What is the difference between light-headedness and dizziness?

Difference Between Light-headedness and Dizziness

Light-headedness refers to a sensation of disturbed spatial orientation without a false sense of motion, while vertigo (often called dizziness) is specifically a false sensation of self-motion or spinning. 1

Key Distinctions

Light-headedness:

• Characterized by feeling faint, woozy, or as if you might pass out
• No sensation of movement or spinning
• Often associated with:
  • Presyncope (feeling like you might faint)
  • Orthostatic hypotension
  • Anxiety or panic disorders
  • Hyperventilation
  • Medication side effects
  • Dehydration or systemic causes 1, 2

Vertigo (True Dizziness):

• Characterized by a false sensation of rotation or spinning
• Clear perception that either you or your surroundings are moving
• Often associated with:
  • Inner ear disorders (BPPV, Ménière's disease)
  • Vestibular neuritis/labyrinthitis
  • Central causes (stroke, vestibular migraine)
  • Typically accompanied by nausea, vomiting, and balance problems 1

Clinical Importance of Distinction

Making this distinction is crucial for proper diagnosis and management:

1. Diagnostic pathway: Light-headedness often requires cardiovascular evaluation (orthostatic blood pressure, ECG), while vertigo requires vestibular assessment (Dix-Hallpike maneuver, HINTS examination) 2, 3

2. Red flags:

   • Light-headedness with exertion may indicate cardiac disease 4
   • Vertigo with neurological symptoms may indicate stroke 1, 2

3. Treatment approaches:

   • Light-headedness: Treat underlying cause (hydration, medication adjustment, anxiety management)
   • Vertigo: Specific treatments like canalith repositioning procedures for BPPV or vestibular rehabilitation 2

Common Pitfalls in Assessment

• Terminology confusion: Patients often use "dizziness" to describe various sensations, requiring careful questioning to determine the exact nature 1, 5
• Incomplete evaluation: Failing to distinguish between types of dizziness can lead to inappropriate testing and delayed diagnosis 2
• Overreliance on imaging: CT and MRI have low diagnostic yield in isolated dizziness without neurological deficits (<1% for CT, 4% for MRI) 1, 2

Diagnostic Approach

When a patient reports "dizziness," clarify the exact sensation by asking:

1. "Do you feel like you or the room is spinning?" (vertigo)
2. "Do you feel like you might faint or pass out?" (light-headedness/presyncope)
3. "Do you feel unsteady or off-balance when walking?" (disequilibrium)
4. "Is it a vague feeling of disconnection from your surroundings?" (non-specific light-headedness) 3, 6

The Barany Society provides clear definitions that help distinguish these sensations, emphasizing that true vertigo involves a false sensation of motion, while light-headedness involves disturbed spatial orientation without motion perception 1.

By accurately distinguishing between light-headedness and vertigo, clinicians can pursue appropriate diagnostic pathways, avoid unnecessary testing, and provide targeted treatment for the underlying cause.