What could be causing my weakness, feeling of coldness, near vomiting, and vertigo?

Immediate Assessment for Acute Symptoms

Your symptoms of weakness, feeling cold, near vomiting, and head spinning most likely represent either acute vestibular syndrome (inner ear problem), vasovagal syncope (fainting episode), or less commonly a serious neurological event that requires immediate evaluation. 1

Critical Red Flags Requiring Emergency Care

You need immediate emergency evaluation if you have any of these:

• Inability to stand or walk 2
• Severe headache (new or worst ever) 2
• Slurred speech, facial droop, or arm/leg weakness 1, 3
• Double vision or vision loss 3
• Confusion or difficulty thinking clearly 1
• Chest pain or severe shortness of breath 1

Most Likely Diagnoses Based on Your Symptoms

If Your Spinning Lasts Seconds to Minutes with Head Movement

This pattern suggests benign paroxysmal positional vertigo (BPPV), the most common cause of vertigo. 1, 2 The key features are:

• Episodes triggered by rolling over in bed, looking up, or bending down 1
• Spinning sensation lasts less than 60 seconds 1, 2
• Nausea and feeling cold are common accompanying symptoms 1
• No hearing loss or ringing in ears 1

Treatment: Canalith repositioning procedures (Epley maneuver) have 80% success rates after 1-3 treatments, and medications are unnecessary for typical BPPV. 1, 2

If Your Spinning Is Constant and Severe (Hours to Days)

This pattern suggests acute vestibular syndrome, which could be vestibular neuritis (inner ear inflammation) or, in 25% of cases, stroke. 3, 4

Vestibular neuritis features: 4

• Severe continuous spinning lasting days
• Severe nausea and vomiting
• Cannot tolerate any head movement
• No hearing loss
• Otherwise normal neurological function

Stroke warning signs (present in up to 25-75% of acute vestibular cases in high-risk patients): 3, 4

• Age over 50, diabetes, hypertension, or prior stroke 3
• Severe inability to walk or stand 3
• New severe headache 2
• Any focal neurological symptoms 3

If You Feel Faint or Nearly Passed Out

Your symptoms of weakness, feeling cold, nausea, and spinning could represent vasovagal syncope (near-fainting). 1 Classic features include:

• Feeling cold and sweating before the event 1
• Nausea and abdominal discomfort 1
• Lightheadedness and vision changes 1
• Pallor (looking pale) 1
• Symptoms improve when lying down 1

Immediate Self-Management

If you have no red flags above: 1, 5

• Lie down immediately in a safe place to prevent falls 1
• Stay hydrated with small sips of water or electrolyte drinks 5
• Avoid sudden head movements 1
• Do not drive or operate machinery 6

Avoid these common mistakes: 2

• Do not assume normal strength and coordination rules out stroke—up to 80% of stroke patients with vertigo have no other neurological deficits 3
• Do not rely on your description of "spinning" versus "lightheadedness"—the timing and triggers matter more 2

When to Seek Medical Evaluation

Seek same-day evaluation if: 2, 4

• This is your first episode of severe vertigo
• Symptoms persist beyond a few hours
• You cannot walk safely
• Vomiting prevents you from staying hydrated
• You have risk factors for stroke (age >50, diabetes, high blood pressure, heart disease) 3

Appropriate testing if you see a provider: 2, 4

• Dix-Hallpike maneuver for BPPV (diagnostic test, not imaging) 2
• HINTS examination if symptoms are continuous (can detect stroke better than early MRI when performed by trained practitioners) 2, 3
• MRI brain (not CT) if stroke is suspected 2, 3
• No imaging needed for typical BPPV with positive Dix-Hallpike test 2

Medications to Consider (After Medical Evaluation)

For acute nausea/vomiting only (short-term use): 1, 6

• Meclizine 25-100mg daily can help nausea and vertigo symptoms 6
• Stop after 3 days maximum—prolonged use impairs your brain's natural compensation and delays recovery 1, 4

Avoid: 1

• Vestibular suppressants are not appropriate as primary treatment for BPPV 1
• These medications do not cure the underlying problem 1