menu Contact Us Dizzy Patients Health Care Providers Dizzy Culture Research Site DVD BPPV DVD Tai Chi DVD Understanding Dizziness Acknowledgements Disclaimer Quoting

Epidemiology of Dizziness

Timothy C. Hain, MD Page last modified: January 4, 2014

Relatively little is known about the precise incidence and prevalence of dizziness in the general population. It is generally accepted to be common, although not so common as diabetes or heart disease, and to increase with age. To deal with it rationally, one must break dizziness down into categories:

Even with a breakdown, coming to a reasonable conclusion is very difficult due to differences in populations being studied, differences in definition, and problems with study technique, and variability according to age. On this page, we attempt a synthesis of a large amount of data.

Our bottom line is --

If more data becomes available, these estimates may change of course, but this is likely a reasonable estimate. The main source of error would seem to us to be that there might be an overestimate of otologic dizziness, and consequently an underestimate of medical or undiagosed. These numbers are not at all appropriate for extremes of age -- young or old.

Overall -- the proportion of the entire population that is dizzy.

A different question is -- what is the one year prevalence of dizziness ? Here we define "dizziness" as the sum of vertigo, imbalance and faintness. Considerably more data is available on the elderly, where there have been some large studies. Roughly, there seems to be about 10% of elderly with vertigo, 20% with imbalance, and about 10% with faintness. Younger people have little to no imbalance, and moderately less vertigo -- with 6-8% of children having vertigo being a reasonable estimate. As a rough estimate, the figure from Wiltink of 15% prevalence of dizziness in middle aged adults seems reasonably likely to be correct. The outliers are largely on the bigger side.

Measure Percentage Reference
Vertigo health insurance claims in Taiwan 3.13% Lai, Y. T., T. C. Wang, et al. (2011).
Dizziness in children in UK 5.7% Humphriss, R. L. and A. J. Hall (2011).
Cross sectional study of dizziness in 2547 persons 21% Mendel, B., J. Bergenius, et al. (2010).
Survey of 1287 persons (Germany) 15.8% Wiltink, J., R. Tschan, et al. (2009)
Cross section of 17,638 adults in Sweden with dizziness or faintness 28.7% Tamber, A. L. and D. Bruusgaard (2009).
Cross section of 2751 persons in Australia 36.2% Gopinath, B., C. M. McMahon, et al. (2009).
1801 elderly in germany over age of 65 29% Gassmann, K. G. and R. Rupprecht (2009).
2925 elderly in UK over the age of 65, dizziness 11.1% Stevens, K. N., I. A. Lang, et al. (2008).
2925 elderly in UK over the age of 65, imbalance 21.5% Stevens, K. N., I. A. Lang, et al. (2008).
Cross section of 4869 adults in Germany 22.9% Neuhauser, H. K., A. Radtke, et al. (2008).
938 children in Finland with vertigo 8% Niemensivu, R., I. Pyykko, et al. (2006).
2011 persons over age of 70 in Sweden, dizziness or imbalance 36% Jonsson, R., E. Sixt, et al. (2004).
Young adults, metanalysis 1.8% Sloane, P. D., R. R. Coeytaux, et al. (2001).
Elderly, metanalysis 30% Sloane, P. D., R. R. Coeytaux, et al. (2001).
Persons 65 or older, 6158 studied 9.6% Aggarwal, N. T., D. A. Bennett, et al. (2000).
Cross sectional study of adults, dizziness defined as imbalance 35.4% Agrawal, Carey, Della Santina, Schubert and Minor (2009)

A less precise method of measuring it is to just look at how many patients present to medical clinics. Dizziness is the primary complaint in 2.5% all primary care visits = 8 million/year visits (Sloane, 1989).

Another rough estimate of the overall impact of dizziness can be obtained from survey studies. The NHIS (US national health interviews survey) provided data. About 300,000 persons were affected in the United states over 1986-1988 per year with dizziness and vertigo. About 26% of them were unable to work, accounting for an economic impact of about 75,000 persons per year unable to work due to dizziness and vertigo. If we assume that this causes $30,000 of economic damage each year per person, this means that dizziness/vertigo costs the nation roughly 2.25 billion $ each year. Given that there are about 300 million people in the US, this means that roughly 1 in 1000 people in the US was disabled due to dizziness each year. This is only 0.1%.

