It started with the occasional sensation of feeling off-balance and stopped me in my tracks. I’d had a cold in the run-up to Christmas, which was nothing unusual. I put those initial woozy moments down to the lingering effects of the bug. It would pass, I told myself.
But then the spells became more frequent and prolonged. Suddenly, without warning, the room would be spinning – a bit like I’d stepped off a merry-go-round. I would need to sit to steady myself.
At some moments I no longer felt safe leaving the house, because I worried I could fall and injure myself. I also stopped driving for fear of an attack happening while I was behind the wheel.
Even when the dizzy spells weren’t happening, I didn’t feel right. It was as if my head was underwater and constantly swaying with the tide. And because I couldn’t predict when the attacks would happen, I felt on edge at all times, worried that my world was about to start turning.
I was almost certain, from early on, that the dizziness was due to an inner ear infection – called labyrinthitis – which affects the balance. The problem occurs when a virus gets into a part of the inner ear known as the labyrinth, a series of fluid-containing ducts that help keep the body balanced.
Everything I had learned in medical school had taught me that there was very little I could do to speed up recovery. As with a cold, all you can really do is ride it out.
But, as time passed, it really felt like the dizziness would never end. I spent the entire Christmas period in a state of constant panic and, as the clock struck midnight on New Year’s Eve, I worried that it would go on forever.
In my two decades as a GP, I’ve treated countless patients suffering with dizziness. For many, the problem passes after a few weeks. However, for others, the symptoms continue for months, sometimes even years. This is what doctors call chronic dizziness. Research suggests that more than two million Britons are living with this condition.
Dr Ellie Cannon says her blighting dizzy spells left her feeling as if she had just stepped off a merry-go-round
And for those people, I am in no doubt that life is hellish. I’ve heard heartbreaking stories from patients who have been left unable to work or enjoy even the most basic things, such as popping to the shops.
Perhaps worst of all, the cause of a patient’s chronic dizziness can remain a mystery for a long time, meaning a cure is out of reach. This is, in large part, due to the fact that there are a variety of conditions that can trigger dizziness. Some are more difficult to spot than others.
Most chronic dizziness patients have to resign themselves to extended delays while they are passed from one specialist to the next until the cause of their problem is identified.
At least, that’s what I used to think. Because my own battle with dizziness has changed how I think about how the NHS approaches the problem.
It’s easy to tell people that they need to be patient about getting a diagnosis and treatment for their dizziness. But once you’ve felt your own world spinning out of control to the point where you can’t safely drive your children to the shops, the issue is serious.
It has made me wonder whether GPs spend enough time exploring the possible causes of dizziness before placing people on lengthy waiting lists to see specialists who may-or-may-not be the correct person for them to see.
In other words: Are GPs fobbing off chronic dizziness patients? I posed this question last week in The Mail on Sunday and asked readers if they felt GPs had taken their symptoms seriously.
We received hundreds of shocking letters and emails from people who firmly believe that their family doctor did not – and would not – treat their dizziness with the seriousness it deserves.
One 70-year-old woman from Scunthorpe in Lincolnshire, explained that she had been battling dizziness for more than four years. The problem had progressively become worse to the point where she needed a walking stick to stop herself falling over.
However, her GP had not carried out any tests to look for a cause or offered her any treatment.
Another reader, a 75-year-old man from Glasgow, has suffered with dizziness for 25 years, and ended up in hospital last month after falling and breaking two ribs. Yet despite the severity of his symptoms, the only advice he had received from his GP was to stamp his feet before standing up. Why he needed to do this was never explained to him.
A growing number of experts are speaking out on NHS failures to provide adequate care to patients with chronic dizziness. ‘There is the misconception that dizziness is a mystery problem with unclear causes,’ says Dr Barry Seemungal, a neurologist at Imperial College London.
‘But that’s not the case. It always has a cause, the doctors just have failed to find it. Too many dizziness patients go without a diagnosis. It’s not good enough and it needs to change now.’
Some people’s spells get so bad they feel like they can’t safely drive their children to school
So what are the causes of dizziness – and how can it be tackled? Doctors are taught in medical school that dizzy spells are usually due to problems in the ears, nerves or heart.
One possible trigger is a condition called benign paroxysmal positional vertigo, or BPPV, where calcium crystals in the inner ear come loose, disrupting the body’s balance.
