Based on PubMed | Is dizziness a symptom of fibromyalgia, and what causes it?

Overview

Dizziness can be reported by many people with fibromyalgia, but it is not considered one of the core diagnostic symptoms like widespread pain, fatigue, and sleep problems. ^[1] The most commonly recognized symptoms include chronic widespread pain, fatigue, sleep difficulties, cognitive issues (“fibro fog”), tingling or numbness, and sensitivity to stimuli; dizziness does not appear on most core symptom lists but may occur in some individuals. ^{[1] [2]} When dizziness happens with fibromyalgia, it often relates to overlapping factors such as autonomic nervous system dysregulation, medication side effects, sleep disruption, anxiety, or unrelated inner ear conditions. ^{[3] [4]}

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What fibromyalgia typically includes

Fibromyalgia is a long‑lasting pain condition affecting muscles and soft tissues, characterized by widespread tenderness above and below the waist and on both sides of the body. ^[5] The main features usually include chronic pain, fatigue, and sleep problems, with additional issues like concentration or memory difficulties, tingling or numbness, stiffness, and sensory sensitivity. ^[1] Headaches (including migraines), mood symptoms, and digestive problems (including irritable bowel syndrome) are also commonly associated. ^[2]

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Is dizziness part of fibromyalgia?

Major public health and educational sources list multiple fibromyalgia symptoms but typically do not include dizziness as a prominent or defining feature. ^{[1] [2]} However, clinical studies and expert observations note that people with fibromyalgia often report disabling fatigue and episodes of dizziness, especially with position changes (standing up), suggesting a link with autonomic nervous system dysfunction. ^[3] In practice, dizziness can occur alongside fibromyalgia, but it is more likely secondary to comorbid problems rather than due to fibromyalgia itself as a primary mechanism. ^{[1] [3]}

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Common causes of dizziness in people with fibromyalgia

• Autonomic nervous system (ANS) dysfunction: Many individuals with fibromyalgia show signs of dysautonomia problems in body systems that control heart rate and blood pressure leading to lightheadedness or dizziness when changing positions (orthostatic symptoms). ^[6] A frequent finding on tilt‑table testing is postural orthostatic tachycardia syndrome (POTS), defined by a heart rate rise of more than 30 beats per minute within a few minutes of standing, often accompanied by palpitations and dizziness. ^[3]
• Sleep problems and fatigue: Nonrestorative sleep, which is common in fibromyalgia, can worsen daytime fatigue and a sense of lightheadedness or “wooziness.” ^[1]
• Medication effects: Several medicines used for pain, sleep, anxiety, or other conditions can cause dizziness as a side effect. ^[4]
• Anxiety and hyperventilation: Anxiety, which commonly coexists with fibromyalgia, may trigger hyperventilation and lightheadedness. ^{[2] [7]}
• Headaches and migraines: Migraines often present in fibromyalgia can include vestibular symptoms, with spinning sensations or imbalance. ^[2]
• Inner ear (vestibular) conditions: Dizziness can result from benign paroxysmal positional vertigo (BPPV) or other vestibular disorders, which can happen in anyone and may coincide with fibromyalgia. ^[7]
• Other neurological or medical causes: Broader dizziness causes range from nervous system conditions to circulatory issues, motion sickness, dehydration, and more; these should be considered when evaluating dizziness. ^{[4] [8]}

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How autonomic dysfunction explains dizziness

Research suggests autonomic dysfunction may underlie many non‑pain symptoms in fibromyalgia, including orthostatic intolerance (lightheadedness on standing), palpitations, and faintness. ^[6] Questionnaire studies show higher scores for orthostatic, sleep, sweating (sudomotor), and mucosal symptoms among people with fibromyalgia compared to controls, supporting that dysautonomia is common in this group. ^[6] In clinical testing, tilt‑table evaluations frequently reveal POTS in those with fibromyalgia who complain of dizziness and palpitations. ^[3]

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When to seek medical assessment

Because dizziness has many possible causes, it is reasonable to discuss new, persistent, or severe symptoms with a clinician, especially if dizziness is associated with fainting, chest pain, shortness of breath, severe headache, new neurological symptoms, or hearing loss. ^[8] A medical evaluation may review medications, blood pressure and heart rate changes with position, hydration status, and potential vestibular or neurological contributors. ^[4] For suspected autonomic dysfunction, a clinician may consider orthostatic vital signs or a tilt‑table test when symptoms are triggered by standing and accompanied by marked heart rate increases. ^[3]

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Practical tips to reduce dizziness

• Hydration and salt (as appropriate): Ensuring adequate fluids and, if medically suitable, modest salt intake may help stabilize blood pressure and reduce orthostatic lightheadedness. ^[3]
• Slow position changes: Rising gradually from lying or sitting to standing can lessen symptom spikes due to autonomic shifts. ^[3]
• Review medications: Ask a clinician or pharmacist to check for dizziness‑related side effects and interactions. ^[4]
• Sleep and stress management: Improving sleep quality and addressing anxiety may reduce overall lightheadedness and fatigue. ^{[1] [2]}
• Targeted therapy for vestibular issues: If positional spinning or imbalance suggests BPPV or vestibular migraine, vestibular rehabilitation or migraine management may be considered. ^{[7] [2]}

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Summary

• Dizziness is not a core diagnostic symptom of fibromyalgia, but many people with fibromyalgia report it. ^[1]
• The most common drivers include autonomic dysfunction (orthostatic intolerance/POTS), medication side effects, sleep disruption, anxiety/hyperventilation, migraines, and unrelated inner ear problems. ^{[3] [4] [2] [7]}
• Evaluation focuses on identifying reversible causes and comorbid conditions; autonomic testing can be useful when symptoms are clearly position‑related with rapid heart rate increases. ^{[3] [6]}

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Quick reference table

Potential cause	Why it happens	Clues it may be the cause	What to discuss with your clinician
Autonomic dysfunction (orthostatic intolerance/POTS)	ANS does not regulate heart rate/blood pressure well, leading to lightheadedness on standing	Dizziness with standing, palpitations, improved by lying down	Orthostatic vitals, tilt‑table testing, hydration/salt strategies, compression garments, medication review [3] [6]
Medication side effects	Certain drugs can cause dizziness	Symptoms start after new medication or dose change	Review medication list and alternatives [4]
Sleep disruption and fatigue	Nonrestorative sleep worsens daytime lightheadedness	Poor sleep quality, daytime fatigue	Sleep optimization approaches, sleep disorder screening [1]
Anxiety/hyperventilation	Rapid breathing reduces carbon dioxide, causing lightheadedness	Anxiety episodes, tingling, chest tightness	Anxiety management, breathing techniques [7] [2]
Migraines/vestibular migraine	Migraine can affect balance systems	Headache history, sensitivity to light/noise, episodic vertigo	Migraine evaluation and treatment options [2]
Inner ear disorders (e.g., BPPV)	Crystals in the inner ear trigger positional vertigo	Spinning with head movements, brief episodes	Vestibular exam, maneuvers/rehab [7]