Dizziness, Vertigo and Imbalance

How do I recovery from an episode of dizziness?

After an episode of dizziness, it is important to think about getting back to moving normally. This may be challenging but it can help you recover and prevent longer term problems.

Movement involving your eyes, head and body can help you recover from an episode of dizziness, vertigo or imbalance. You may feel anxious or frightened about moving and this is normal. You may experience some dizziness, vertigo or imbalance as you start to move and this is also normal.

The most important point is to be safe when moving or challenging your balance. Be kind to yourself and use your determination and resilience to start gentle movements, indoors to begin with, progressing to outdoors as you feel safer and stronger.

It is important to pace yourself and think about your own ideas, concerns and expectations for your recovery. People recover at different speeds. As you start to move around you may experience dizziness or imbalance.

• Know your own tolerance to symptoms of dizziness and imbalance, limit the severity of symptoms to five out of ten (moderate severity)
• Expect the dizziness to settle in under five minutes.  If it does not, reduce the time you do the movements for
• Do not avoid triggering the dizziness completely because this can lead to longer term problems with dizziness and imbalance and it can increase sensitivity to movement
• Recognize movements that trigger symptoms and use them as gentle exercises
• Plan activities and pace yourself through the day with both physical and mental activities and have rest periods in between
• Have a safety plan eg. turning the light on at night when going to the toilet or having a mobile phone readily available
• Manage fatigue by being aware of your energy level
• Staying within your ‘energy envelope’, monitor activity and put in rest periods through the day
• Include relaxation and mindfulness activities in your daily routine
• Repeat to yourself the positive things you achieve and approach the challenge of dizziness or imbalance in a way that can help you manage any anxiety, fear, loss of confidence or feelings of threat. This will be different for everyone
• Keep a symptom diary and at the end of each day write down three good things that have happened
• Be realistic about your best hopes for the week ahead and how you may be able to gradually move towards your goal each day
• Maintain good levels of hydration and be especially aware of fluid intake if your symptoms initially included nausea and vomiting. Aim for two to three litres a day
• Try to have a good sleep pattern which involves going to bed and getting up at the same time every day
• Try not to take regular medication for dizziness as this can dampen the brain’s ability to compensate and improve.  People are advised to stop taking acute attack medication for dizziness after three days from initial onset of symptoms if possible. If you are concerned please speak to your GP or prescriber.

How do I improve symptoms of dizziness and imbalance?

To maintain or improve your balance and dizziness your brain needs to receive information from three separate sensory systems in a useful and meaningful way.

Eyes: Visual system

Our eyes offer information about where we are in relation to place and people and helps us to align to objects in our environment.

Ears: Hearing and vestibular balance system

Balance organs (known as the vestibular system) is situated within the inner ear and detects all speeds and directions of movements. It helps us to orientate to where we are, control our posture and position and help keep visual focus when moving our head.

Hearing allows you to move in relation to noise and helps control posture.

Skin, muscles and joints: Somatosensory system

Sensors in all joints, muscles and within the skin provide information about what position our body is in, be that lying, sitting, standing or moving.

This information helps to control posture and movements.

Nerves and Brain:Central and peripheral nervous system

Your brain and nerves transmit and use information from all the sensory systems to control all posture, movement and create an awareness of where we are in space.

This allows you to move, balance and function within your immediate environment to perform your daily activities.

What can I do to improve?

For some people simply getting out of bed will be a challenge. Sit on the edge of the bed for a minute or two and wait for the dizziness to pass before trying to stand. Initially it may be necessary to ask someone to be with you when you try to stand up or go to the toilet. Progress to sitting out in a chair or walking into a different room. Do not avoid moving your head.

Go for a walk every day.

This can be indoors initially and progress to going outside. Begin with five to ten minutes and gradually build up to 30 minutes per day. Vary your route and gradually try to go to busier places. It is normal to feel a little strange or disorientated at first. Your balance reactions may feel slow or you may get dizzy as you look around.

