Many people who contract COVID-19 report experiencing feelings of unsteadiness or lightheadedness, a common neurological symptom appearing during the acute phase and months after recovery. Lightheadedness is generally defined as a feeling of being faint, woozy, or unsteady, often associated with near-fainting. It is important to distinguish this from vertigo, which is the specific sensation that you or your surroundings are spinning or rotating. While both can occur with COVID-19, their underlying causes are often different.
Lightheadedness During Acute Infection
The acute phase of a COVID-19 infection, typically the first one to two weeks, often presents with lightheadedness due to temporary, systemic effects. A primary cause is the generalized inflammatory response leading to fever and dehydration. Elevated body temperature depletes fluid stores, reducing overall blood volume in the circulatory system. This temporary hypovolemia can cause orthostatic hypotension, a sudden drop in blood pressure when moving to standing, resulting in momentary lightheadedness.
The physiological burden of the illness, coupled with reduced appetite and profound fatigue, also contributes to overall weakness and unsteadiness. In more severe cases, lightheadedness may stem from hypoxia, or reduced oxygen saturation in the blood. When the infection involves significant lung damage, low oxygen levels can manifest as confusion and dizziness, since the brain is sensitive to oxygen deprivation. These acute causes are generally temporary and resolve as systemic function returns to normal.
The Role of Neuroinflammation and the Nervous System
Beyond simple systemic factors, lightheadedness and balance issues can be traced to the virus’s impact on the nervous system and the body’s inflammatory response. The SARS-CoV-2 virus, or the intense immune reaction it provokes, can affect the neural pathways responsible for balance. The virus can gain access to the central nervous system via the olfactory bulb or by crossing the blood-brain barrier, leading to neuroinflammation.
The inflammatory response, characterized by a surge of signaling molecules called cytokines, can irritate the nerves and structures controlling equilibrium. This inflammation is why some people experience balance problems even with a mild infection. The inner ear, specifically the vestibular system which controls spatial orientation, can be directly affected. Disruption to the delicate fluid and nerve balance in the inner ear can cause significant unsteadiness and balance impairment.
The virus can also temporarily disrupt the function of the Autonomic Nervous System (ANS), which controls involuntary bodily functions like heart rate and blood pressure. This disruption is known as autonomic dysfunction or dysautonomia. When the ANS is impaired, it struggles to regulate blood pressure and heart rate properly, especially when changing posture. This poor control over vascular response contributes to orthostatic intolerance, where the body cannot maintain adequate blood flow to the brain upon standing, leading to dizziness.
Addressing Persistent Dizziness and Orthostatic Intolerance
For many individuals, dizziness becomes a chronic problem that lingers weeks or months after the acute illness, recognized as a symptom of Long COVID. This persistent lightheadedness is often linked to ongoing autonomic nervous system dysfunction that did not resolve with the initial infection. Chronic dizziness is a recognized post-viral syndrome.
A specific form of dysautonomia frequently diagnosed in Long COVID patients is Postural Orthostatic Tachycardia Syndrome (POTS). POTS is characterized by an abnormal increase in heart rate when a person moves from a reclining to an upright position. The diagnostic criteria require the heart rate to increase by at least 30 beats per minute within ten minutes of standing. This rapid heart rate response attempts to compensate for poor blood flow regulation, often resulting in debilitating symptoms like severe lightheadedness, fatigue, and cognitive impairment.
Another potential cause for chronic symptoms involves the inner ear, specifically a condition called vestibular neuritis. This post-infectious complication involves the inflammation of the vestibular nerve, which connects the inner ear to the brain and is responsible for sending balance and head position information. The inflammation of this nerve can result in a persistent spinning sensation or general disequilibrium that requires specialized vestibular rehabilitation therapy.
Symptom Management and When to Seek Emergency Care
Managing mild to moderate lightheadedness at home focuses on supporting the body’s circulatory and nervous systems. Maintaining consistent hydration, particularly with fluids containing electrolytes, helps support blood volume and stabilize blood pressure. People experiencing lightheadedness should make slow, deliberate movements when changing positions, such as pausing before standing up. Rest and avoiding sudden movements are helpful strategies to prevent dizzy spells.
Certain symptoms suggest a more serious medical event and necessitate immediate emergency care. You should call 911 or seek immediate medical attention if lightheadedness is accompanied by:
- Chest pain or pressure.
- An inability to catch your breath.
- A sudden loss of consciousness or fainting.
- New-onset confusion or sudden difficulty speaking.
The acute appearance of severe, spinning vertigo combined with weakness on one side of the body, a severe headache, or trouble walking could indicate a stroke or other serious neurological event.