Post-COVID dizziness, experienced as lightheadedness, unsteadiness, or vertigo (a spinning sensation), is a common and persistent symptom following acute infection. This lingering effect is frequently grouped under the umbrella of Long COVID, or Post-Acute Sequelae of COVID-19 (PASC). Understanding the underlying causes and implementing targeted strategies can provide an effective path toward management and recovery. This guide outlines the different mechanisms behind post-COVID dizziness and the actionable steps for treatment.
Understanding the Mechanisms of Post-COVID Dizziness
The persistence of dizziness after the initial illness is primarily due to the virus’s effect on several interconnected body systems. One major cause is dysfunction in the vestibular system, the balance mechanism located in the inner ear. The virus may trigger inflammation or an autoimmune response that damages the vestibular nerve or inner ear structures, leading to conditions like vestibular neuritis or Benign Paroxysmal Positional Vertigo (BPPV).
Another common mechanism involves the autonomic nervous system (ANS), the body’s involuntary control center for functions like heart rate and blood pressure. This post-viral dysautonomia often presents as Postural Orthostatic Tachycardia Syndrome (POTS). In POTS, changing from a lying or sitting position to standing causes the heart rate to increase excessively, resulting in lightheadedness due to the failure to properly regulate blood flow to the brain.
The neurological system can also be affected by direct viral action or generalized neuroinflammation. This disruption of central balance processing in the brain can trigger or worsen conditions like vestibular migraine. Understanding which system is primarily involved is paramount, as the specific treatment approach depends entirely on the correct diagnosis.
Immediate Self-Management and Lifestyle Adjustments
Simple adjustments to daily habits can significantly mitigate post-COVID dizziness, especially for those experiencing orthostatic intolerance. Aggressively increasing fluid intake to two to three liters of water daily, along with a high intake of salt (around three to five grams), helps expand blood volume, which is often low in POTS patients. This high-salt approach should be discussed with a healthcare provider, particularly if other health conditions are present.
Pacing activities and avoiding quick changes in posture are beneficial for preventing symptom flares. When moving from lying down to standing, sit on the edge of the bed for a moment, then stand up slowly to give the body time to adjust blood pressure. If sudden lightheadedness occurs while standing, performing counter-maneuvers, such as tensing the leg and abdominal muscles or crossing the legs, can help push blood back toward the brain.
Adjusting the home environment can reduce the risk of falls and decrease anxiety related to unsteadiness. This includes ensuring adequate lighting, especially at night, and removing trip hazards like loose rugs or electrical cords. For people with lightheadedness upon standing, wearing waist-high compression garments (20–30 mmHg pressure) can prevent blood from pooling in the lower extremities. Dietary modifications, such as eating smaller, more frequent meals rich in whole grains and lean protein, help stabilize blood sugar, preventing drops that can worsen dizziness.
Specific Medical and Rehabilitation Therapies
Professional treatment often begins with Vestibular Rehabilitation Therapy (VRT), a specialized form of physical therapy designed to retrain the brain to process balance signals correctly. For cases of BPPV, which involves dislodged calcium crystals in the inner ear, a physical therapist performs a Canalith Repositioning Procedure, most commonly the Epley maneuver. This series of precise head movements guides the crystals back into their proper location, often providing immediate relief.
If the issue is vestibular hypofunction (where one inner ear is damaged), VRT focuses on adaptation and habituation exercises. Gaze stabilization exercises involve rapidly moving the head while focusing on a stationary target, helping the brain adapt to faulty inner ear signals. Habituation exercises involve repeated, controlled exposure to movements that provoke dizziness, gradually training the brain to ignore the abnormal input and reduce the symptom response.
For dizziness related to Postural Orthostatic Tachycardia Syndrome, pharmacological intervention is often necessary alongside lifestyle changes. Medications like beta-blockers (e.g., propranolol or metoprolol) can be prescribed to slow the heart rate and reduce palpitations. Other medications include fludrocortisone, which helps the body retain salt and water to increase blood volume, and midodrine, which constricts blood vessels to improve blood pressure regulation when standing. Pyridostigmine may also be used to help rebalance the autonomic nervous system.
Recognizing When Specialist Care is Needed
While many cases of post-COVID dizziness improve with self-management and physical therapy, certain symptoms require immediate evaluation by a medical professional. Any sudden, severe dizziness accompanied by specific neurological symptoms should be treated as an emergency. These red flags include:
- A severe headache unlike any experienced before.
- New weakness or numbness on one side of the body.
- Difficulty speaking or slurred speech.
- Double vision.
Specialist referral is warranted if the dizziness is accompanied by chest pain, shortness of breath, or fainting (syncope), as these symptoms may indicate a cardiac or circulatory issue. A persistent, worsening imbalance or vertigo that fails to improve after four to six weeks of consistent self-management and VRT suggests the need for further diagnostic testing. Specialists like a neurologist, cardiologist, or an otolaryngologist (ear, nose, and throat doctor) can help identify less common underlying issues or tailor a more aggressive treatment plan.