Proportions of patients in each category: There are substantial otologic, neurological, general medical, and psychiatric/undiagnosed causes of vertigo (see below).

The proportion of patients in each category is known to some extent, from clinics that have reported differential diagnosis.

TABLE 1: DIAGNOSES IN DIZZY PATIENTS.

 

ER1

Otology2

Dizzy Clinic4

Neuro-Otology3

Otologic (%)

24.0

41.4

64.7

34

Neurological

1.7

4.8

8.1

23

Medical

32.0

1.8

0

5

Psychogenic

 

21.1

9.0

 

Unknown or Unlocalized

42.3 (both)

18.9

5.5, 40%5

13.3

21

number studied

121

2222

812

102

Table 1 summarizes the results of several studies of diagnoses obtained in dizzy patients according to the setting where the patients were seen, and shows that dizziness is multifactorial. No specialty, be it otology, neurology, internal medicine or psychiatry, has a clear preponderance of dizzy patients.

Much more about dizziness in the ED can be found here.

OTOLOGIC

According to Neuhauser and others (2005), vestibular vertigo is common in the general population, affecting more than 5% of adults in 1 year. The frequency and health care impact of vestibular symptoms at the population level have been underestimated. We agree with this assessment.

TABLE 2: CAUSES OF OTOLOGIC DIZZINESS

Measure Percentage Reference
Cross sectional study of dizziness in 2547 persons 10.5% of population Mendel, B., J. Bergenius, et al. (2010).
Meniere's disease 0.19% population Harris, J. P. and T. H. Alexander (2010).
"Vestibular vertigo" in 2751 Australians 10% Gopinath, B., C. M. McMahon, et al. (2009).
"Vestibular vertigo" in 4869 adult Germans 4.9% Neuhauser, H. K., A. Radtke, et al. (2008).
BPPV in 4869 adult Germans 1.5% one year prev. von Brevern, M., A. Radtke, et al. (2007).
BPPV in ENT clinic in Japan 23-41% of dizzy Uno, A., M. Nagai, et al. (2001).
Vestibular, not BPPV in ENT clinic in Japan 22% Uno, A., M. Nagai, et al. (2001).
BPPV in "elderly" 9% Oghalai, J. S., S. Manolidis, et al. (2000).
Metaanalysis of 12 articles, peripheral cause 44% of dizzy patients Kroenke, K., R. M. Hoffman, et al. (2000).
Dizziness in Scottish children 15% Russell, G. and I. Abu-Arafeh (1999).

Otologic vertigo estimates vary widely.The two largest studies are those of Mendel et al (2010) and Neuhauser et al (2008), which suggested percentage of the population varying between 4.9% and 10.5%. If we accept the estimate that 15% of the population has dizziness of any cause, this would suggest somewhere between 1/3 and 2/3 of all dizzy patients have inner ear problems.

Many studies have documented that BPPV accounts for only a small fraction of all dizziness. Nedzelski, in a primarily ENG setting, et al reported BPPV to compose 17.1% of their patients (1986). This is a reasonable estimate for most "dizzy" practices.

 

NEUROLOGICAL DIZZINESS

Table 3: CAUSES OF NEUROLOGICAL DIZZINESS

Measure Percentage Reference
MAV in midlife women 5% Hsu, L. C., S. J. Wang, et al. (2011).
Migraine vertigo in 4869 Germans 0.89 % 1 year Neuhauser, H. K., A. Radtke, et al. (2006).
Metaanalysis of 12 articles, central cause 11% of dizzy patients Kroenke, K., R. M. Hoffman, et al. (2000).
Metanalysis of 12 articles, stroke 6% of dizzy Kroenke, K., R. M. Hoffman, et al. (2000).
Metanalysis of 12 articles, Brain tumor 1% of dizzy Kroenke, K., R. M. Hoffman, et al. (2000).
117 elderly veterans in Neurology clinic, brainstem 22% of dizziness Davis, L. E. (1994).

Neurological dizziness is loosely defined here as a group of conditions causing dizziness that are usually diagnosed and treated by neurologists. In addition to dizziness associated with dysfunction of the central nervous system, it also includes dizziness or ataxia caused by sensory neuropathy and visual dysfunction.

