A lot of times, other healthcare providers ask me, “What is the difference between dizziness and dysequilibrium?” Although they are similar, there are a few differences.
The Difference Between Dizziness and Dysequilibrium?
“Dizziness” is a vague term commonly used by patients as a description of symptoms. Similar to a complaint of “pain,” the complaint of “dizziness” does not indicate anything clinically specific but warrants a detailed history and a thorough examination by a medical professional.
According to the Barany Society (a Sweden-based International society of vestibular experts), the difference between dizziness and dysequilibrium is that dizziness is defined as the “sensation of disturbed or impaired spatial orientation WITHOUT a false or distorted sense of motion.”
In most cases, patients with dizziness often complain of lightheadedness, a floaty feeling, or general fogginess in the brain.
Dizziness can be caused by many different problems, such as medication side effects, drug interactions especially with alcohol, medication errors, diabetes, blood pressure issues, nutritional deficiencies, anemia, dehydration, anxiety, panic attacks, irregular heart rate, etc.
Dizziness in the #1 complaint to physicians from patients over 75 years old in the US and is usually multi-factorial.
About 45 – 50% of cases of dizziness in older patients have an inner ear problem, or a vestibular component.
Vestibular problems are often unrecognized, especially in elderly individuals, and can lead to devastating falls, fear of falling and serious fall-related injuries. Ultimately, dizziness can result in a deterioration of quality of life.
Therefore, ALL OLDER ADULTS who are complaining of dizziness or vertigo, or having unexplained repeated falls, should be evaluated by a Vestibular Specialist to discover the ROOT CAUSE of their complaints.
The difference between dizziness and dysequilibrium is that dysequilibrium is a general feeling of being “off balance,” or being unable to remain upright and move through space with confidence. Most commonly, this occurs during standing or walking.
Dysequilibrium may also be described by patients as feeling “weak in the knees” or “my knees feel like they will buckle,” in the absence of quadriceps muscle weakness. The quadriceps muscle is on the front of the thigh.
People commonly interchange “imbalance,” “disequilibrium,” and “dysequilibrium.” Those are all three synonymous terms.
These are some of the key difference between dizziness and dysequilibrium. To learn more about dizziness, dysequilibrium and vertigo, please visit our sister site, BetterBalanceInLife.com.
This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.
I heard you on You
I heard you mention on You Tube that you have procedures involving bean bags to restore some feeling in feet. I have peripheral neuropathy in my feet but no pain and am 73.
Can you send information how to get access to foot procedures.
I am glad you saw my videos on YouTube!
The foot therapy exercise program can be found and purchased for home use here:
The online course includes instructional videos, handouts, audio files, and helpful tools like a trouble-shooting guide.
Let me know how it goes for you and if you have any more questions.
You can email me directly at firstname.lastname@example.org.
Kim Bell, DPT
My equilibrium imbalance was first noted 5-6 years ago. I’d had episodes of short duration maybe minutes or an hour where I seemed “off- balance”.
Then 2-3 years ago when playing with my granddaughter, I looked upside down and it triggered this feeling again only it lasted for several days. I saw an ENT , but eventually BPPV was r/o, and the symptoms just subsided.
Then a year later, June 2, 2019, I felt like I was off balance when I was on my feet and bending forward. Like when I needed to put a golf ball on a tee. However, this time it lasted 4 months, 24/7. I wasn’t able to get into see a neurologist until 4 months. He diagnosed it as vestibular migraine and prescribed 120mg verapamil. It seemed to work and the symptoms subsided.
Over the next 18 months I used the verapamil as needed, but it was very seldom.
In January of 2021 I was diagnosed with prostate cancer and in March given a medication for prostate cancer that I inject subcutaneously.
Within a week or so I had a recurrence of imbalance while standing and then it subsided for a couple months until I had another injection of my prostate medication on June 7.
Since that day, I’ve had equilibrium problems 24/7 and I’ve stayed on verapamil although dosage was changed to 40mg twice a day from 120mg daily.
I can’t understand why if this is a migraine it is continuous.
You are correct that a continuous migraine is very rare, except in people with chronic neck issues, poor posture, or poor ergonomics which continually trigger a daily migraine. The verapamil is to prevent the migraine episodes in your case.
Whenever you start a new medication, you should read the insert that comes with the prescription stating the common and rare side effects. I mention that since you had worse symptoms after both injections.
I suggest you look up your new injectable medication that you have been using for the prostate to see if imbalance is an expected side effect. You can also ask your pharmacist or search online. Whenever I start with a new patient, I look up all of their medications to determine if any of the symptoms might be a medication side effect.
You can discuss that further with your doctor, if you determine it is a concern. I did not research the medication you mentioned.
