My dizziness keeps coming back: where do I start?
If you feel dizzy every few days or weeks and cannot tell why, start with an internist. Internal medicine sees the whole picture because recurrent dizziness can come from many things: anaemia, dehydration, a drop in blood pressure on standing, blood sugar, thyroid, medicines, or a problem in the heart or inner ear [1, 3]. Sometimes more than one cause is at work.
At the first visit the doctor asks specific questions about the type of dizziness, its timing, duration and relation to posture, food and medicines, carries out a clinical examination, and then decides whether the assessment stays in internal medicine or needs another specialty such as ENT, neurology or cardiology [1, 3]. If a warning sign appears, such as sudden severe dizziness with weakness on one side, trouble speaking, chest pain or fainting, that needs emergency care, not a clinic [1, 2, 4].
The important thing is not to interpret the dizziness on your own or wait until it gets worse. This article explains the types of dizziness, the questions that help the doctor, and when internal medicine is enough versus when a referral is needed.
An initial examination may include watching how you walk and balance, a focused neurological check and a review of medicines. The clinician chooses these steps from the history rather than giving every person every test [8].
Not all dizziness is the same: the types the doctor asks about
The doctor's first question is: what exactly do you feel? Because the word dizziness describes different sensations, and each type points the doctor in a different direction.
The first type is vertigo: a feeling that the room is spinning around you or that you are spinning. Vertigo usually points to the inner ear or the balance centres in the brain, and it comes in episodes lasting seconds to hours [2, 3]. The NHS explains that vertigo is a symptom, not a disease on its own, and the cause needs assessment [2].
The second type is light-headedness or feeling close to fainting: a sense that you might fall or that the world went dark for a moment. This usually comes from low blood pressure, dehydration, low blood sugar, anaemia or a new medicine [1, 4]. The Mayo Clinic notes that the feeling of near-fainting is often most obvious when you stand up quickly from sitting or lying [4].
The third type is unsteadiness: a sense that you might fall or that your walking is unstable. This can relate to nerves, muscles, the inner ear or certain medicines [3, 4], and it tends to be most noticeable while walking.
Some people feel a mixture, and the doctor tries to identify the dominant type to narrow the diagnosis. But no single description confirms a diagnosis on its own without a full examination and questions [1, 3].
The distinction is not so you can diagnose yourself, but so you can describe the sensation more precisely at the visit, which saves time and helps the doctor focus on the likeliest possibilities.
Balance relies on information from the eyes, inner ear and sensory input from muscles and limbs. That is why saying you feel unsteady does not by itself locate the problem [7].
Five things that help the doctor understand the dizziness from the first visit
At the consultation the doctor's questions are not random; each one settles or excludes a possibility. Five details from you make a real difference.
First: the trigger and posture. Does the dizziness come when you stand up from sitting or lying quickly? If so, that leans toward postural blood-pressure drop. If it comes when you turn your head or roll over in bed, it may point to the inner ear [1, 2, 4]. The NHS says dizziness on standing can be postural hypotension [1].
Second: the duration. An episode of seconds is different from one of half an hour, hours, or dizziness that lasts all day. Very short movement-triggered episodes may suggest an inner-ear crystal disorder, while longer episodes have other possibilities [2, 3].
Third: ear symptoms. Is there ringing, hearing loss or a feeling of fullness in the ear alongside the dizziness? If so, that draws attention to an inner-ear problem that may need ENT assessment [2, 3]. If there are no ear symptoms at all, the possibilities shift elsewhere.
Fourth: medicines, fluids and food. Blood-pressure medicines, diabetes medicines, some sedatives and some heart drugs can cause dizziness, especially when the dose changes or a new drug is added [1, 4]. Drinking too little in the heat or during fasting causes dehydration that leads to dizziness [1]. The Mayo Clinic notes that medicines are among the most important causes to review [4].
Fifth: other accompanying symptoms. Tiredness and pallor suggest anaemia. Thirst and frequent urination suggest diabetes. Palpitations suggest a heart-rhythm problem. And if there is leg swelling or breathlessness with the dizziness, the scope of the examination widens [1, 3, 4]. Each of these is confirmed by the doctor through questions, examination and appropriate tests.
Writing these details down before the visit makes the consultation faster and more focused.
Common medical causes of recurrent dizziness
The causes are many, and the doctor does not look for all of them at once. He starts with the most common and the most dangerous, based on your history and examination, then narrows the possibilities.
