Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal pain, profound fatigue, and cognitive difficulties often called “fibro fog.” Patients frequently report sensations related to balance, which can be broadly grouped as dizziness or true vertigo. Dizziness describes unsteadiness, lightheadedness, or a feeling of near-fainting. True vertigo is the distinct, false sensation that you or your surroundings are spinning or moving. The balance issues experienced by people with fibromyalgia are typically chronic, non-spinning dizziness or a feeling of being off-balance.
The Direct Link: Dizziness as a Symptom of Fibromyalgia
Dizziness and imbalance are highly reported symptoms in the fibromyalgia (FM) population, indicating a strong association with the disorder. Research consistently shows that these balance problems affect a large number of FM patients. Studies suggest that between 60% and 70% of individuals diagnosed with fibromyalgia experience dizziness or unsteadiness.
This prevalence rate is significantly higher than in the general population, establishing a clear link between the condition and balance dysfunction. The symptom is often chronic, increasing daily disability and the risk of falls. This frequent complaint is a recognized component of the fibromyalgia syndrome, not merely a side effect of pain or fatigue.
Underlying Mechanisms Causing Dizziness
The physiological basis for dizziness in fibromyalgia is complex, rooted primarily in the central nervous system’s altered processing of sensory information.
Central Sensitization
One main driver is central sensitization, where the brain and spinal cord become hypersensitive to incoming signals, including those related to balance. This heightened responsiveness amplifies sensory input, leading to an exaggerated perception of unsteadiness. This mechanism causes a sense of disorientation or internal movement that does not match external reality.
Autonomic Nervous System Dysfunction
Another significant factor is autonomic nervous system dysfunction, also known as dysautonomia, which is common in fibromyalgia. This system regulates involuntary body functions, including heart rate and blood pressure. Dysregulation can result in orthostatic intolerance, where blood pressure is poorly maintained when changing positions, such as standing up quickly. This temporary drop in blood flow to the brain causes the lightheadedness, faintness, or “pre-syncope” feeling many FM patients describe.
Cervical Spine Involvement
Cervical spine involvement also contributes to balance issues due to chronic muscle tension and stiffness in the neck and shoulder area. The neck contains sensory receptors that send proprioceptive signals—information about the body’s position in space—to the brain. Chronic pain and stiffness in the upper cervical region can distort these signals, providing faulty information about head position. This conflict between visual, inner ear, and neck-based balance information leads to unsteadiness or disequilibrium.
Differentiating Fibromyalgia-Related Dizziness from Other Conditions
Dizziness in a fibromyalgia patient can stem from the disorder itself, but it must be distinguished from other treatable conditions that often co-occur.
Vestibular Migraine
Vestibular migraine is a frequent co-morbidity with fibromyalgia. It causes episodic vertigo that can last from minutes to several hours. Unlike a classic migraine, an episode may occur without a headache, but is often accompanied by sensitivity to light or sound.
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV must be ruled out because its treatment is highly specific. BPPV causes brief, intense spinning vertigo triggered by specific head movements, such as rolling over in bed or looking up. The spinning sensation typically lasts for only seconds to a minute, which contrasts sharply with the chronic unsteadiness of fibromyalgia-related dizziness.
Medication Side Effects
Medication side effects are a common culprit for dizziness in FM patients, who often take multiple pharmaceuticals. Drugs like pregabalin (Lyrica) and duloxetine (Cymbalta), commonly prescribed for fibromyalgia, list dizziness as a potential side effect. Medication-induced dizziness may present as general drowsiness or unsteadiness and is often dose-dependent.
Management and Treatment Approaches
Managing dizziness requires a multi-faceted approach that addresses the unique mechanisms associated with fibromyalgia.
Vestibular Rehabilitation
Physical therapy, specifically vestibular rehabilitation (VR), is a highly beneficial non-pharmaceutical intervention. VR involves customized exercises designed to retrain the brain to process balance information more effectively. These exercises often include gaze stabilization and habituation techniques, helping the brain adapt to conflicting sensory inputs and improve stability and balance confidence.
Lifestyle Adjustments
Simple lifestyle adjustments can significantly mitigate dysautonomia-related lightheadedness. Due to poor blood pressure regulation, standing up slowly from a sitting or lying position is recommended to allow the body time to adjust blood flow. Maintaining adequate hydration and increasing salt intake, under medical guidance, may also help increase blood volume and reduce lightheaded episodes.
Treating Comorbidities
Reducing the impact of comorbidities and other contributing factors can also alleviate dizziness. Treating underlying conditions like severe neck pain or frequent migraines often results in improved balance symptoms. Focusing on good sleep hygiene, stress management, and low-impact exercise helps stabilize the nervous system, reducing the hyper-responsivity that contributes to chronic dizziness.