Exercise induced Vertigo and Unsteadiness

Timothy C. Hain, MD•Most recent update: April 3, 2023

About 1/100 patients that the author sees in his clinical dizziness practice present with symptoms that are provoked by strenuous exercise. Because exercise stresses many systems at the same time, this is a broad category that takes some sorting out. The purpose of this page is to direct the reader to more information about these categories.

The heart is the first thing to check for this symptom is the heart -- "event triggered monitoring" is particularly useful for irregular heart beats, and stress tests for angina. However below are some clues for non-heart related.

Provoking features:

• Working out in general
  • Cardiac issues such as variant angina, arrhythmias. (common --many references)
    • Walking-duration related (usually cardiac). Gao and Wu (2021); Park et al, 2012
  • Exercise induced migraine (uncommon)
  • Multiple sclerosis (very unusual)
  • Subclavian steal (very unusual) -- relates to use of hand/arm.
  • Tumors of the 8th nerve (very uncommon) -- e.g. Foster and Chen, 2017
  • Hypertension during weight lifting or other strenuous activities (unclear how common)
  • Respiratory insufficiency (rare, Lowhagen et al, 1999)
  • vertebrobasilar insufficiency (rare, basically claudication of the brain).
  Head position with respect to gravity (positional vertigo)
  • BPPV (most common)
  • Positional vertigo in general
  • Vertigo during sexual activity (unclear how common)
  • Central conditions such as damage to cerebellum (very rare)
• Head position with respect to neck (cervical vertigo)
  • Vertebral artery compression (uncommon)
  • Cervical cord compression (common)
  • Severe neck arthritis (rare)
• Pressure (i.e. straining)
  • Perilymph fistula (rare)
  • Chiari malformation (rare)
  • Superior canal dehiscence (rare)
• Going from lying down to standing
  • Blood pressure fluctuations (common)
  • CSF leak (unclear how common)

References:

• Foster, E., and L. Chen. 2017. 'Exercise-Induced Vertigo in Vestibular Schwannoma', JAMA Otolaryngol Head Neck Surg, 143: 955-56.
• Gao, L. L., and C. H. Wu. 2021. 'Transient ventricular arrhythmia as a rare cause of dizziness during exercise: A case report', World J Clin Cases, 9: 9205-10.
• Lowhagen, O., et al. (1999). "Exercise-induced respiratory symptoms are not always asthma." Respir Med 93(10): 734-738.
• Motiejunaite, J., P. Balagny, F. Arnoult, L. Mangin, C. Bancal, M. P. d'Ortho, and J. Frija-Masson. 2020. 'Hyperventilation: A Possible Explanation for Long-Lasting Exercise Intolerance in Mild COVID-19 Survivors?', Front Physiol, 11: 614590.
• Park, M. Y., W. S. Shin, B. J. Shim, S. J. Lee, J. H. Park, Y. S. Koh, and J. M. Lee. 2012. 'Exercise-induced intranodal atrioventricular block', Korean Circ J, 42: 698-701.