According to Drachman, "Older people are especially vulnerable because there are more things that can interact to produce conditions leading to dizziness. For example, excessively low blood pressure may result from medicines used to lower your hypertension or treat prostate problems—the low blood pressure may make you dizzy when you stand up."

Many Different Factors

There are a range of conditions that can cause dizziness. Finding the origin of the sensation is perplexing and frustrating to doctors and their patients. Causes vary from low blood pressure to medicine side effects to neurologic or inner ear problems. Examples of conditions that can increase the risk of include:

• History of heart attack
• History of head trauma or whiplash
• Arthritis
• Diabetes
• Migraine
• Anxiety
• Alcohol abuse
• Smoking
• High intake of caffeine

"One of the most common causes of dizziness is known as benign paroxysmal positional vertigo (BPPV)," Drachman says. "This is a sensation of actually spinning around, which may occur when you lie down, sit up, or roll over in bed. This rotational sensation is known as 'true vertigo' and occurs when tiny calcium crystals in one part of the inner ear break loose and drift into one of the semicircular canals in another part of the ear." As the loose crystals move back and forth where they do not belong, they can cause dizziness, sometimes associated with nausea, upon certain movements.

It is important to note that there is a difference between vertigo and dizziness. Vertigo refers to a sensation of motion when you are resting; dizziness denotes less specific symptoms, such as lack of balance and lightheadedness. This subtle difference can be an important factor in diagnosing the problem.

Another reason for dizziness can be attributed to the circulatory system, which supplies the brain and inner ear with blood and oxygen. Insufficient circulation, due to hardening of the arteries, decreased blood pressure, or poor heart function, can all result in dizziness. A drop in blood pressure when first standing up, a condition called "postural hypotension," triggers many episodes of dizziness. Feeling anxious can also precipitate dizziness. Certain neurologic disorders can bring on episodes of dizziness, as well.

" Transient ischemic attacks, known as 'ministrokes,' can produce vertigo, which is almost always associated with other symptoms such as numbness or weakness of an arm or leg," Drachman says. "Following head injuries, people may experience lightheadedness, and sometimes vertigo if the inner ear is affected. In younger people, multiple sclerosis can be a cause of dizziness."

Many medicines may cause dizziness. Some examples include:

• Heart medicines (eg, alpha blockers, beta blockers, angiotensin-converting enzyme inhibitors, diuretics, nitrates)
• Medicines that affect the central nervous system (eg, antipsychotics, opioids, drugs to treat Parkinson's disease, muscle relaxants, tricyclic antidepressants)
• Erectile dysfunction medicines (eg, sildenafil [Viagra], drugs to relieve cramps in the bladder)

If you notice that the dizziness is more significant during a specific time of day or after trying a new medicine, it may be that the drug is a key culprit.

Do Not Suffer in Silence

Dizziness is not a normal consequence of aging. It is a symptom that the body is not functioning properly. If you are experiencing symptoms, talk to your doctor. A diary chronicling your activities, medicines, and descriptions of dizzy episodes often help doctors narrow the possibilities.

"While many people get dizzy and many causes are benign, some are not," Drachman concludes. "Always seek medical care if you feel as if your world is unstable."