From the Guidelines
The most common cause of lightheadedness is orthostatic hypotension, which occurs when blood pressure drops suddenly upon standing up, as supported by the 2018 ESC guidelines for the diagnosis and management of syncope 1. This happens because gravity pulls blood downward, temporarily reducing blood flow to the brain. Dehydration frequently contributes to this condition, so maintaining adequate fluid intake is essential, especially during hot weather or after exercise. Some key points to consider:
- Other common causes include low blood sugar, anxiety, anemia, inner ear problems, and medication side effects.
- To manage lightheadedness, sit or lie down immediately when symptoms occur, rise slowly from sitting or lying positions, stay hydrated by drinking 6-8 glasses of water daily, eat regular meals to maintain blood sugar levels, and avoid sudden position changes.
- If lightheadedness is severe, persistent, or accompanied by other symptoms like chest pain, shortness of breath, or severe headache, medical attention should be sought promptly as it could indicate a more serious underlying condition, as noted in the 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope 1.
- The pathophysiology of orthostatic hypotension is complex and involves the autonomic nervous system, as discussed in the 2009 guidelines for the diagnosis and management of syncope 1.
- Recent studies, such as the 2021 ACR Appropriateness Criteria for syncope, emphasize the importance of a detailed history and physical examination in evaluating patients with syncope or presyncope, and suggest that imaging studies should be limited to select patients based on clinical assessment 1.
- Additionally, the 2017 ACC/AHA/HRS guideline highlights the importance of considering postural orthostatic tachycardia syndrome (POTS) as a potential cause of lightheadedness, particularly in young women 1.
From the Research
Causes of Lightheadedness
- Lightheadedness is a common symptom that can be caused by various factors, including orthostatic hypotension (OH) 2, 3, 4, 5, 6
- Orthostatic hypotension is a decline in blood pressure that occurs when moving from a lying to a standing position, resulting in symptoms of cerebral hypoperfusion, such as lightheadedness and syncope 2
- The most common causes of lightheadedness include:
- Primary autonomic disorders, such as Shy-Drager syndrome 2, 4
- Reversible nonautonomic causes, such as reduced blood volume 2
- Underlying diseases, such as diabetes mellitus 2, 4
- Drugs 2, 3
- Neurogenic orthostatic hypotension, which is characterized by a decrease in blood pressure upon standing associated with symptoms of lightheadedness, dizziness, and visual "white-out" 4, 5
Risk Factors
- Elderly people are predisposed to OH 2
- Patients with Parkinson's disease are also at risk of developing OH, which can cause unexplained falls, syncope, lightheadedness, and cognitive impairment 6
- Other risk factors include hypovolemia, blood pressure lowering drugs, and supine hypertension 3, 6
Diagnosis and Treatment
- The diagnosis of OH is based on the documentation of postural hypotension accompanied by symptoms of cerebral ischemia 2
- Nonpharmacologic approaches are preferred and include increasing sodium intake, avoiding rapid postural changes, and wearing elastic garments 2, 3
- Pharmacological interventions, such as midodrine, droxidopa, fludrocortisone, and sympathomimetic agents, can be used to treat OH, especially in patients who fail to respond to nonpharmacologic measures 3, 4, 5, 6