A head rush, or orthostatic hypotension, is caused by a sudden drop in blood pressure. This condition is more common in people over the age of 65 but can occur at any age. Orthostatic hypotension affects between 5 and 20 percent of the population.¹

Orthostatic hypotension can occur after eating or standing and can be with or without symptoms. The symptoms are usually temporary and include lightheadedness, dizziness, fainting, and muscle aches.

Most people have an occasional episode of dizziness when standing, especially if they have a viral infection, dehydration, or are on prolonged bed rest. If your symptoms are chronic or occur repeatedly, it may indicate another health problem, which should be investigated by your doctor.

Symptoms Of Chronic Dizziness

When you stand up suddenly, your body needs to compensate quickly for a sudden drop in blood pressure in the upper body.²

1. When you stand, gravity allows between 500 to 1,000 mL of blood to pool in your legs.
2. When this happens, not as much blood returns to your heart.
3. The amount of blood pumped from your heart and blood pressure both fall.
4. Your blood vessels constrict to maintain your blood pressure.

If your blood vessels do not constrict fast enough to maintain your blood pressure, it drops too much. For most people, standing causes a decrease in blood pressure of 5 to 10 mm Hg and an increase in their pulse by 10 to 25 beats per minute.

In people with orthostatic hypotension, systolic blood pressure drops at least 20 mm Hg (millimeters of mercury), and diastolic blood pressure drops at least 10 mm Hg. This is because their nervous system does not respond quickly enough. This can cause the symptoms, referred to as a head rush. However, it is a bit of a misnomer in that it is a decrease in blood flow to the head, not an increase that is causing symptoms.

The drop in blood pressure can cause the following symptoms due to decreased blood flow into the brain:

• Dizziness
• Lightheadedness
• Visual symptoms
• Fainting
• Weakness
• Sweating
• Neck and shoulder achiness
• Confusion

Orthostatic hypotension is more common in older adults. This is likely due to decreases baroreceptor sensitivity and slow compensation to changes in blood pressure.

Causes Of Chronic Dizziness

The most common cause of chronic dizziness with position changes is decreased baroreceptor sensitivity. This is most common in older adults, but can occur at any age.

Neurogenic Causes

Neurologic conditions can also cause chronic dizziness. Examples include:

• Parkinson’s disease
• Dementia with Lewy bodies
• Neuropathies associated with diabetes, vitamin B12 deficiency, toxins, and certain infections
• Familial dysautonomia
• Paraneoplastic syndrome

Decreased Blood Volume

A decrease in blood volume can decrease blood pressure and cause dizziness and lightheadedness. Common causes include:

• Dehydration
• Vomiting
• Diarrhea
• Bleeding
• Diuretic use

Drug-Induced

All drugs have side effects. Sometimes the beneficial effect of the medication can also cause side effects. For example, weight loss medications typically do not decrease blood pressure, but weight loss can. Some people may notice increased dizziness when standing, when dieting, or after weight loss.

Several drugs cause a decrease in blood pressure as a primary response or a side effect, including the following:³

• Oral ED medications: These medications are phosphodiesterase inhibitors. They cause blood vessel dilation to increase blood flow into the penis. Oral ED medications also cause widened blood vessels throughout the body and cause a decrease in blood pressure.
• Blood pressure medications: These medications intend to decrease blood pressure but can increase your risk of dizziness or lightheadedness when standing.
• Antidepressants: Most antidepressants can decrease blood pressure and your body’s response to falling blood pressure, especially tricyclic antidepressants.
• Dopaminergic and anticholinergics: These medications treat Parkinson’s disease and can cause dizziness and lightheadedness.

Other Causes Of Chronic Dizziness 

These conditions may coexist with orthostatic hypotension because they cause similar symptoms, have a similar physiologic cause, or are side effects of medications.

Postural Orthostatic Tachycardia Syndrome (POTS)

Postural orthostatic tachycardia (POTS) syndrome is like orthostatic hypotension in that changes in body position cause an increase in heart rate, which causes symptoms. The symptoms are almost identical to those associated with orthostatic hypotension, and the lifestyle management suggestions are as well. POTS is diagnosed when you have symptoms that occur when standing upright, but orthostatic hypotension and dehydration have been ruled out as a cause.

Diabetes 

Diabetes is a risk factor for orthostatic hypotension, which can cause dizziness. But dizziness and lightheadedness are not typically associated with type 2 diabetes.

Low blood sugar, or hypoglycemia, can also cause dizziness, sweating, and fainting. Symptomatic hypoglycemia is more common in type 1 diabetes but can be a medication side effect in type 2 diabetes.

When To Talk To Your Doctor About Chronic Dizziness

Chronic dizziness is a nonspecific symptom that may have multiple causes, some serious. If you have dizziness or lightheadedness, it could be a benign condition, or it may be an inner ear or heart problem.

If you have confusion or brain fog, it may be due to vitamin B12 deficiency or a neurologic condition.

If you faint or lose consciousness when standing, it may be due to an undiagnosed heart condition.

Isolated dizziness and lightheadedness when going from sitting to standing are common, but if your symptoms persist or get worse, talk with your doctor.

Treatment Options For Chronic Dizziness

If you have drops in your blood pressure when standing, slowly change position to give your body time to adjust.

These lifestyle modifications can also reduce your symptoms:

• Avoid prolonged bed rest or sitting
• Stay hydrated
• If your symptoms increase after eating, avoid large meals
• Avoid excessive alcohol consumption as it is dehydrating
• Avoid hot, humid environments
• Exercise to maintain good muscle tone in your legs
• Wear compression stockings to reduce blood accumulation in your legs

Vitamin B12 deficiency is a known cause of neuropathies. These changes in nerve function can increase orthostatic hypertension and other neurologic conditions. Ask your doctor if vitamin B12 deficiency may be contributing to your symptoms.

Age is a risk factor for orthostatic hypotension, and dizziness when standing increases your risk for falls. Maintaining good muscle tone in your legs and developing a good sense of balance are great age management techniques that can decrease your risk and symptoms.

There are many potential causes of chronic dizziness. If you are uncertain about what is causing your symptoms or if they persist, see your doctor.

DISCLAIMER

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Palma J-A, Kaufman H. (2022). Mechanisms, causes and evaluation of orthostatic hypotension. UptoDate
2. Kaufmann H, Norcliffe-Kaufmann L, Palma JA. Baroreflex Dysfunction. N Engl J Med. 2020 Jan 9;382(2):163-178. doi: 10.1056/NEJMra1509723. PMID: 31914243.
3. Magkas N, Tsioufis C, Thomopoulos C, Dilaveris P, Georgiopoulos G, Sanidas E, Papademetriou V, Tousoulis D. Orthostatic hypotension: From pathophysiology to clinical applications and therapeutic considerations. J Clin Hypertens (Greenwich). 2019 May;21(5):546-554. doi: 10.1111/jch.13521.

• General
• News
• Erectile Dysfunction
• Anti-Aging
• Lifestyle
• Hair Loss
• Sexual Health
• Weight Loss
• Performance
• Nutrition