You may want to read my article on symptomatic BPPV, and get a second opinion from a vestibular physical therapist.
Since you were playing upside down when the feeling was triggered while playing with your granddaughter, you could even have the very rare subtype of anterior canal bppv which is often missed, and I discuss in this article.
You can use this article to find a vestibular physical therapist.
BPPV can cause imbalance 24/7 when you are on your feet. People with vestibular migraine are more likely to get recurrent BPPV than someone without vestibular migraine.
Also, other health problems like foot neuropathy can cause imbalance and disequilibrium, so you may want to see a podiatrist to have your feet checked out.
I would say there are many possible causes for your discomfort so I hope you can have a comprehensive physical exam by both a vestibular physical therapist and a podiatrist.
If you have neck pain, you may need to find a physical therapist who specializes in neck care. Neck alignment issues can cause imbalance also. You can search for one on this directory.
I hope that helps!
Kim Bell, DPT
After completing prostate radiation treatment, and prior, I’ve been on Lupron injections every 6 mo. without incident. About a month ago I started getting dizzy/light-headed spells. They’d last maybe a half a minute to a couple of minutes. Usually starts when I have quick eye movements, up or down. No issues in the morning when getting out of bed and moving around. My blood sugar at times is higher than it should be too, over 7.0 a1C. Could this be caused by high blood sugar in combination with the Lupron? Not sure what to think….. Thanks
I am not sure and would not be able to offer any medical advice unless I evaluated you in person.
It is important to notify your Primary provider and the doctor that prescribed the Lupron injections, in case these are medication side effects or drug interactions.
In addition to that, I suggest you find a vestibular provider to evaluate you using the directories I share in this blog.
Also, I suggest an evaluation by a Neuro-Optometrist you can find on the doctor locator at COVD.org.
Getting a thorough evaluation of both your inner ear and your eyes may help shed some light on the root cause for you.
Before you consult any more providers, I suggest you outline your situation by answering the questions I list in this blog. That should improve the efficiency of any future consultations.
I hope you feel better soon!
Kim Bell, DPT
I’ve have this bout of reoccuring lightheadedness (cannot concentrate and having a feeling of a fever or headache in front of my head but when I go to check my temperature its normal). I am NOT dizzy where I cannot stand up or walk but my head feels foggy and slightly lightheaded. This has been going off and on for over 2 years now. My neurologist did a brain scan and it came back normal. I went to an ENT and everything was normal. Seems like no doctors can figure out what I have. When I get it it can last for months and I can not have it for months. When I do have it, I would have to take like a 2 hr nap to feel better. I do not feel dizzy when standing from a sitting or lying position. My doctor thought I am having mild migranes and prescribed 400mg Magnesium and 100mg Vitaman B2 Riboflavin but that didnt seem to make any difference. What do you think? I am 64 yr old and am keeping my blood pressure under control.
Good thing your brain scan was normal! Good news, even though it leaves a mystery.
I have written this article and this article and this article on vestibular migraines.
This article and this article are on dizziness from the neck.
This article on the gut and vertigo.
The neck and the gut are common migraine triggers. Also, poor ergonomics or poor posture can trigger recurrent migraines.
I hope something I shared gives you an insight.
You can search for a more specialized vertigo doctor using this article.
The best way to present your case is using the Q&A format I share in this blog.
Hi Dr Kim
I have been suffering major dizziness for nearly 2 yrs. It happens for no apparent reason I don’t get headaches I just can’t walk without losing my balance and some days I can’t get off the chair. It usually lasts for about 3 to 4 days. Sometimes I can go months without an episode. Sometimes it’s every week. I had had a brain scan, all normal, ENT all normal and the neurologist has no idea either. I wish someone could tell me what it is.
I am sorry to hear all this, but it is good that all your tests and brain scan were normal.
If you have any change in your hearing during these episodes or a hissing sound in your ears, you should notify your neurologist as that can be helpful for the diagnosis.
Imbalance that lasts for days and then resolves may possibly be a vestibular migraine. That can cause imbalance and can occur without a headache.
Other symptoms of vesitublar migraine are described in this blog.
One key diagnostic feature of vestibular migraine is typically people feel one or more heightened senses during the episode that return to normal when the episode resolves:
Light sensitivity, sensitivity to loud sounds, or heightened sense of smell.
If you discover that vestibular migraine is the cause of your episodes, you may want to talk to your neurologist about medication management.
More obscure root causes include gut issues or neck issues, so one of those articles may ultimately be helpful.
If you want to present your case in a more clear and concise way to your current a future health care providers, I suggest you create a case summary using the questions I ask in this blog.