when to seek medical care for dizziness, fainting, or seizures can be challenging. Most episodes are harmless, but some require urgent evaluation. Understanding the warning signs of serious conditions can help you make informed decisions about seeking care.

When to Contact Your Healthcare Provider

For dizziness, you should contact your healthcare provider if dizziness doesn't resolve on its own, if it significantly affects your daily activities, if you have dizziness with hearing changes (hearing loss or ringing in the ears), if your dizziness feels different from previous episodes, or if you experience dizziness along with neck stiffness or fever.

For fainting, contact your healthcare provider if you've had a fainting episode (even if you feel fine afterward), if a child faints without an obvious trigger like crying or breath-holding, if you're fainting repeatedly, or if you notice any new symptoms accompanying your fainting episodes.

For seizures, contact your healthcare provider promptly if you've had your first seizure (even if it resolved quickly), if your seizures change in character or frequency, if you're experiencing side effects from anti-epileptic medication, or if you're planning pregnancy and take anti-epileptic medications.

Emergency Situations

Some situations require immediate emergency care. Call your local emergency number immediately if a seizure lasts more than 5 minutes, if a second seizure occurs shortly after the first, if the person doesn't regain consciousness after a seizure, if the person has breathing difficulties after a seizure, if fainting is accompanied by chest pain, palpitations, or shortness of breath, if fainting occurs during physical exertion or while lying down, if there are signs of stroke (facial drooping, arm weakness, slurred speech), if dizziness is severe and accompanied by double vision, difficulty speaking, or weakness on one side of the body, or if the person is pregnant and experiences any of these symptoms.

How Are These Conditions Diagnosed?

Diagnosis involves a detailed medical history, physical examination, and often specialized tests. For dizziness, balance tests and hearing assessments are common. Fainting evaluation may include ECG and tilt-table testing. Seizures typically require EEG (brain wave recording) and brain imaging with MRI or CT.

Diagnosing the cause of dizziness, fainting, or seizures often requires detective work. Healthcare providers rely heavily on detailed descriptions of what happened, what you felt, and what witnesses observed. Because these symptoms are often episodic and may not be happening when you see the doctor, this history is crucial for guiding further testing.

Diagnostic Tests for Dizziness

The evaluation of dizziness typically starts with a thorough physical examination, including checking your blood pressure lying down and standing (looking for orthostatic hypotension), examining your eyes for abnormal movements (nystagmus), and performing simple balance tests.

Specialized balance testing may include the Dix-Hallpike maneuver, where the doctor moves your head in specific ways to check for BPPV; electronystagmography (ENG) or videonystagmography (VNG), which record eye movements in response to various stimuli; and caloric testing, where warm and cool air or water is directed into the ear canal to stimulate the balance system.

Hearing tests are often included because the balance and hearing systems are closely connected in the inner ear. If a neurological cause is suspected, brain imaging with MRI or CT may be ordered.

Diagnostic Tests for Fainting

An electrocardiogram (ECG) is almost always performed after a fainting episode to check for heart rhythm problems. Blood tests may check for anemia, blood sugar abnormalities, and electrolyte imbalances.

A tilt-table test may be performed if vasovagal syncope is suspected. You lie on a table that is then tilted to an upright position while your blood pressure and heart rate are monitored. This can reproduce the conditions that trigger fainting in susceptible individuals.

If a heart rhythm problem is suspected but not captured on a regular ECG, you may need to wear a Holter monitor (continuous ECG recording for 24-48 hours) or an event recorder (a device you activate when you feel symptoms).

Diagnostic Tests for Seizures

Electroencephalography (EEG) is the primary test for evaluating seizures. Electrodes placed on your scalp record the electrical activity of your brain. This can show characteristic patterns of epilepsy even between seizures. Sometimes a sleep-deprived EEG or video-EEG monitoring (where you're recorded on video while having an EEG for several days) is needed to capture seizure activity.

Brain imaging with MRI is standard for anyone with new-onset seizures. MRI can reveal structural abnormalities that might be causing seizures, such as tumors, scarring from previous injury, or developmental abnormalities. CT scans may be used in emergency situations because they're faster.

Blood tests check for electrolyte imbalances, blood sugar abnormalities, kidney and liver function (important for choosing medications), and sometimes genetic markers.

How Are Dizziness, Fainting, and Seizures Treated?

Treatment depends on the underlying cause. Dizziness often responds to vestibular rehabilitation exercises, medication, or treating the underlying condition. Fainting treatment focuses on avoiding triggers and, in some cases, medications or pacemakers. Epilepsy is primarily treated with anti-epileptic medications, with surgery as an option for some patients.

Treatment approaches vary significantly depending on the underlying cause of your symptoms. In many cases, once the cause is identified, effective treatments are available.

Treatment for Dizziness

Treatment for dizziness depends entirely on its cause. BPPV is often effectively treated with repositioning maneuvers like the Epley maneuver, which moves the displaced crystals back to where they belong. These maneuvers, performed by a healthcare provider or learned for home use, are successful in most cases.

Vestibular rehabilitation is a type of physical therapy that helps your brain compensate for inner ear problems. Through specific exercises, you can retrain your brain to rely on other senses for balance. This is particularly helpful for vestibular neuritis and other inner ear conditions.

Medications can help manage symptoms but usually don't cure the underlying problem. Options include medicines for nausea and vomiting, medications that reduce the sensation of dizziness (vestibular suppressants), and diuretics for Meniere's disease to reduce fluid buildup.

Lifestyle modifications can make a significant difference. Staying hydrated, rising slowly from sitting or lying positions, reducing caffeine and alcohol intake, and practicing stress management techniques can all help reduce dizziness episodes.

Treatment for Fainting

For vasovagal syncope, treatment usually involves learning to recognize warning signs and taking action to prevent fainting (lying down, tensing leg muscles, drinking water). Avoiding known triggers is important. In severe cases, medications that increase blood pressure or heart rate may be prescribed.

For orthostatic hypotension, treatment includes staying well-hydrated, increasing salt intake (if approved by your doctor), wearing compression stockings to prevent blood pooling in the legs, rising slowly from lying or sitting, and sometimes medications to raise blood pressure.

For cardiac syncope, treatment addresses the underlying heart condition. This might include medications to control heart rhythm, a pacemaker to regulate heart rate, an implantable cardioverter-defibrillator (ICD) for dangerous rhythm problems, or surgery to correct structural heart problems.

Treatment for Epilepsy

Anti-epileptic medications are the first-line treatment for epilepsy. There are more than 20 different medications available, and finding the right one (or combination) often takes some trial and error. These medications don't cure epilepsy but prevent seizures as long as they're taken. With proper medication, over 50% of people with epilepsy become seizure-free, and many others have significant reduction in seizure frequency.

Surgery may be an option for people with focal epilepsy that doesn't respond to medications. If seizures consistently start in one area of the brain that can be safely removed, surgery can sometimes cure epilepsy. Extensive testing is needed before surgery to ensure it's safe and likely to be effective.

Vagus nerve stimulation (VNS) is an option for people whose seizures don't respond to medication and who aren't candidates for surgery. A device similar to a pacemaker is implanted under the skin in the chest, with a wire connecting to the vagus nerve in the neck. The device delivers regular electrical pulses to the nerve, which can reduce seizure frequency in about half of people who try it.

Dietary therapies, particularly the ketogenic diet (high fat, very low carbohydrate), can reduce seizures in some children with epilepsy that doesn't respond to medications. This diet must be medically supervised and requires careful planning.

How Do You Help Someone Having a Seizure?

Stay calm and time the seizure. Clear the area of dangerous objects, protect the head, loosen tight clothing, and turn the person on their side when convulsions stop. Never put anything in their mouth or try to restrain them. Call emergency services if the seizure lasts more than 5 minutes.

Knowing how to respond when someone is having a seizure can prevent injuries and potentially save a life. Many common beliefs about what to do during a seizure are actually myths that can cause harm.

Step-by-Step First Aid for Seizures

Step 1: Stay calm and note the time. Most seizures end on their own within 1-3 minutes. Knowing how long the seizure lasts is important information for medical providers.

Step 2: Clear the area. Move away any hard or sharp objects that could cause injury. If the person is near stairs, traffic, or water, guide them away from danger if possible.

Step 3: Protect the head. If the person is on a hard surface, place something soft (a folded jacket, towel, or your hands) under their head to prevent injury.

Step 4: Loosen tight clothing. Loosen any ties, collars, or tight clothing around the neck to help breathing.

Step 5: Turn on side when convulsions stop. Once the convulsions stop, gently roll the person onto their side (recovery position). This helps keep the airway clear and prevents choking if they vomit.

Step 6: Stay until fully recovered. Stay with the person and speak calmly as they regain consciousness. They may be confused, tired, or embarrassed. Reassure them that they're safe and tell them what happened.

When to Call Emergency Services

Call emergency services if the seizure lasts more than 5 minutes, if a second seizure occurs shortly after the first, if the person doesn't start breathing normally or doesn't regain consciousness after the seizure, if the person is injured during the seizure, if the person is pregnant, has diabetes, or has a known heart condition, if this is the person's first seizure, or if the seizure happens in water.

What Can You Do to Manage These Conditions?

Self-care strategies include staying well-hydrated, getting adequate sleep, managing stress, avoiding known triggers, taking medications as prescribed, and doing recommended exercises. Keeping a symptom diary can help identify patterns and triggers to discuss with your healthcare provider.

While medical treatment is often necessary, there's much you can do on your own to manage dizziness, reduce fainting risk, and minimize seizure triggers.

Self-Care for Dizziness

Balance exercises can help your brain compensate for vestibular problems. A simple exercise you can do at home: Sit down and slowly turn your head to look at a point far to your left, then slowly turn to look at a point far to your right. Repeat 10-15 times. Then look up at a point above you, then down at a point below you. Repeat 10-15 times. Do this several times a day. It's actually helpful if these movements make you slightly dizzy—that's how your brain learns to recalibrate.

Avoid alcohol, as it can worsen dizziness and affect balance. Stay well-hydrated, especially in hot weather. Rise slowly from lying or sitting positions. Consider reducing caffeine, which can worsen anxiety-related dizziness.

Self-Care for Fainting Prevention

Learn to recognize your warning signs and respond quickly by lying down or sitting with your head between your knees. Stay well-hydrated—dehydration is a common trigger. Avoid standing still for long periods; if you must, shift your weight, rise on your toes, or cross and uncross your legs to keep blood flowing. If you feel faint, you can cross your legs and tense your leg and abdominal muscles to help maintain blood pressure. Ask for accommodations if you know you're likely to faint in certain situations (such as lying down for blood draws).

Self-Care for Epilepsy

Taking your medication consistently is the most important thing you can do. Set alarms, use a pill organizer, or use a medication-tracking app. Never stop your medication suddenly without medical supervision, as this can trigger severe seizures.

Prioritize sleep, as sleep deprivation is one of the most common seizure triggers. Keep a regular sleep schedule, even on weekends. Manage stress through techniques like deep breathing, meditation, or yoga. Limit alcohol, which can lower the seizure threshold and interact with medications. Be cautious with flashing lights if you have photosensitive epilepsy.

Keep a seizure diary recording when seizures occur, what happened before them, and any potential triggers. This information helps your healthcare provider optimize your treatment.