Experiencing bouts of dizziness while standing? Dozens of conditions—some serious, some not—may be to blame for this symptom.

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At some point in life, you may have experienced dizziness while standing up. Dizziness includes three subtly different symptoms:

• Lightheadedness, where your head feels light, as if you may feel faint
• Vertigo, where you feel that the room or world is spinning
• Unsteadiness, where you feel like you are unstable and might fall

Sometimes a dizzy spell can be so bad that you fall or faint. And you’re not alone.

Dizziness affects about 5 to 10 percent of people, an incidence that rises to 40 percent in people over 40. Around 4 million Americans visit the emergency room each year with dizziness. In this article, we will specifically address the symptom of dizziness while standing up—a symptom where you feel fine when sitting or lying or generally when up and about, but dizzy when you stand for a time.

12 Common Causes of Dizziness While Standing Up

Dizziness while standing up is a symptom, not a disease, for which there are many possible causes. The most common:

1. Dehydration, which may be due to vomiting, diarrhea, fever, lack of fluid intake, extreme heat, and other conditions.

2. Orthostatic hypotension, a sudden fall in blood pressure that occurs when a person assumes a standing up position. It is due to a disorder of the sympathetic nervous system and is usually benign and mild.

3. Benign positional vertigo, a phrase that describes a spinning feeling that occurs when you move your head.

4. Labyrinthitis, an irritation and swelling of the inner ear.

5. Meniere disease, a disorder of the inner ear. Meniere disease can cause severe dizziness, tinnitus, hearing loss that comes and goes and the feeling of ear pressure or pain.

6. Infections such as influenza.

7. Low blood sugar.

8. Heart problems or stroke, which may present with dizziness on standing up, although often, other symptoms—such as chest pain or headache—may be more pronounced.

9. Medical shock and bleeding in the body, which can cause low blood pressure and severe dizziness along with other symptoms.

10. Neurological disorders such as Parkinson’s, Myasthenia Gravis, and MS (multiple sclerosis) sometimes present with dizziness as an early symptom.

11. Medication side effects. Many medications, including blood pressure medications, antibiotics, medications for anxiety and depression, and chemotherapy drugs, can cause dizziness.

12. Vitamin or mineral deficiencies such as magnesium, iron, or B12.

Dizziness may occur as an isolated symptom or in conjunction with other symptoms. If you suffer from dizziness and are going to see your doctor, make a note of all other accompanying symptoms, no matter how slight, as this may help with diagnosis.

When to See Your Doctor for Dizziness

If you have mild symptoms that persist, make a routine appointment to see your doctor. Symptoms that may warrant an urgent assessment or a visit to the emergency room include:

• An episode of severe or sustained dizziness, with or without a fall
• Head injury
• High fever, headache, or neck stiffness
• Uncontrolled shaking, episodes of seeming absent (such as a lapse in awareness or staring into space) or seizures
• Trouble keeping fluids down
• Chest pain, irregular heart rate, or shortness of breath
• Weakness or inability to move limbs or face
• Visual, hearing, or speech impairment
• Fainting and loss of alertness

Diagnosis & Treatment

Below are the types of clinical assessments and treatments you can expect when experiencing dizziness.

• Medical history and symptoms. Your doctor will ask you questions about your medical history and current symptoms. The specifics are important in diagnosis of dizziness while standing up, so make a note of accompanying symptoms.
• Medical examination. Your doctor will likely perform a general examination, which may include examination of heart, lungs, nervous system, eye, and ears. Heart rate, temperature, and blood pressure will usually be measured.
• Investigations. Your doctor may be able to make a diagnosis without further tests. However, he or she may request:
  • Complete blood count (CBC)
  • Electrocardiogram (EKG/ECG)
  • Echocardiogram to examine heart valves
  • Hearing tests
  • Balance testing (ENG)
  • Magnetic Resonance Imaging (MRI)
  • Treatment depending on diagnosis.

What to Do If You Suffer from Dizziness While Standing Up

If you tend to get lightheaded when you stand up:

• Make sure you’re drinking enough fluids. According to the National Institutes for Health, women should ingest approximately 2.7 liters (91 ounces) and men 3.7 liters, from all beverages and foods, each day. You may need more if you’re exercising frequently, live in a hot climate, are pregnant, or are sick.
• Avoid getting up too quickly. If you are standing up from lying, transition to sitting for a few moments and see how you feel before standing up. If you feel dizzy, find something sturdy to hold on to.
• Do not drive, operate heavy machinery, or climb when you are suffering from dizzy spells, as this can be dangerous to you and others.

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Originally published in 2017, this post is regularly updated.