Chronic Fatigue Syndrome & Dizziness

Problems with Balance & Fainting

Dizzy man in bed
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For people with chronic fatigue syndrome (ME/CFS), dizziness is often a part of daily life. In some cases, it's a "head rush" now and then or a few moments of staggering when beginning to walk. In other cases, balance is much worse and fainting is a serious threat.

So what's behind the dizziness and related problems? These symptoms could be related to a number of known components of ME/CFS. These include changes to the way you walk, abnormalities of the heart and blood pressure control, and nervous system dysfunction.

The Problems With Dizziness

A little dizziness now and then probably isn't a big problem. It's something most people experience from time to time, whether due to illness, head injury, hunger or dehydration, or just standing up too fast.

However, when dizziness is frequent and severe, it can have a major impact on your life. That's the case for many people with this disease. In a study of syncope (the medical term for fainting), researchers found that women hospitalized for syncope were especially more likely to have ME/CFS.

Dizziness and balance problems can make it dangerous to be active. Even those who are well enough to walk around a store may not feel safe doing so because of the risk of falling or passing out. Those who do fall or pass out on occasion risk injury, which further lowers their quality of life.

So this symptom can be especially limiting and create a lot of extra fear and anxiety when it comes to such simple things as walking down stairs.

Because of this impact, it's important for us to understand the causes of dizziness and look for ways to lessen or overcome this symptom.

Walking: Abnormal Gait in ME/CFS

For more than 20 years, researchers have been studying the walking pattern, or gait, of people with ME/CFS. They've found several abnormalities.

According to a study published in the Journal of Neuroengineering and Rehabilitation, differences between people with ME/CFS and healthy people include:

  • slower walking speed (velocity)
  • smaller steps
  • more time spent on the foot during steps
  • fewer steps per minute (cadence)
  • smaller swinging movements in the hips, knees, and ankles

Earlier research had noted that gait abnormalities started right away, and thus weren't the result of those with ME/CFS getting worn out quickly.

But how do these gait issues relate to balance? Certainly, it's possible for the way you walk to throw it off. However, it's not clear whether gait issues contribute to balance problems. In fact, some researchers have hypothesized that they could be caused by poor balance, possibly due to irregularities in how the brain controls the muscles, or other neurological abnormalities.

Also, a 2016 study in Clinical Biomechanics suggests that gait issues may be directly tied to the inability to maintain balance when first starting to walk. Still, we don't know what the cause-and-effect relationship is between gait and balance. It'll take more research to know for sure how they impact each other.

Heart & Blood-Pressure Abnormalities

Multiple (non-lethal) heart abnormalities are linked to ME/CFS, and some of them may be responsible for dizziness in the condition.

One study found a small heart chamber (the left ventricle) in people with ME/CFS. Researchers said fainting and orthostatic intolerance were common symptoms that may be related to the small chamber.

Orthostatic intolerance (OI) is the name for getting dizzy when you stand up. It's caused by a blood-pressure irregularity. OI is sometimes called neutrally mediated hypotension (NMH). In some cases, it's diagnosed as an overlapping condition called postural orthostatic tachycardia syndrome (POTS).

What's supposed to happen when you rise is that your blood pressure increases in order to fight gravity and keep enough blood and oxygen in your brain.

In OI or POTS, the blood pressure falls instead of rising, which leaves your brain temporarily starved for oxygen.

Most people get this occasionally—it's the head rush feeling associated with standing up too fast. In ME/CFS, it's much more common and may not involve moving faster than usual.

This problem is common enough in ME/CFS that at least one study has called for its use as a diagnostic test. The research team studied the pulse wave of the heart when changing position and say they found differences that could diagnose the disease with 82-percent accuracy.

The reason for these abnormalities with the heart and blood pressure is generally believed to be dysfunction of the autonomic nervous system, which is called dysautonomia.

Treating Dizziness & Balance Problems

It's possible that your ME/CFS treatment regimen will help alleviate dizziness and balance problems. If not, you may want to talk to your doctor about treatments focused on this specific symptom.

One small study has looked at the feasibility of home orthostatic training in ME/CFS and suggested that it was well tolerated and may be effective. Training included regular use of a tilt table and appeared to reduce the amount of blood pressure drop with changing position.

Another study looked at exercise training aimed at improving strength and balance without aggravating further symptoms. Only 61 percent of participants were able to complete the study. However, those who did complete it developed better balance and strength.

Before you begin any kind of exercise regimen, make sure you check with your doctor and that you understand a hallmark symptom of ME/CFS called post-exertional malaise. This symptom can cause a sharp and sometimes lasting increase in symptoms following even mild or moderate exercise. Any exercise program you take part in should be tailored to your individual tolerance for exertion.

Living With Dizziness & Balance Problems

Until you find treatments that effectively lessen your dizziness and balance problems, you may want to consider using some mobility and disability aids.

Things like a bar in the shower and sturdy handrails on stairs can help you in situations that might make you more likely to stumble or fall.

Many people with ME/CFS or other conditions that cause dizziness use a cane. It's something they can lean on at those times when the world starts to spin. In more severe cases, a walker may be appropriate.

You may also want to consider using a wheelchair in public. A lot of stores offer motorized scooters so you can shop while sitting.

It may feel strange to use these aids—we're conditioned by society to see those as only for people who are physically unable to walk—but they're available for anyone who can benefit from them, and that includes those with impaired balance. They're for those who lack the energy to walk as well, and ME/CFS can certainly put you in that category!

Sources:

Allen J, Murray A, Di Maria C, Newton JL. Chronic fatigue syndrome and impaired peripheral pulse characteristics on orthostasis—a new potential diagnostic biomarker. Physiological measurement. 2012 Feb;33(2):231-41. doi: 10.1088/0967-3334/33/2/231.

Miwa K, Fujita M. Cardiovascular dysfunction with low cardiac output due to a small heart in patients with chronic fatigue syndrome. Internal medicine. 2009;48(21):1849-54.

Paul L, Rafferty D, Wood L, Maclaren W. Gait characteristics of subjects with chronic fatigue syndrome and controls at self-selected and matched velocities. Journal of neuroengineering and rehabilitation. 2008 May 27;5:16. doi: 10.1186/1743-0003-5-16.

Rasouli O, Stendsdotter AK, Van der Meer AL. TauG-guidance of dynamic balance control during gait initiation in patients with chronic fatigue syndrome and fibromyalgia. Clinical Biomechanics. 2016 Aug;37:147-52. doi: 10.1016/j.clinbiomech.2016.07.008.

Ulas UH, Chelimsky TC, Chelimsky G, et al. Comorbid health conditions in women with syncope. Clinical autonomic research. 2010 Aug;20(4):223-7. doi: 10.1007/s10286-010-0070-x.

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