Meanwhile, low blood pressure, which may be from heart problems, or even due to an infection like Covid, can cause a form of dizziness that occurs when patients stand up after sitting or lying down. This is known as orthostatic hypotension.
We are also taught that the blood sugar condition diabetes can trigger dizziness. However, research shows there are other factors.
Deficiencies in vitamin B, magnesium and iron, excessive caffeine consumption, mental health problems such as anxiety or depression, and even hormonal changes during the menopause are linked to chronic dizziness.
Another trigger we are still learning about is a condition called vestibular migraine. Unlike a normal migraine, it does not usually trigger headaches. However, it does appear to respond to migraine drugs.
To find the cause, GPs need to eliminate all the other possible triggers. This involves various investigations including blood tests and completing an in-depth medical history.
And here lies the problem. This takes time. Sometimes hours of one-on-one sessions with a patient. But GPs only have around ten minutes with each person they see every day. We all wish this wasn’t the case, but it is. And so chronically dizzy patients are sometimes referred to hospital specialists. The problem with this is that, unless the GP has a good idea what is causing the issue, they may not send the patient to the right specialist.
A neurologist or an ear, nose and throat (ENT) specialist may seem like the natural first place to send a patient with dizziness. But not if the problem is caused by a vitamin deficiency, for instance.
So, many people end up waiting months for an appointment only to be sent back to their GP, and the process starts all over again.
But what else can GPs do? Well, experts I’ve spoken to believe there are simple changes we could make.
The first is that GPs should stop dishing out anti-dizziness tablets – which is what often happens. These drugs – such as prochlorperazine, better known as Compazine – combat the nausea and spinning patients experience. However, experts say there can be dangerous consequences.
To find the cause of a patient’s dizziness, GPs need to eliminate all the other possible triggers through various investigations – such as blood tests and analysing medical histories
‘These drugs stop patients feeling so sick and dizzy, but they sometimes worsen the sense of balance,’ says Professor Petroc Sumner, a dizziness expert at Cardiff University. ‘This can even increase the risk of dangerous falls.’
Experts also warn that a worrying number of patients are being misdiagnosed with a condition called Meniere’s disease. It’s an inner ear disorder, which doctors do not fully understand, have no reliable test for and cannot cure. Yet, according to neurologist Dr Seemungal, it is ‘grossly overdiagnosed’ on the NHS.
The danger of this is that, once Meniere’s is diagnosed, investigations for other possible causes stop – meaning patients never get the right treatment.
In contrast, experts say that GPs should be more vigilant for benign paroxysmal positional vertigo (BPPV) – the inner ear problem caused by loose calcium crystals in the fluid-filled spaces.
‘It’s one of the more common causes of chronic dizziness and it’s easy to diagnose,’ says Toby Ellmers, a brain researcher at Imperial College London.
‘If dizziness comes on when a person turns over in bed, then it’s likely to be BPPV – but we sometimes hear from patients who were never asked that question.’
I would add here, I always ask this because BPPV is a problem that can be fixed in less than five minutes. This is done using a simple treatment called the Epley Manoeuvre, which involves contorting the head through a series of poses. Another important underlying issue that experts believe many GPs miss is anxiety.
‘It might not be what triggers the dizziness in the first place, but anxiety often makes it worse,’ says Toby Elmmers. ‘Patients will often develop a fear of falling, which stops them from leaving the house.
‘Then, when they don’t get the right care from GPs, they worry they will never be cured, and get even more anxious.
‘All this anxiety can compound the dizziness and stops patients from getting better.’
This is an issue I know all too well from my own bouts of dizziness. I’m happy to say they have eventually faded, but not before some trying moments.
I believe my fears that the dizziness could go on indefinitely were making the problem worse.
I know from my patients living with chronic pain that catastrophising over debilitating symptoms can make them last longer. The same is true for dizziness.
It was only after I managed to convince myself that the symptoms were temporary that they started to ease. Trying to get back to normal activities, like going to work and doing household chores also helped. This approach won’t work for everyone, but for some, it could make a real difference.
Finally, my main piece of advice for anyone suffering with dizzy spells: be specific and be forceful. If the dizziness comes on during a certain action – such as standing up or turning over in bed – mention this.
Does it get worse at certain times of the day or after eating certain foods? Does it get more severe when stressed?
These are all questions you need to have answers to before you walk into the GP surgery.
