Dizziness: Heavy Head and Light Feet Symptoms Explained

Dizziness characterized by a heavy head and light feet?

Hello Dr.
Jiang,
I've been experiencing dizziness for the past two mornings upon waking up.
It's a sensation of feeling heavy-headed and light-footed, with the dizziness being most severe when standing, somewhat less when sitting, and completely absent when lying down.
I start feeling dizzy after getting out of bed (around 7:30 AM), but it improves significantly after breakfast (around 8:30 AM).
After lunch (around 3:00 PM), I didn't eat anything else, and by around 6:00 PM, I felt dizzy again.

I've had episodes of dizziness throughout my life, but I fainted once in early September of the year before last.
When I went to the hospital, the doctor mentioned it seemed like vasovagal syncope and suggested I undergo a tilt table test.
However, I didn't do it at that time because I had to attend classes in another city.
I've had more dizziness since then, and as the doctor advised, lying flat for about half an hour usually helps.
However, this is the first time I've felt dizzy immediately upon waking up.
A few days ago, I also felt a bit of soreness at the back of my head.

There is a history of diabetes in my family.
Could you please advise me on what might be the issue? Should I see a neurologist again like last time? Thank you, doctor.

Cheng, 20~29 year old female. Ask Date: 2021/06/17

Dr. Jiang Junyi reply Neurology

Hello Ms.
Cheng,
Based on your description, the first consideration for your symptoms is mild heat syncope associated with heat-related illnesses.
The primary cause is vasodilation of the skin microvasculature in high-temperature outdoor environments, leading to blood pooling in the lower body and a subsequent decrease in cerebral blood flow.
This can result in symptoms such as dizziness and weakness in the limbs when transitioning from a lying to a standing position or when standing up suddenly after squatting, which can cause hypotension.
Typically, resting in a cool place and lying down, along with replenishing vitamins, fluids, and electrolytes, can help alleviate symptoms.
I would like to know if you have been supplementing with electrolytes, as hyponatremia can also present with similar symptoms.
Mild hyponatremia may go unnoticed or only cause nausea and general weakness, while persistent sodium deficiency can lead to headaches and lethargy.
I recommend developing a habit of adequately hydrating and replenishing electrolytes.
Pay attention to whether your urine output has decreased or if the color has darkened.
Regarding excessive vagal stimulation, this can lead to bradycardia and decreased cardiac output, often related to emotional factors.

Additionally, consider the possibility of cardiogenic syncope, which may involve arrhythmias, valvular heart disease, cardiac myxomas, acute myocardial infarction, or coronary artery spasm leading to arrhythmias and hypotension.
I suggest you consult with a neurologist and a cardiologist for further evaluation and follow-up.
However, due to the recent surge in COVID-19 cases, it is advisable to wait until the situation stabilizes before visiting the hospital for examinations.
Please ensure to practice self-protection, maintain cleanliness and disinfection, and adhere to preventive measures before and after seeking medical care.
Thank you for your inquiry, and feel free to discuss any related questions further!
Wishing you good health and safety,
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2021/06/17

More Info

Dizziness, particularly the sensation of a "heavy head and light feet," can be a perplexing symptom that may arise from various underlying causes. Based on your description, it appears that your dizziness is most pronounced when standing, less so when sitting, and absent when lying down. This pattern suggests that your symptoms may be related to postural changes, which can be indicative of several conditions.

One potential explanation for your symptoms is orthostatic hypotension, a condition where blood pressure drops significantly upon standing. This can lead to dizziness or lightheadedness, particularly after prolonged periods of lying down. When you stand up, gravity causes blood to pool in your legs, and if your body does not compensate quickly enough by increasing your heart rate or constricting blood vessels, you may experience dizziness. Given your family history of diabetes, it is also worth considering that fluctuations in blood sugar levels could contribute to your symptoms, especially if you have not eaten for an extended period.

Another possibility is vestibular dysfunction, which affects the inner ear and balance. Conditions such as benign paroxysmal positional vertigo (BPPV) or vestibular neuritis can cause dizziness that may be exacerbated by changes in position. However, your symptoms seem to improve after eating, which may suggest that they are more related to blood flow and pressure regulation rather than inner ear issues.

The fact that you have experienced dizziness since childhood and had a fainting episode in the past, which was attributed to vasovagal syncope, adds another layer of complexity. Vasovagal syncope can occur in response to triggers such as stress, pain, or prolonged standing, leading to a temporary drop in heart rate and blood pressure, resulting in dizziness or fainting.

Given your symptoms and history, it would be prudent to consult a healthcare professional, particularly a neurologist or a cardiologist, to further evaluate your condition. They may recommend tests such as blood pressure monitoring in different positions, blood tests to check for glucose levels, and possibly a tilt table test to assess how your body responds to changes in posture.

In the meantime, here are some strategies that may help alleviate your symptoms:
1. Hydration: Ensure you are well-hydrated, as dehydration can exacerbate dizziness.

2. Diet: Eating regular meals and snacks can help maintain stable blood sugar levels, which may prevent dizziness related to low blood sugar.

3. Slow Movements: When transitioning from lying down to sitting or standing, do so slowly to allow your body time to adjust.

4. Physical Activity: Engaging in regular physical activity can improve circulation and help your body adapt to changes in posture more effectively.

In summary, while your symptoms could be related to several factors, including orthostatic hypotension, vestibular issues, or even dietary influences, a thorough evaluation by a medical professional is essential to determine the underlying cause and appropriate treatment. Your history of dizziness and fainting warrants a careful assessment to ensure that any potential issues are addressed promptly.

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