Postural hypotension is one possible cause assessed in internal medicine: you stand up from sitting or lying, your pressure drops temporarily, and you feel dizzy or your vision goes dark for a few seconds. Its causes are varied: dehydration, blood-pressure medicines, long-standing diabetes affecting the nerves, [1, 4]. Checking blood pressure with a change of position can help the clinician assess this possibility instead of assuming it from symptoms alone [4].
Anaemia and iron deficiency are causes that are often detected late. When haemoglobin falls, the body does not deliver enough oxygen to the brain, and you feel dizzy, tired, pale and short of breath on effort [1, 3]. If you suspect anaemia, the article on anaemia symptoms and a CBC explains the initial tests.
Dehydration is simple but its effect is significant, especially in an Egyptian summer or during fasting. Low fluid intake reduces blood volume and causes dizziness, headache and tiredness, and sometimes simply drinking enough water and resting improves the symptoms [1, 4].
Low blood sugar can cause dizziness with trembling, sweating and hunger, especially in people taking diabetes medicines. Prolonged high sugar can cause numbness and unsteadiness through its effect on the peripheral nerves [1, 4].
Thyroid problems, whether underactive or overactive, affect the heart, circulation and energy, and dizziness may be part of the wider picture [4].
Some heart and vascular problems can cause recurrent dizziness: an irregular heart rhythm can mean the brain receives too little blood for a few seconds, producing dizziness or near-fainting, and sometimes palpitations [4].
The list does not end here, and that is exactly why the doctor does not diagnose from one symptom alone. Each cause has different questions, examinations and tests, and internal medicine begins the comprehensive assessment and then determines whether another specialty is needed.
If dizziness appears on standing, blood-pressure measurements and a medicine review can help assess postural hypotension; the sensation alone cannot confirm the diagnosis [6].
Vertigo and inner-ear problems: when is it internal medicine and when is it ENT?
Vertigo, the sensation that the room is spinning, usually comes from the inner ear, which houses the balance system. The best-known cause is benign paroxysmal positional vertigo, which happens when tiny crystals in the inner ear move out of place and send wrong signals to the brain. It comes in short bursts of seconds to a minute when you turn your head or roll over in bed, then settles [2, 3]. The NHS says it is the most common cause of vertigo [2].
Other causes include vestibular neuritis or labyrinthitis, which produce a severe episode that can last hours to days [2]. Ménière's disease causes vertigo episodes with tinnitus, hearing loss and a feeling of fullness in the ear, and without hearing tests the diagnosis can be difficult [2, 3].
Migraine too can cause vertigo, even without a severe headache; this is called vestibular migraine and needs specialist assessment [3, 4].
Internal medicine can carry out the initial assessment and exclude general causes such as anaemia, blood pressure, blood sugar and medicines, and if the vertigo strongly suggests an ear or balance problem, the doctor refers you to ENT or neurology for specialised tests [1, 3]. That is not a failure of diagnosis; it is a normal part of the plan: internal medicine sorts and the specialty completes.
Do not perform exercises or manoeuvres you found online for vertigo without a diagnosis. Some manoeuvres are indeed used in the clinic for benign positional vertigo, but without confirming the diagnosis first the wrong exercise may be ineffective or needlessly uncomfortable.
MedlinePlus explains that benign positional vertigo is often triggered by head movement or rolling over in bed, and that confirmation depends on a clinician's examination [10].
When does internal medicine refer to another specialty?
A referral does not mean internal medicine could not help; it means that after the initial assessment a clearer direction needs specialist tools or expertise.
ENT: if vertigo recurs with ear symptoms such as tinnitus, hearing loss or fullness, or if it is positional and short and needs a specialist manoeuvre. ENT has balance and hearing tests that internal medicine does not perform [2, 3].
Neurology: if assessment points to a neurological cause or vestibular migraine. Sudden weakness, speech trouble or trouble walking with new severe dizziness needs emergency care immediately rather than a routine referral. Vestibular migraine may also need neurology assessment [3, 4].
Cardiology: if the assessment suggests an irregular heartbeat or repeated palpitations, an ECG and further tests may be needed as the clinician decides [4]. Chest pain or fainting with new severe dizziness needs emergency assessment.
