From the Guidelines
Dizziness after COVID-19 infection is primarily caused by neuroinflammation, damage to blood vessels, and injury to neurons, leading to autonomic nervous system dysfunction and vestibular system impairment. If you're experiencing dizziness following COVID, you should first consult with your healthcare provider to rule out serious causes. For symptom management, vestibular rehabilitation exercises can help retrain your balance system - these include simple head movements like slowly turning your head side to side while seated, progressing to standing positions as tolerated 1. Over-the-counter medications like meclizine (25mg every 4-6 hours as needed) may provide temporary relief, but shouldn't be used long-term as they can delay recovery.
Some key points to consider when managing dizziness after COVID-19 infection include:
- Staying hydrated and avoiding sudden position changes, particularly when getting up from lying down
- Ensuring adequate rest and gradually increasing physical activity as tolerated
- The importance of follow-up with a neurologist or ENT specialist for further evaluation and targeted treatment if symptoms persist
- The potential for long-term cognitive impairment, seizures, dementia, psychosis, and other neurocognitive conditions, which have been reported to persist for at least 2 years after COVID-19 infection 1
It's essential to note that long COVID can encompass multiple adverse outcomes, including cardiovascular, thrombotic, and cerebrovascular disease, type 2 diabetes, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and dysautonomia, especially postural orthostatic tachycardia syndrome (POTS) 1. However, the primary concern for dizziness after COVID-19 infection remains the neuroinflammatory and autonomic nervous system dysfunction, which can be addressed through vestibular rehabilitation exercises and careful management of symptoms.
From the Research
Causes of Dizziness after COVID-19 Infection
The exact causes of dizziness after COVID-19 infection are not fully understood, but several studies suggest possible explanations:
- Vestibular dysfunction: Studies have shown that COVID-19 infection can cause vestibular dysfunction, which can lead to dizziness and vertigo 2, 3, 4.
- Reactivation of neurotropic viruses: One study suggests that COVID-19 infection can reactivate neurotropic viruses, such as VZV, which can cause vestibular dysfunction and dizziness 3.
- Inner ear damage: COVID-19 infection may cause inner ear damage, leading to vestibular dysfunction and dizziness 4.
- Central nervous system involvement: The role of the central nervous system in the onset of equilibrium disorders should be considered, as COVID-19 infection may have a neurotropic effect on the central nervous system 4.
- Post-infectious inflammation: Imbalance may be a late complication of COVID-19 due to post-infectious inflammation of the nervous tissue 4.
Possible Mechanisms
The possible mechanisms of dizziness after COVID-19 infection include:
- Direct damage to the vestibular system: COVID-19 infection may directly damage the vestibular system, leading to dizziness and vertigo 2, 3.
- Indirect damage to the vestibular system: COVID-19 infection may indirectly damage the vestibular system by reactivating neurotropic viruses or causing post-infectious inflammation 3, 4.
- Central nervous system involvement: The central nervous system may be involved in the onset of equilibrium disorders, leading to dizziness and vertigo 4.
Clinical Implications
The clinical implications of dizziness after COVID-19 infection include:
- Proper referral and follow-up: Patients with dizziness after COVID-19 infection should be properly referred and followed up to prevent more serious complications, such as ARDS and multi-organ failure 2.
- Vestibular rehabilitation: Vestibular rehabilitation may be effective in reducing symptoms and facilitating recovery in patients with vestibular dysfunction after COVID-19 infection 5.
- Comprehensive studies: Comprehensive studies are needed to investigate the long-term effects of COVID-19 on the vestibular system and to determine the underlying mechanisms of dizziness after COVID-19 infection 4, 6.