Vertigo and Dizziness

Dizzy Woman

Dizziness and vertigo are commonly reported symptoms in people with Parkinson’s disease (PD). Most experts agree that dizziness and vertigo can be broadly defined as the sensation of spinning or whirling, and the sensation can be associated with balance problems.

In general, both symptoms are less notable in people in the early stages of Parkinson’s. It is more common for older people with Parkinson’s to experience dizziness or vertigo. Many people with PD experience vestibular dysfunction (balance issues related to the inner ear) even without vertigo or dizziness symptoms.

While these non-movement symptoms are common, doctors often miss the diagnosis. To optimize your treatment, know how to identify vertigo and dizziness, so you can address the issue with your care team. 

Common Causes of Dizziness and Vertigo in Parkinson’s and How to Treat Them:

  • Orthostatic hypotension (OH): a persistent drop in blood pressure that occurs upon moving from sitting to standing or from lying down to sitting up or standing. It can result in the temporary loss of consciousness. It is the most commonly overlooked cause of dizziness in people with Parkinson’s. OH can be treated with: hydration (drinking 6-8 glasses of water a day), compression stockings, increasing salt in your diet and sometimes by medications (such as Florinef, Midodrine, Droxidopa, or Mestinon). Moving the legs before standing can pump blood into the body, potentially lessening the symptoms.
     
  • Medication-induced dizziness or vertigo: dopamine agonists are the most common drugs associated with dizziness or vertigo in PD. With the help of your doctor, this medication related issue can be treated by weaning the dosage and slowly discontinuing the drug or drugs causing the side effect. Common drugs associated with dizziness include anticonvulsants, antihypertensives, antibiotics, antidepressants, antipsychotics, pain medications and anti-inflammatory drugs.
     
  • Deep Brain Stimulation (DBS): The surgical procedure can be associated with dizziness or vertigo. Either symptom can emerge soon after surgery. A health professional determines if the dizziness is caused by the device by simply powering it on and off. Once the device is turned off, you should be observed by your caregiver or medical team to confirm if the dizziness or vertigo resolves. If it does resolve, your healthcare team may need to check the location of the electrodes (usually by brain imaging) and possibly re-program the device. Turning the device on and off may not be enough and a full ENT evaluation may be necessary.
     
  • Benign Paroxysmal Positional Vertigo (BPPV): sudden dizziness when turning in bed or dizziness lasting only a few seconds. It can be diagnosed using the Dix-Hallpike maneuver. It can be treated by seeing a physical therapist who is an expert in vestibular rehabilitation or by learning a series of simple movements you can self administer at home, such as the Semont maneuvers. Recent research has revealed that BPPV may occur in 11% of people with PD and who experience dizziness (Bloem, 2013).
     
  • Migraine headaches: pain in the head can be a potential cause of dizziness or vertigo. Some experts refer to this as migraine-induced vertigo. In most cases, treating the headache or migraine can resolve the dizziness.
     
  • Transient ischemic attack or stroke: sudden onset of dizziness, usually in the presence of other neurological signs, could possibly be a transient ischemic attack (a brief stroke-like attack) or stroke. If a stroke is suspected, you should seek medical attention immediately and undergo appropriate imaging and potentially stroke-related therapies.

In people with early Parkinson’s disease (diagnosed for only a few years), the dizziness has in many cases linked to a lower Montreal Cognitive Assessment score (a thinking test) raising the possibility that dizziness may be a non-movement symptom associated with cognitive decline (Kwon, 2020).

Dizziness or vertigo can be tied to many causes and is not unique to Parkinson’s. Symptoms can be caused by medications, low blood pressure, anxiety, cold, flu, dehydration, heart conditions and more. Tell your doctor immediately if you regularly experience dizziness or vertigo.

Page reviewed by Dr. Michael S. Okun, Parkinson’s Foundation Medical Director, Professor and Chair, Department of Neurology, Executive Director of the Fixel Institute for Neurological Diseases; a Parkinson's Foundation Center of Excellence.

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