When you walk you should feel your heart rate increase, get a little sweaty and slightly short of breath but still able to hold a conversation. This is a normal response to moderate exertion exercise. Try not to hold onto anyone but you can use a walking aid or walking poles if needed. Walk side by side with someone if it improves your confidence and enables you to start going outside. If you are going outside plan your activity and route, have an emergency plan and take a mobile phone if possible. Let someone know your plans, if possible.

Look around.

Target your vision to pick out details of things near and far away. For example, look for the pattern on tree bark, leaves or flowers or try to pick out everything that is red on your route.

Walk in the daylight.

This will help with your vitamin D levels and sleep patterns.

Maintaining an active balance system, including strength and cardiovascular fitness needs to be part of your everyday routine. Continue to gently challenge your balance system and it will improve.

Do not exceed more than five out of ten discomfort with symptoms including pain, fatigue, headaches, dizziness, vertigo or imbalance. Should activity trigger severe constant symptoms or moderate symptoms persist once triggered beyond 24 hours please seek advice from your GP or healthcare professional and reduce or stop the trigger exercise.

Are there specific exercises I can do to improve dizziness and balance?

Head movements

• Turn your head to look from side to side. Try to target your vision either side. Repeat five times. When comfortable increase gradually, adding one head turn each day to a maximum of 10 times within the first 10 days of recover
• Move your head to look up to the ceiling and then down, taking your chin to your chest. Try to target your vision by looking at something on the ceiling and floor. Repeat five times
• When comfortable increase gradually adding 1 repetition each day to a maximum of 10 times.

Bending forward

• In sitting, bend forwards to take your head and shoulders towards your lap. Alternatively, in standing, bend to take your head and shoulders forwards and down, reaching toward a chair seat then return to upright again

• Repeat five times. When comfortable increase gradually adding one repetition each day to a maximum of 10 times.

Eyes Closed

• Practice standing up and sitting down with your eyes open to start with and progress to doing it with your eyes closed without using your hands if possible. Do this in a safe place like at a table or from your bed. Repeat for 20 seconds to one minute. Build up your tolerance gradually. Its normal for it to feel strange and a little disorientating
• Practice closing your eyes while sitting or standing still. Begin by focusing on the weight distributed through your feet. Wiggle or squeeze your toes then consciously feel the ground beneath your feet. Close your eyes for ten seconds. Increase to up to 30 seconds as you become steadier and more confident. Repeat five times. You may feel a gentle sway this is normal, try to keep the weight evenly distributed over your feet.

Online resources

The Otago Balance programme is an evidence-based exercise programme shown to improve balance and reduce falls risk. Some NHS services have put Otago programme videos online and can be found on platforms such as YouTube, etc..

When should I seek help?

Consult your GP or physiotherapist if:

• Symptoms fail to improve or persist for longer than six week
• Symptoms are constant, severe and worsenin
• You have palpitations, shortness of breath or chest pain with dizzines
• You have any signs of new muscle weakness, tingling, numbness or sudden change to your handwriting
• You have unexplained falls and trip
• You get dizziness for less than one minute rolling over in bed, looking up or down or
• You have constant noise or tinnitus or loss of hearing on one sid
• If you are concerned things are not progressing how you expect them to.

Go to A&E if:

• You have a severe headache reaching maximum intensity within five minutes of onset.
• You have new onset arm or leg weakness or neurological signs like speech and swallowing problems, facial drooping or loss of consciousness
• You have sudden and severe loss of hearing.

You must not rely on this information as an alternative to medical advice. It is to be issued following assessment by health professionals with specialist knowledge in vestibular and balance health care. The information provided must not be used in the absence of prior medical or therapy assessment.

Our patients matter

Mersey Care NHS Foundation Trust listens and responds to patients and their carers to help improve the services we deliver.

If you have any comments, compliments or concerns you can speak with a member of staff or contact our Patient Advice and LiaisonService (PALS) and Complaints Team.

Telephone: 0151 471 2377
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Email: palsandcomplaints@merseycare.nhs.uk