Dizziness When Changing Body Position: Causes

The sensation that the room has tilted or is swimming usually lasts a few seconds. Most often the cause lies in the inner ear: the fluid in it starts moving when the position of the head changes. We explain what causes lie behind dizziness when changing body position and which signs mean that you must not delay.

Why the head spins when changing body position

In the inner ear there are fluid-filled tubes — the semicircular canals. When you move, the fluid inside them shifts, and this flow tells the brain about the position of the body. In benign paroxysmal positional vertigo, abbreviated as BPPV, small calcium particles resembling bone tissue break off and begin to float inside the canal. The displacement of otoconia changes the hydromechanics of the inner ear fluid, the brain receives conflicting signals about body position — and responds with a sensation of rotation.

Dizziness when lying down and when turning from side to side

One of the typical triggers is turning over in bed. In BPPV, the rotation usually begins suddenly and lasts from a few seconds to minutes. The attack may be accompanied by nausea and vomiting, a sensation of loss of balance, and sometimes visual symptoms — a feeling that objects are jumping or shifting. The attack itself can last for hours, and in severe cases — for days and months.

Dizziness when turning and tilting the head back

Tilting the head back to look at something above is a typical everyday trigger. In BPPV, it is precisely certain head movements, rather than body position, that provoke the rotation. True vertigo is the sensation of rotation of oneself or the surrounding world, and it differs from simple unsteadiness.

Positional vertigo and other possible causes

BPPV is the most common type of vertigo: it accounts for 17 to 35 percent of all cases. The risk is higher if a relative has had this condition, if there has been a head injury — even a mild blow — or if there has been an inner ear infection such as labyrinthitis.

• labyrinthitis — an inner ear infection caused by a cold or flu virus;
• vestibular neuritis — inflammation of the vestibular nerve;
• Meniere's disease — a rare inner ear disease with tinnitus and hearing loss;
• migraine;
• side effects of certain medications.

Sometimes the cause cannot be established. Inner ear problems affecting balance remain the most common group of causes.

How a doctor determines the cause of dizziness

The conversation begins with questions: when the dizziness occurs, how long it lasts, what you were doing. The doctor may then ask you to move quickly from a sitting to a lying position — such a test often provokes symptoms. The Dix-Hallpike maneuver is more precise: the head is fixed in a certain position and you are asked to lie back sharply while the doctor observes involuntary eye movements — nystagmus. Nystagmus can be seen with the naked eye, with Frenzel goggles, or on a videonystagmograph; if the picture is unclear, electronystagmography, CT or MRI of the head, MR angiography, hearing testing, and a caloric test are ordered.

The theory of positional vertigo has a long history: at the beginning of the 20th century, the Russian physician S. I. Belinov pointed to the role of otoconia, and one of the founders of the theory is considered to be the Englishman Charles Hallpike — in 1952 his work on the rotating chair and the physical theory of the cupular mechanism was published.

When you need to see a doctor urgently

A routine reason to see a doctor is dizziness that does not go away or keeps returning. An urgent reason is the combination of rotation with a severe headache, severe nausea or vomiting, high temperature, fever, or chills. Double vision or loss of vision, hearing loss, speech impairment, weakness, numbness, or tingling in an arm or leg require immediate help.

Dizziness by itself is not a reason to call an ambulance; 103 or 112 — if it is accompanied by double vision or loss of vision, hearing loss, speech impairment, weakness, numbness, or tingling in an arm or leg.

This overview is for reference: it explains the mechanisms but does not replace a consultation with a doctor who sees you and your history as a whole.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer