Vertigo is closely related to dizziness but also involves the perception of actually seeing the room spin about you, similar to what happens when you spin around rapidly and then stop. Vertigo is frequently accompanied by nausea and a loss of balance; it may pass quickly, or it may last for hours or even days. It can be a disturbing condition which increases the risk of injury from falling and may, depending on severity, duration and frequency, prevent a person from performing their normal duties. It is usually self-limiting, but may intermittently reappear over weeks or months.
Vertigo may result from other vestibular (inner ear – balance center) disorders such as Meniere’s disease or vestibular neuritis, or may be a symptom of a more serious illness such as a stroke or tumor. Anyone with vertigo should be seen immediately by a doctor and avoid hazardous activities (such as driving, operating heavy machinery and climbing, etc.) until one week after symptoms disappear.Benign Paroxysmal Positional Vertigo (BPPV).
Among the most common causes of the condition called vertigo is BPPV. Thousands of people, mainly elderly, are going untreated for BPPV because doctors are unaware of how to diagnose and treat it – despite a quick, simple diagnostic test and speedy treatment being available. Treatment shows almost immediate results.
BPPV is caused by calcium carbonate crystals (octonia) moving out of position into the semicircular canals in the inner ear. As they float around, certain types of head movement will induce vertigo. The misplaced crystals can easily be moved back into position, even by patients themselves.
Dr Peter West, consultant audiological physician at the Queen Alexandra Hospital in Portsmouth, England, has stated that using a simple technique to manipulate the head and return the loose crystals to their correct position is for many a permanent cure. “It is just like maneuvering marbles round a tray in a child’s toy.” Others who suffer continued episodes of BPPV can have repeat treatments.
The diagnosis of BPPV is determined by a clinical history, with a typical complaint of vertigo whenever the patient leans forward, arises from a supine (lying-down) position, or rolls over in bed.
The diagnosis is confirmed by a positive response on the Dix-Hallpike maneuver. This maneuver is conducted while sitting on an examining table and begins with the patient’s head being turned either to the right or to the left by about 45 degrees. The patient is then moved rapidly from a sitting position onto their back with the head hanging off of the back of the examining table while the head continues to be in the same 45-degree position. The patient is instructed to keep his or her eyes open so that the examiner can see eye movement during the entire procedure. If BPPV is present, vertigo will begin after a period of 5 to 10 seconds and usually will last from 30 seconds to a minute. Eye movements will occur and the patient will complain of dizziness. After the signs and symptoms subside, the patient is returned to the sitting position. The eye movement (nystagmus) may reverse in direction and the patient may again experience vertigo. If a positive response occurs, the same maneuver is repeated. The opposite ear is then tested in a similar fashion. The offending ear is the one that is toward the floor when BPPV occurs during this maneuver.
The treatment is called the Epley Maneuver or Canal Repositioning Maneuver. Pictures of the procedure can be viewed here.
Labyrinthitis
In the most general terms this is a condition which causes irritation of tiny hair cells which project into fluid-filled canals (labyrinths) within the balance center in the inner ear. Normal balance is, to a degree, controlled by movement of the fluid, in response to changes in body position. Labyrinthitis is a condition where the hair cells become irritated or inflamed and discharge randomly, tricking the brain into thinking you are moving or spinning.
Risk factors include recent viral illness, respiratory or ear infection, use of prescription or nonprescription drugs (especially aspirin), stress, fatigue, or a history of allergy, smoking or alcohol consumption. The prompt treatment of respiratory infections and ear infections may help prevent labyrinthitis. The use of OTC Sudafed or other decongestant early in the course of a recurrent labyrinthitis attack can sometimes abort it.
Symptoms can include dizziness, nausea and vomiting, loss of balance (especially falling toward the affected side), hearing loss in the affected ear (especially with bacterial labyrinthitis), ringing or other noises in the ears (tinnitus) and involuntary eye movements.
Although labyrinthitis usually runs its course over a few weeks, symptoms may need treatment. Medications that may reduce symptoms include antihistamines, anticholinergics, sedative/hypnotics, antinausea medications and diazepam (valium). The antihistamine meclizine (Antivert) is commonly used.
Recovery is usually spontaneous and hearing usually returns to normal. The spread of inflammation to other ear areas or to the brain are rare.
Signs, symptoms & indicators of Vertigo
Not suffering from vertigo
No general dizziness
Risk factors for Vertigo
Multiple Sclerosis / Risk
Vertigo, vestibular and cerebellar ataxia and proprioceptive dysfunction are all relatively commonly seen in multiple sclerosis.
Vertigo suggests the following may be present
Multiple Sclerosis / Risk
Vertigo, vestibular and cerebellar ataxia and proprioceptive dysfunction are all relatively commonly seen in multiple sclerosis.
Recommendations for Vertigo
Vinpocetine
Vinpocetine at 20 to 40mg a day has been helpful for vertigo from various causes.
Ginkgo Biloba
A double-blind placebo-controlled study of 67 people with vertigo found that 160mg of Ginkgo biloba extract per day significantly reduced symptoms compared to placebo. At the end of the 3-month study, 47% of the ginkgo group had completely recovered, as compared to only 18% of the placebo group.[ Presse Med. 1986;15: pp.1569-1572]
Ginger Root (Zingiber officinalis)
Ginger’s anti-nausea action also helps dispel dizziness, particularly when the dizziness is aggravated by motion sickness. Older people, who can be unsteady on their feet, may particularly benefit from ginger’s steadying influence.
Physical Therapy
In a study, 95% of those using the modified Epley procedure (MEP) for benign paroxysmal positional vertigo (BPPV) for one week no longer experienced symptoms of vertigo. [Neurology July 13, 2004;63(1): pp.150-2]
There are different procedures, basically doing the same thing. There are several demonstrations on YouTube, and many times a patient can successfully do a procedure at home.
Rest
To prevent worsening of symptoms during episodes of labyrinthitis, keep still and rest during attacks, gradually resuming activity. Avoid sudden position changes, do not try to read during attacks and avoid bright lights.
Manipulation
An osteopath may suggest a few treatments of gentle cranial manipulation or Craniosacral Therapy (CST). This has caused some cases of recurrent dizziness to disappear.
Hypnosis
Hypnosis has been used for vertigo that is a result of head trauma, with some apparent success. [Int J Clin Exp Hypn. 1976;24: pp.195-201]
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
Glossary
Vertigo
The sensation of spinning or whirling; a state in which you or your surroundings seem to whirl dizzily.
Nausea
Symptoms resulting from an inclination to vomit.
Meniere's Disease
An affliction of the middle ear characterized by vertigo, nausea, vomiting, tinnitus and progressive deafness.
Neuritis
Nerve inflammation, commonly accompanying other conditions such as tendonitis, bursitis or arthritis. Neuritis is usually accompanied by neuralgia (nerve pain).
Stroke
A sudden loss of brain function caused by a blockage or rupture of a blood vessel that supplies the brain, characterized by loss of muscular control, complete or partial loss of sensation or consciousness, dizziness, slurred speech, or other symptoms that vary with the extent and severity of the damage to the brain. The most common manifestation is some degree of paralysis, but small strokes may occur without symptoms. Usually caused by arteriosclerosis, it often results in brain damage.
Benign
Literally: innocent; not malignant. Often used to refer to cells that are not cancerous.
Calcium
The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. Calcium is also important to heart health, nerves, muscles and skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.
Allergy
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Over-The-Counter
A drug or medication that can legally be bought without a doctor's prescription being required.
Tinnitus
A sensation of noise (ringing or roaring) that is caused by a bodily condition and can usually only be heard by the person affected.
Sedative
Calming, quieting; drug that quiets nervous excitement.
Antihistamine
Drugs, used to treat allergy symptoms, which block the action of histamine on body tissues.
Ataxia
Failed muscular coordination, irregular muscular action.
Multiple Sclerosis
Demyelinating disorder of the central nervous system, causing patches of sclerosis (plaques) in the brain and spinal cord, manifested by loss of normal neurological functions, e.g., muscle weakness, loss of vision, and mood alterations.