Hello friends,
This is a problem I have suffered with most of my life as I lost the hearing in my left ear at age 5, causing my equilibrium to be off. But 7 years ago it became decidedly worse with the onset of fibromyalgia, clinical MS and my chronic migraines. My husband and i tended to joke about it but it became dangerous at times especially if on the stairs.
In fibromyalgia, dizziness, poor balance, and falls are common complaints. For some people, these can be a minor annoyance that pops up on occasion. In others, they can be severely debilitating and lead to regular injuries.
Falling, and especially falling frequently, is a serious problem. The last thing you need when you're already in constant pain is to hurt yourself all the time. Frequent falls or balance problems can also lead to a fear of falling.
That fear can, in turn, can make you afraid to remain active, even within your limits.
Falling is less a symptom and more a consequence of the symptoms of dizziness and poor balance. With this condition, falls and balance problems may also be related to changes in how we walk.
So why does fibromyalgia include these problems? And what can we do about them?
Fibromyalgia & Dizziness
In fibromyalgia, dizziness most often comes on when you first stand up. It's similar to the feeling of a "head rush" from when you stand up too quickly, only it can happen any time you go from lying down or sitting to standing up. The sudden onset of dizziness can make you sway on your feet, stagger, or it may even make you fall or faint.
Dizziness and fainting in this condition may be tied to a particular subgroup, according to a 2017 study published in the European Journal of Pain.
In addition to dizziness and fainting, this subgroup also had the highest pain levels as well as a variety of symptoms and overlapping conditions including cognitive dysfunction ("fibro fog"), irritable bladder, vulvodynia, and restless legs syndrome.
Research suggests that this symptom stems from dysfunction of the autonomic nervous system (ANS), which is called dysautonomia.
The ANS is involved with a lot of critical functions in your body, including heart rate, blood pressure, respiratory rate, body temperature, metabolism, and digestion.
Dizziness resulting from dysautonomia can be called orthostatic intolerance, neurally mediated hypotension, or postural orthostatic tachycardia syndrome (POTS). Essentially, these things mean that the heart and the brain aren't communicating properly with each other.
What should happen is that when you stand up from a lying or sitting position, the ANS increases your blood pressure in order to fight gravity and keep a sufficient supply of blood in your brain. With dysautonomia, this doesn't happen like it should. Instead, the blood pressure can actually drop when you stand, and the result is dizziness or lightheadedness. In POTS, the heart rate speeds up as blood pressure drops.
Dizziness may be associated with heart palpitations, blurred vision, increased pulse rate, chest pain, and a type of fainting called vasovagal syncope.
Not everyone with fibromyalgia-related dizziness faints, though. In a 2008 study, researchers say dizziness and palpitations were more common than fainting. They also say POTS was one of the most common fibromyalgia symptoms they observed during tilt-table tests, which measure your response to changes in position.
Alleviating Dizziness & Fall Risk in Fibromyalgia
The more successful you are at treating your fibromyalgia, the less these symptoms should be a problem. However, if they need more attention or you've been unable to find effective fibromyalgia treatments, you have several options.
For dizziness from POTS, orthostatic hypotension, or neurally mediated hypotension, your doctor may be able to recommend medications that help. These can include:
- SSRI/SNRIs
- benzodiazepines
- beta blockers
Some of these drugs may help alleviate other fibromyalgia symptoms, as well—SSRIs and SNRIs are commonly prescribed for this illness. Your doctor may also recommend lifestyle changes.
If you smoke, research published in the rheumatologic journal Joint, Bone, Spine suggests that quitting may help alleviate fainting and several other symptoms of fibromyalgia.
When it comes to balance and gait, physical therapy is a common treatment. You might also want to ask your doctor whether something like yoga, tai chi, aquasize is safe for you.
Until you find ways to improve these symptoms, it pays to be careful. Assistive devices such as a cane or walker may help keep you on your feet. Seated exercises may be the safest option, and they're certainly a better choice than being less active than you can be.
Hugs,
