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Dizziness

 

Dizziness after a COVID infection can be:

      • a sensation of spinning or an altered sense of motion often called vertigo;
      • lightheadedness; a feeling as if you might faint.

Both can make you feel slightly off balance.

Many studies have reported that COVID can cause dizziness during the acute phase of the infection, during recovery or as part of Long COVID symptoms.

Vertigo

Vertigo is often seen in viral infections because you are weaker and run down or because the virus has affected the vestibular system – the link between your inner ear and your brain.

If the vestibular system is affected you may find that you get dizzy when you:

      • move your head;
      • see lots of movement in front of your eyes (e.g. a fast, busy scene in a movie);
      • change position quickly. This can also make you feel nauseous and your balance may be compromised.

Dizziness can also be linked with ringing in the ears, reduced hearing, eye strain and headaches. These may come and go throughout the day. If they are constant or very intense, you should inform your healthcare professional as they may want to do some further investigations.

Lightheadedness

Lightheadedness can be caused by a range of things and the most common include:

      • Dehydration
      • Some types of prescription medication
      • Low blood sugar levels
      • Anxiety or stress
      • Postural hypotension – a sudden drop in blood pressure upon standing, that goes away after sitting or lying back down.
      • Iron deficiency anaemia

Postural orthostatic tachycardia syndrome (PoTS) is an abnormal increase in heart rate, that occurs after sitting up or standing. Some typical symptoms include dizziness, fainting, fatigue and palpitations. PoTS is diagnosed if your heart rate increases by 30 beats a minute (bpm) or more (40bpm in those aged 12 to 19) usually within 10 minutes of standing.

What are the symptoms of PoTS?

    You can develop PoTS suddenly, or it can begin gradually.

    You can get symptoms almost immediately, or a few minutes after sitting up or standing. Lying down may relieve some of the symptoms.

    Typical symptoms of PoTS can include (alongside an increase in heart rate):

    • dizziness or lightheadedness
    • fainting
    • problems with thinking, memory and concentration – this combination of symptoms is often called “brain fog”
    • heart palpitations
    • shaking and sweating
    • weakness and fatigue
    • headaches
    • poor sleep
    • chest pain
    • feeling sick
    • shortness of breath

    Some people notice that a hot environment, eating, strenuous exercise or having a period can make their symptoms worse.

    These symptoms are non-specific and can be due to many different causes such as medicine or low blood pressure, so it’s a good idea to get a proper diagnosis. Sometimes they can be misdiagnosed as anxiety or panic attacks.

      Some people may have had dizziness and balance problems before having COVID and can experience worsening of symptoms.

      What can I do to help my dizziness?

      Most people will be able to manage their own recovery and see significant improvements over time. 

      Top tips 

      Move slowly when moving from lying and sitting to standing

      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.

      Aim to move normally

      This may be challenging and take a long time. Movement involving your eyes, head and body has been shown to help reduce dizziness and improve balance and fatigue in many conditions affecting the balance system.

      Be safe

      You may feel mild dizziness during movement. Reassure yourself its ok to feel mild dizziness and you are safe. Dizziness should stop within 1-2 minutes of being still.

      Exercises to help with your vertigo

      Here are some exercises that may help your recovery. 

      Start by performing these exercises once a day in the evening. After they feel ok, repeat the exercises again earlier in the day. Ideally, these exercises should be completed five times a day. 

      All of the following exercises should be performed for 30 seconds each:

          • Slow controlled eye movements with the head staying still
          • Slow controlled head movements with the eyes staying fixed on a target
          • Slow controlled eyes and head moving together
          • Slow controlled eyes and head moving in opposite directions

      Have something stable to hold onto if needed (e.g. the kitchen sink) for the following exercises:

          • Stand with your feet together
          • Stand with one foot in front of the other, touching heel to toe
          • Stand on one leg
          • Stand on the other leg

      If you find these exercises too easy with your eyes open, repeat these exercises with your eyes closed.

      Pace, Plan and Prioritise: Over exertion can make lightheadedness worse so it is important to pace, plan and prioritise your daily activities. 

      If you have lightheadedness on standing:

          • Avoid rapidly moving from lying or sitting to a standing position (rise slowly after lying down – sit for a while before standing).
          • Avoid or limit prolonged periods of bed rest, sitting or standing.
          • Activity – whilst over exertion can make light headedness worse, following an ongoing activity programme can improve symptoms. Try to do some activity every day, even for just a few minutes. Being active can help you keep fit and build muscle (strong calf muscles should help pump blood back to your heart).
          • Avoid stress – periods of stress can make symptoms of lightheadedness worse.
          • Keep hydrated by eating and drinking regularly – symptoms of light headedness can be made worse when eating and drinking patterns change so try and stick to a routine and avoid long periods without eating or drinking.
          • Rest during illnessInfections and other illnesses can worsen symptoms – rest and accept a reduction in activity levels if you become unwell. You may take longer than expected to recover.
          • Avoid or limit alcohol and caffeine which causes the blood vessels to widen, therefore lowering blood pressure.
          • Include more salt in your diet, however this is not advisable if you have high blood pressure or kidney or heart disease, so ask your specialist first.
          • Try wearing support tights or other forms of compression clothing, to improve blood flow in your legs.
          • Elevate the head end of your bed, so you’re not sleeping fully horizontal.

      Action to avoid fainting

      Fainting can be avoided by learning to take notice of early warning signs such as, lightheadedness, dizziness, nausea, and sweating, and taking action.

      Immediate action:

          • Preferably lie down and elevate your legs.  Sit down if this is not possible.

      If your circumstances make this difficult:

          • Cross your legs while standing or rock up and down on your toes.
          • Clench buttocks and abdominal muscles.
          • Clench your fists.

      The risk of fainting can also be minimised by:

          • Coming up from lying to standing slowly, sitting for a while first. 
          • Avoiding prolonged standing (or sitting) – fidgeting is the key.
          • Avoiding having your hands over your head for a prolonged time.
          • Prolonged sitting can cause symptoms in some people. Elevating your legs can be helpful.

      When should I seek help for my post COVID dizziness?

       

      Consult your GP or healthcare professional if:
      • Symptoms are constant, severe and worsening.
      • You have unexplained falls near fainting and trips.
      • You have constant noise/ tinnitus or loss of hearing.
      • If you think you have POTS or low blood pressure.
      Seek urgent help if:

        You have a sudden onset of dizziness along with any of the following symptoms:

        • Chest pain
        • Palpitations
        • Shortness of breath
        • Loss of consciousness
        • Face, arm or leg weakness and / or any neurological signs like speech and swallowing problems, facial drooping
        • You have new onset sudden and severe loss of hearing.

         

        Last Reviewed on 2 December 2021

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