If you need a referral, ask for a summary of the initial assessment and any test results to share with the next specialist. And if the condition turns out to be simpler than expected, internal medicine can continue the follow-up itself.
The general rule: internal medicine is a good starting point when the cause is unclear, and it finds the shortest path to the right specialty instead of you touring several clinics. If you want to understand this idea further, the article on mixed symptoms and whether to start with an internist or another specialist explains the principle in detail.
Heat, fasting and screens: everyday factors that worsen dizziness
On hot days, fluid loss or heat exhaustion may accompany dizziness, particularly with exertion or difficulty drinking enough. Dehydration is one possible cause listed by the NHS, but feeling better after rest or water does not establish that it is the only cause [1]. Note the circumstances of an episode and tell your clinician.
If you fast and have diabetes or take blood-pressure medicines, describe the timing of food, fluids and medicines when an episode happens. Low blood sugar is a known cause of dizziness in some people with diabetes, and dizziness on standing can be linked to postural hypotension [1]. Ask your clinician about fasting and medicine timing for your circumstances; do not change doses on your own.
Poor sleep, stress and new medicines are useful details in the history, but none is a diagnosis on its own. Arrange medical assessment when dizziness keeps returning or does not settle, even if heat or tiredness seems a likely explanation [1]. Seek emergency care for any warning sign described in this article.
What to bring to your first dizziness consultation
Write a detailed description of the dizziness: is the room spinning, do you feel light-headed, or do you feel unsteady? When does it come and how long does it last? Is there a trigger such as a particular posture, effort or heat? And are there other symptoms with it such as ringing, hearing loss, palpitations, numbness, tiredness or nausea?
List every medicine, supplement, vitamin and herb you take, with the dose and the date you started or any dose change. The US National Library of Medicine advises preparing a full medicine list before the visit [5].
Bring any previous blood tests, scans or ECGs, home blood-pressure or blood-sugar readings if available, and a summary of any earlier visit about dizziness to any specialty.
Also note how many hours you slept in the last week, roughly how much water you drink, and whether you fast or drink a lot of coffee. This information may seem simple but it helps the doctor reduce unnecessary tests.
If you have specific questions, write them down, for example: is my dizziness from the new medicine? Do I need an ultrasound or a hearing test? This makes the visit clearer for you. And if you want to know exactly what happens at a first internal-medicine visit from the questions to the examination to the plan, the article on your first internal medicine visit in Maadi explains it step by step.
Warning signs: when does dizziness need emergency care?
Recurrent dizziness needs assessment, and some accompanying symptoms call for emergency care. If dizziness is new and severe with sudden weakness or numbness in a limb or the face, trouble speaking, double vision, or new difficulty walking, call for an ambulance or go to emergency care. Symptoms that disappear should not be assumed safe [2, 4].
Also seek urgent help when new severe dizziness comes with chest pain, a rapid or irregular heartbeat, trouble breathing, fainting or seizures, a sudden severe headache, ongoing vomiting, or a sudden change in hearing [4]. Vertigo with a very high temperature needs urgent assessment; if a stiff neck or severe headache is also present, do not delay emergency care [2].
Do not drive yourself while dizzy. Call an ambulance or ask someone to take you to emergency care. For dizziness that recurs without these warning signs, arrange a medical appointment rather than diagnosing it yourself [1, 4].
The CDC lists sudden trouble with balance, speech or vision, or weakness on one side as possible stroke signs. Time matters, so do not wait for symptoms to disappear [9].
Booking a dizziness consultation in internal medicine
If dizziness keeps coming back and you need a comprehensive first assessment, you can book an internal medicine consultation at the La Rose branch in New Maadi with Dr Mohab Ashraf Fouad, a specialist in internal medicine, diabetes, liver, digestive disease and endoscopy. The consultation is on Saturdays from 4 to 7 pm. The visit starts with questions about symptoms and medicines and a clinical examination; the doctor then decides which tests are appropriate for dizziness.
The visit covers the doctor's specialties. If after the initial assessment the case turns out to need another specialty such as ENT, neurology or cardiology, the doctor will explain the next step and help you prepare the initial assessment information for the next specialist.
To book, call or send a WhatsApp message to 010 4066 1893 or use the booking page. Please confirm the slot when booking because schedules can change. If you want to know more about the clinic and the consultation approach, read the article on constant fatigue and which tests to do, which explains the comprehensive assessment.
