“Beta, kuch meetha kha lo, low BP hoga.”

If you’ve ever felt the room tilt, your head suddenly become light or your balance briefly disappear for a while, chances are someone in your family has said this to you.

It’s one of those explanations we grow up hearing. A spoon of sugar. A glass of salted water. Lie down for a while. You’ll be fine. And often, the feeling does pass. But here’s the question we rarely ask:

Was it actually low BP?

Low blood pressure can certainly cause dizziness or light-headedness, sometimes a Sinking sensation, blurring of vision or at best a blackout. But dizziness has many possible causes, and low blood pressure is only one of them.

A particular type of low blood pressure, called orthostatic hypotension, happens when blood pressure falls significantly after standing up and / or the brain gets devoid of blood. It can be assessed by checking blood pressure and heart rate while lying down and again after standing.

However, the ideal process is to measure blood pressure with a proper blood pressure instrument by a professional person after lying 30 minutes in supine posture then on sudden standing up, and again after 3, 6 and 10 minutes of standing. If the systolic blood pressure falls by 20mm of Hg or more or if the diastolic blood pressure falls by 10mm of Hg or more, you are having orthostatic hypotension. Orthostatic hypotension is often the adverse effect of some medicines but may be due to other diseases also

The oft-used explanation of ‘low-BP’ is a matter of habit rather than any plausible diagnosis. In my four decades of working in Neurotology and vertigo care, I encounter this pretty frequently. Low BP is often made the scapegoat in patients of vertigo/ dizziness, but as the disease remains undiagnosed, it keeps on repeating over and over again.

Dizziness, vertigo (head spinning) and unsteadiness are symptoms, not diagnoses. They can arise from several different conditions involving the inner ear, the brain, the spine, the eyes, from nerves and certain sensors in the legs, from medicines, from anaemia, from metabolic disorders and even from cardiovascular diseases. In fact, it may also arise from some types of psychic ailments also. To treat the above-mentioned symptoms, the underlying disease causing the dizziness, vertigo or unsteadiness needs to be known with certainty.

Sometimes the cause is relatively simple and completely curable. Benign Paroxysmal Positional Vertigo (BPPV), for example, is a common balance disorder in which certain movements of the head trigger very brief spells of head spinning. It can often be treated with a simple physical procedures called ‘particle repositioning manoeuvres’.

But the important point is this:

You cannot know the cause simply by how the symptom feels like

That is why recurrent episodes of head spinning or long continued dizziness and / or unsteadiness deserve attention.

If you keep feeling dizzy when you get out of bed, turn your head, walk, look up or move suddenly, don’t automatically blame “low BP” or on the other common scapegoat ‘cervical spondylosis’. Though low blood pressure can sometimes make a person feel dizzy, yet cervical spondylosis is one of the rarest causes of head spinning or for that matter any of the other vestibular symptoms.

And if you are having recurrent episodes of spinning, unsteadiness, or a fear of falling, don’t keep treating each episode as an isolated event. There must be something wrong in the balance system more often in the ears or in the brain or in the spinal cord. This needs to be identified and treated

What is actually causing this?

A proper evaluation of dizziness may involve a very detailed history, a thorough clinical examination and, where required, specialised testing of the balance and hearing systems; sometimes some imaging studies too are required. These are all very time-consuming effort-driven and often costly processes and there are no short-cuts to it.

The goal is not simply to stop the sensation for a few hours. The goal is to find the reason why is it happening.

At the Institute of Neurotology & Centre of Excellence for Vertigo & Balance Disorders at Pacific OneHealth, Hospital, Lajpat Nagar, New Delhi, our approach remains the same even after four decades of medical practice on vertigo and balance disorders. Balance disorders can be of sinister origin, and they are not to be shoved under the carpet, or suppressed temporarily by some symptom relieving drugs or the so called ‘anti-vertigo’ drugs. It is not to be taken as a passing phase or an old age problem, or as generalised weakness. The dictum in neurotological practice is –Do not guess the cause of dizziness. Find it, establish the diagnosis of the underlying disease  and correct it.

And the right diagnosis can be the beginning of getting your balance—and the first step to getting your confidence and independence back.

(The author is Dr Anirban Biswas, Principal Director – Institute of Neurotology & Centre of Excellence for Vertigo & Balance Disorders, Pacific OneHealth, New Delhi.)