Dizziness, balance, and falls during fibromyalgia flare-ups


In fibromyalgia, dizziness, poor balance, and falls are the common complaints. For some people, they are a minor annoyance that comes up on occasion. In others, they can be severely debilitating and lead to regular injuries.

Falling, and especially frequent falling, is a serious problem. The last thing you need when you’re already in constant pain is to hurt yourself all the time. Frequent falls or balance problems can also lead to fear of falling.

That fear can, in turn, make you afraid to stay active, even within your limits. According to a study in  Clinical Rheumatology,  73 percent of people with fibromyalgia have a fear of physical activity, and almost 75 percent have problems with balance.

Falling is less a symptom and more a consequence of symptoms of dizziness and poor balance. In this condition, falls and balance problems can also be related to changes in the way we walk.

So why does fibromyalgia involve these problems? And what can we do about it?

Fibromyalgia and dizziness

In fibromyalgia, dizziness appears most often when you first get up. It is similar to the “rushing head” feeling when you get up too fast, it can only happen every time you lie down or sit up. The sudden onset of dizziness can cause you to sway on your feet, wobble, or may even cause you to fall or pass out.

Dizziness and fainting in this condition may be related to a particular subgroup, according to a 2017 study published in the  European Journal of Pain .

In addition to dizziness and fainting, this subgroup also had the highest levels of pain, as well as a variety of overlapping symptoms and conditions, including cognitive dysfunction (“fibro fog”), irritable bladder, vulvodynia, and restless leg syndrome.

Research suggests that this symptom is due to dysfunction of the autonomic nervous system (ANS), which is called dysautonomia.

The ANS is involved with many critical functions in your body, including heart rate, blood pressure, respiratory rate, body temperature, metabolism, and digestion.

Dizziness caused by dysautonomia may be called orthostatic intolerance, neural-mediated hypotension, or postural orthostatic tachycardia syndrome (POTS). Essentially, these things mean that the heart and brain are not properly communicating with each other.

What should happen is that when you get up from a lying or sitting position, the ANS raises your blood pressure to combat gravity and maintain a sufficient supply of blood to your brain. With dysautonomia, this doesn’t happen the way it should. Instead, blood pressure can actually drop when you’re standing up, and the result is dizziness or lightheadedness. In POTS, your heart rate speeds up as your blood pressure drops.

Dizziness may be associated with heart palpitations, blurred vision, increased pulse rate, chest pain, and a type of fainting called vasovagal syncope.

However, not everyone with fibromyalgia-related dizziness passes out. In a 2008 study, researchers say that dizziness and palpitations were more common than fainting. They also say that POTS was one of the most common fibromyalgia symptoms they observed during tilt table tests, which measure your response to changes in position.

Balance and gait problems in fibromyalgia

In addition to the possibility of falls, research suggests that people with fibromyalgia walk differently from healthy people. A 2009 study found that about 28 percent of people with this disease have an abnormal gait (gait).

In a 2017 functional performance study, researchers said gait and balance were severely impaired in this condition. The differences include:

significantly shorter stride length

Slower pace

the way the body sways when walking

The researchers found that gait and balance differences were worse in people who had more pain, stiffness, fatigue, anxiety, and depression.They recommended that physicians evaluate their fibromyalgia patients’ gait and posture to find the best type of rehabilitation and fall prevention for them.This study is part of a growing body of scientific literature demonstrating balance and gait problems in this condition that can lead to falls. However, evaluating and treating these symptoms may not be a high priority for your doctor. If you are concerned, be sure to mention them at your next appointment.

Relieve dizziness and risk of falls in fibromyalgia

The more successful you are in treating your fibromyalgia, the less these symptoms should be a problem. However, if they need more care or if you haven’t been able to find effective fibromyalgia treatments, you have several options.

For POTS dizziness, orthostatic hypotension, or brain-mediated hypotension, your doctor may recommend medications that help. These can include SSRI / SNRI, benzodiazepines, and beta blockers. Some of these medications can also help relieve other fibromyalgia symptoms – SSRIs and SNRIs are commonly prescribed for this disease. Your doctor may also recommend lifestyle changes.

If you smoke, research published in the rheumatology journal  Joint, Bone, Spine suggests that quitting smoking can help relieve fainting and other fibromyalgia symptoms.

When it comes to balance and gait, physical therapy is a common treatment. You can also ask your doctor if something like yoga, tai chi, or qigong is safe for you.

Until you find ways to improve these symptoms, it is worth being careful. Assistive devices, such as a cane or walker, can help you stay upright. Seated exercises may be the safest option, and they are certainly a better option than being less active than you can be.

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