What Can Cause Dizziness in MS?

Patient Expert
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Being diagnosed with multiple sclerosis (MS) is enough to make your head spin. The amount of information available regarding MS and its symptoms is downright dizzying. But MS doesn’t just figuratively turn your world topsy-turvy, it can literally make things unsteady and disorienting.

Dizziness is a common symptom that affects approximately 20 to 30 percent of people in the general population. The term dizziness is a bit vague, but it basically means a feeling of disequilibrium. One particular subtype of dizziness that can affect people with MS is vertigo — a sensation that you or the world around you is spinning or balanced on a tilted axis.

Central vertigo, caused by disease of or damage to the central nervous system, is responsible for almost one-fourth of cases of dizziness reported by all patients. The most common central causes of dizziness and vertigo are cerebrovascular disorders related to blood circulation in the brain, migraine, multiple sclerosis, tumors in the brain stem or cerebellum, neurodegenerative disorders, some medications, and psychiatric disorders.

Dizziness in MS may be caused by nystagmuseye movement disorders, vestibular problems, or lesions on certain parts of the brain or cranial nerves. According to a 2013 study published in the journal Multiple Sclerosis and Related Disorders, dizziness affects more than 70 percent of people with MS. Prior studies suggested that dizziness affects 49 to 59 percent of people with MS.

Although dizziness is a fairly common symptom, there's not much research on the subject. Researchers using data from the North American Research Committee on Multiple Sclerosis (NARCOMS) patient registry found that dizziness is often associated with lower health-related quality of life and seems to affect more people with lower socioeconomic status. Of those patients who reported dizziness, 60 percent classified it as mild, 30.9 percent as moderate, and 7.55 percent as severe.

Discussing dizziness with your doctor

With the varied causes of dizziness, it is important to be very descriptive in explaining what you experience. If your dizziness is really more of a fleeting lightheadedness, changes in blood pressure may be the cause. When lightheadedness is combined with fainting (syncope), it may be associated with an abnormal heart rhythm (arrhythmia). Lightheadedness may also be connected to anxiety or stress, allergies, dehydration, viral infections, or use of alcohol or drugs.

Dizziness combined with vertigo is often associated with a disconnect between messages sent to the brain from sensory nerves in the body, vision, and/or the inner ear. A common form of vertigo, called benign paroxysmal positional vertigo (BPPV), is associated with quick movements of the head and is a potential cause of nystagmus. People with BPPV do not usually feel dizzy all of the time. BPPV may be confused for Ménière disease, which affects the inner ear.

Problems with proprioception (awareness of your body position in space) and/or vestibular function (affecting spatial orientation and our sense of balance) can create a sense of disorientation that may be described by some as dizziness. While vestibular function is closely tied to the workings of the inner ear and nerves that connect it to the brain, proprioception is closely related to sensory nerves connected to the tissues near and around our joints. If you can’t feel your feet or ankles, it becomes more difficult to know which way you may be leaning when you close your eyes. The resulting impaired balance is more likely caused by lesions in the spine than in the brain.

In a study of 30 people with relapsing-remitting MS (RRMS) who underwent neurological and otolaryngological examination, 86 percent demonstrated vestibular function alterations. All but one of those 26 cases had a peripheral cause, involving the inner ear or vestibular nerve. Whether the cause of dizziness is connected to vestibular function or reduced proprioception, vestibular rehabilitation — a special form of neurophysical therapy — may be helpful in improving symptoms, function, safety, and quality of life.

To be specific in describing your dizziness, answer these questions:

  • When do you experience the dizziness?
  • How long does it last and how long have you been experiencing it?
  • Do you notice other symptoms that seem to be related to the dizziness?
  • Does anything make it worse or make it better?
  • Does it feel like you are moving when you are not, or that the room is moving?
  • Do you notice that it occurs only when you move or look in certain directions?
  • Does it seem like things in your peripheral vision move or flutter?
  • Have you been sick recently, for example with the flu, or have allergies?
  • Have you been dehydrated?
  • Do you experience tinnitus?
  • Have you fallen or fainted as a result of your dizziness?
  • Does your dizziness cause you to feel nauseated or vomit?
  • Do you notice problems with your eyes or vision?

Dizziness is common in MS. Effective management can improve quality of life. Please talk to your doctor if you notice new or ongoing problems with dizziness, lightheadedness, vertigo, or impaired balance.

See more helpful articles:

MS Signs & Symptoms: What is Nystagmus?

Vertigo and Eye Movements in Multiple Sclerosis

Building Your Best MS Health Care Team

Sources:

Edlow JA, Newman-Toker DE. Medical and Nonstroke Neurologic Causes of Acute, Continuous Vestibular Symptoms. Neurol Clin. 2015;33(3):699-716, xi. doi: 10.1016/j.ncl.2015.04.002.

Karatas M. Central vertigo and dizziness: epidemiology, differential diagnosis, and common causes. Neurologist. 2008;14(6):355-364. doi: 10.1097/NRL.0b013e31817533a3.

Marrie RA, Cutter GR, Tyry T. Substantial burden of dizziness in multiple sclerosis. Mult Scler Relat Disord. 2013;2(1):21-28. doi: 10.1016/j.msard.2012.08.004. Epub 2012 Sep 25.

Peyvandi A, Naghibzadeh B, Ahmady-Roozbahany N. Neuro-otologic manifestations of multiple sclerosis. Arch Iran Med. 2010;13(3):188-192.

Thurtell MJ, Brinkley JJ. Treatment of Nystagmus and Saccadic Oscillations. June 23, 2013; Available from EyeRounds.org/tutorials/Nystagmus/

Zeigelboim BS, Arruda WO, Mangabeira-Albernaz PL, et al. Vestibular findings in relapsing, remitting multiple sclerosis: a study of thirty patients. Int Tinnitus J. 2008;14(2):139-145.

Zeigelboim B, Liberalesso P, Jurkiewicz A, et al. Clinical benefits to vestibular rehabilitation in multiple sclerosis. Report of 4 cases. Int Tinnitus J. 2010;16(1):60-65.