Management of Lightheadedness When Going Home
Patients experiencing lightheadedness should immediately sit or lie down to prevent falls and potential injury, as physical injuries occur in approximately 30% of syncope cases, with 5% experiencing severe trauma. 1
Immediate Actions for Lightheadedness
Physical Counterpressure Maneuvers (PCMs)
Perform PCMs to prevent progression to full syncope 1:
- Leg crossing with muscle tensing
- Squatting
- Arm tensing
- Isometric handgrip
- Neck flexion
These maneuvers work by compressing the vascular compartment, increasing systemic vascular resistance, and raising blood pressure to improve cerebral perfusion 1
PCMs have demonstrated approximately 50% reduction in syncope risk compared to no intervention 1
Contraindications for PCMs
Do not use PCMs if the patient has 1:
- Symptoms of heart attack or stroke
- Chest pain
- Accompanying injury
- Bleeding
- Signs of stroke
Home Safety Measures
Environmental Modifications
- Improve lighting - use a task lamp and carry a pocket flashlight 2
- Reduce glare - consider yellow, amber, or plum tinted eyeglasses 2
- Install grab bars by the toilet and in the shower 2
- Remove throw rugs and obtrusive electric cords 2
- Ensure no sharp-edged furniture 2
- Use color-coded or graphic labels as orientation cues 2
Behavioral Recommendations
- Avoid sudden position changes (from lying to standing)
- Maintain adequate hydration
- Lie flat as much as possible if lightheadedness persists 2
- Minimize bending, straining, stretching, and twisting movements 2
- Avoid strenuous exercise temporarily 2
- Do not drive when experiencing lightheadedness 2
When to Seek Medical Attention
Advise patients to seek urgent medical attention if they develop 2:
- New-onset severe back or leg pain
- Lower limb motor weakness or sensory disturbance
- Urinary or fecal incontinence
- Urinary retention
- Perineal sensory disturbance
- Nausea and vomiting or fever
- Symptoms that worsen or do not improve within 1-2 minutes 1
Long-term Management Considerations
- Consider increased salt and fluid intake for recurrent episodes 1
- Identify and avoid personal triggers
- Consider compression stockings for orthostatic causes 1
- Ensure optimal management of comorbid conditions 2
- Establish a predictable daily routine (meals, exercise, bedtime) 2
Special Considerations
- Patients with benign paroxysmal positional vertigo (BPPV) may require additional home supervision due to fall risk 2
- For patients with orthostatic hypotension, symptoms may be delayed and appear after 13-30 minutes of standing 3
- Patients should not be left alone for long periods and should return to the hospital immediately if symptoms worsen 2
By following these guidelines, patients with lightheadedness can safely manage their condition at home while minimizing the risk of falls and other complications.