Kroenke et al (2000) suggested that 11% of dizzy patients had central vertigo. The "600 pound gorilla" of central dizziness is Migraine. Roughly 1% of the population has migraine associated vertigo. If we accept the 15% overall prevalence of dizziness above, 1/15 is 6.6%, and 6.6/11.1 is roughly 50%. Thus migraine should reasonably cause roughly half of all central dizziness. There are huge age and gender effects as migraine is mainly a disorder of middle aged women, and fades with age. Women have far more migraine than men.

The incidence of neurological dizziness in the emergency setting is very low. The incidence in the primary care setting is unknown, but probably also low. Only neurologists report a substantial proportion of dizzy patients with neurological dizziness, and even in this setting, "neurological" diagnoses account for only about 1/3 of their cases (Drachman and Hart, 1972; Macrae, 1960).

Vertigo in the neurology setting is dominated by vascular causes, combined with a larger number of rarer miscellaneous causes. A variety of miscellaneous causes of dizziness make up the remainder. Vertigo attributed to "miscellaneous", includes disorders of CSF drainage, multiple sclerosis, the Chiari malformation, cervical vertigo, and conditions accompanied by central positional nystagmus or tremor.

MEDICAL DIZZINESS

Table 4: CAUSES OF "MEDICAL" DIZZINESS

Measure Percentage Reference
Orthostatic dizziness in Germany 10.9 (12 month) Radtke, A., T. Lempert, et al. (2011).
Cross-sectional study of elderly in Netherlands, all dizzy 8.3% Maarsingh, O. R., J. Dros, et al. (2010B)
Cross-sectional study of elderly in Netherlands, cardiovascular 57% of dizzy Maarsingh, O. R., J. Dros, et al. (2010A)
Dizzy clinic in Japan 19% of dizzy Uno, A., M. Nagai, et al. (2001).
Cardiac Arrythmia 1.5% of dizzy Kroenke, K., R. M. Hoffman, et al. (2000).

The main cause of "medical" dizziness is low blood pressure, which is very common, but often called something other than dizzy such as "light headed", or "presyncope". Here the reported data varies hugely. The statistic of 10.9% of the population seems unduly high to us, considering our choice of 15% of the entire population having dizziness overall.

General medical diagnoses are assigned to about 33% of cases of dizziness seen in the emergency setting. These include disorders which alter blood pressure, blood sugar, or which are attributed to an infection or medication. In the primary care setting, medical causes account for a similar fraction of diagnoses. Hypertension, disturbances of blood glucose, and coronary atherosclerosis are the most common diagnoses (Sloane 1989). General medical diagnoses are very unusual in specialty settings, associated with only 2% of diagnoses in the otology setting and 5% in the neurotology setting.

UNLOCALIZED DIZZINESS

Measure Percentage Reference
Cross-sectional study of elderly in Netherlands, unknown 39% of all dizzy Maarsingh, O. R., J. Dros, et al. (2010B)
Vertiginous patients in ENT clinic 26.1% Isaradisaikul, S., N. Navacharoen, et al. (2010).
Epidemiological study of 2169 patients with vertigo (Japan) 26.8% of all dizzy Yin, M., K. Ishikawa, et al. (2009).
Patients referred to neurotology clinic with normal examination 10.6% Odman, M. and R. Maire (2008).
"Phobic postural vertigo" in outpatient dizziness unit 22-26% of all dizzy Strupp, M., M. Glaser, et al. (2003).
Metaanalysis of 12 articles, psychiatric cause 16% of dizzy patients Kroenke, K., R. M. Hoffman, et al. (2000).
Metanalysis of 12 articles, unknown cause 13% of dizzy Kroenke, K., R. M. Hoffman, et al. (2000).

It is very clear that unlocalized dizziness is extremely common. We think it is best to "lump" dizziness attributed to psychiatric origin with undiagnosed dizziness. With this in mind, it appears that the median for the studies above is roughly 26%. We will use 25% as it is a more convenient number.

Unlocalized vertigo includes patients whose symptoms are attributed to a patients whose vertigo is attributed to an event without further definition (such as head trauma) and patients with vertigo and dizziness of unclear origin. Common variants of unlocalized variants include "hyperventilation syndrome", "post-traumatic vertigo," and "nonspecific" dizziness.

 

REFERENCES

Copyright October 6, 2013 , Timothy C. Hain, M.D. All rights reserved. Last saved on October 6, 2013