Health & Wellness Wednesdays

“Around, around the sun we go: The moon goes round the earth. We do not die of death: We die of vertigo.” ― Archibald MacLeish

INTRODUCTION

Dizziness is a feeling that may be hard to describe, but often involves feeling like you are spinning, swaying, or tilting, or like you are about to fall or pass out. Dizziness can also cause you to feel lightheaded or giddy, or to have difficulty walking straight.

"Vertigo" is one common type of dizziness. If you have vertigo, you may feel like you are moving or like the room is moving around you, even when you are still. Vertigo can be caused by a number of different problems involving the inner ear or brain.

This article is primarily about vertigo, including causes and available treatments.

SYMPTOMS

If you have vertigo, you may feel like you are:

●Spinning (or the room is spinning around you)

●Tilting or swaying

●Off balance

These feelings can come and go, and may last for seconds, minutes, hours, or days. You may feel worse when you move your head, change position (eg, stand up or turn over in bed), cough, or sneeze. Depending on what is causing your vertigo, you might also have other symptoms, such as:

●Nausea or vomiting

●A headache or sensitivity to light and noise

●Double vision, trouble speaking or swallowing, or weakness

●Shortness of breath, sweating, or a racing heartbeat

If you think you may have vertigo, see your health care provider (see 'When to seek help' below). It will help if you can describe how long your symptoms last, what triggers the symptoms, and any other problems you are having. These clues can help point to the cause of your vertigo.

COMMON CAUSES OF VERTIGO

Vertigo typically happens when there is a problem in the vestibular system. The vestibular system, which controls balance, includes parts of the inner ear and nervous system (figure 1). Different conditions can affect the vestibular system. Some are not serious, while others can be life threatening.

Benign paroxysmal positional vertigo — Benign paroxysmal positional vertigo (BPPV), sometimes called benign positional vertigo or simply "vertigo," is the term used to describe vertigo that develops due to misplaced collections of calcium in the inner ear. Episodes of vertigo are typically brief in people with BPPV, lasting a few seconds to less than a minute. They can be triggered by moving the head in certain ways.

BPPV often resolves on its own, but also can be treated effectively with a procedure called "canalith repositioning" (the collections of calcium in the inner ear are called canaliths). This is done by a doctor, nurse, or therapist in the office by moving your head into certain positions. It is sometimes called the Epley maneuver. The movements encourage the calcium collection to move into a part of the inner ear where it will be reabsorbed. You may begin to feel better immediately after this treatment or within a day or two. If the treatment is successful, you may be given instructions on how to perform similar movements at home, if your symptoms return.

Meniere disease — Meniere disease is a chronic condition that is thought to be related to a buildup of fluid in the inner ear. It causes repeated episodes of vertigo as well as hearing loss, ringing in the ear, and a feeling of fullness in the ear. These symptoms often affect one ear. Episodes can be severe and last several minutes or hours; vertigo is often accompanied by nausea and vomiting. A feeling of being off balance can last for several days after an episode.

While Meniere disease is a lifelong condition, nonsurgical treatments are effective in managing symptoms in approximately 90 percent of people.

Vestibular neuritis — Vestibular neuritis, also known as labyrinthitis, is thought to be related to a virus that causes swelling around the nerve involved in maintaining balance. People with vestibular neuritis develop sudden, severe vertigo; nausea; vomiting; and difficulty walking or standing up. Some people also develop hearing loss in one ear. Typically, these problems last several days and then gradually resolve, although some people have residual dizziness or problems with balance that can last for several months. Hearing loss can be permanent.

Vestibular migraine — Migraine can be a cause of episodes of vertigo. Most, but not all, people with vestibular migraine also have typical migraine headaches and other migraine symptoms (such as visual aura or light sensitivity) that can either accompany the spells of vertigo or occur separately. The duration of vertigo is variable, but most episodes last several minutes to a few hours.

Preventive treatments for migraine headache can also be helpful for vestibular migraine. (See "Patient education: Migraine in adults (Beyond the Basics)".)

Other causes of vertigo — Many other conditions can cause vertigo. They include:

●Head injury – Head injuries can affect the vestibular system in a variety of ways and lead to vertigo.

●Medications – Some medications can affect the function of the inner ear or brain and lead to vertigo. Rarely, some medications can actually damage the inner ear.

●Problems affecting the brain – Stroke or transient ischemic attack (TIA), bleeding in the brain, or multiple sclerosis can also cause vertigo. There are usually other symptoms besides vertigo that occur with these brain problems.

WHEN TO SEEK HELP

You should seek help immediately if you have dizziness or vertigo along with any of the following:

●New or severe headache

●Fever higher than 100.4ºF (38ºC)

●Seeing double or having trouble seeing clearly

●Trouble speaking or hearing

●Weakness in your arm or leg

●An inability to walk without assistance

●Passing out

●Numbness or tingling

●Chest pain

●Vomiting that will not stop

In addition, you should seek help immediately if you have vertigo that lasts for several minutes or more if you:

●Are an older adult (60 years or older)

●Have had a stroke in the past

●Have risk factors for stroke (eg, high blood pressure, diabetes, or smoking)

If you have dizziness or vertigo that comes and goes but you do not have any of the above problems, make an appointment with your health care provider. They will perform a physical exam and ask about your symptoms and medical history. They will probably check:

●Your eyes – You might be asked to follow an object with your eyes, or focus on something while moving your head from side to side.

●Your balance and gait – This involves watching you walk, to see if you lean or tilt to one side, as well as checking your balance while you stand still.

●Your hearing – Your doctor or nurse will check your hearing in both ears.

Depending on what they find during your examination, your doctor might do additional tests. They might include an imaging test, such as magnetic resonance imaging (MRI), to look at the structure of your brain.

VERTIGO TREATMENT

In most people, vertigo is bothersome, but it is not caused by a serious problem. Treatment for vertigo aims to treat the underlying cause (if the cause is known), relieve symptoms, and help with recovery.

Disease-specific treatment — If your doctor is able to identify the cause of your vertigo, they can recommend treatments such as medications, procedures, or lifestyle changes. Sometimes, treating the underlying condition relieves or resolves the vertigo; other times, treatment is aimed at slowing disease progression and improving your overall prognosis. Some of the more common disease-specific treatments are described above. (See 'Common causes of vertigo' above.)

Relieving vertigo and related symptoms — If you have episodes of vertigo that are severe or last for hours or days (regardless of the cause), your doctor may recommend a medication to relieve severe vertigo and associated symptoms, like vomiting. Treatment with medication is not usually recommended if your vertigo lasts only seconds or minutes.

Medications may include:

●An antihistamine, such as the prescription medicine meclizine (sample brand name: Antivert), or nonprescription medicines like dimenhydrinate (sample brand name: Dramamine) or diphenhydramine (sample brand name: Benadryl). These medicines are also commonly used to treat or prevent motion sickness.

●Prescription antinausea medicines, such as ondansetron (sample brand name: Zofran), promethazine (sample brand name: Phenergan), or metoclopramide (sample brand name: Reglan).

●Prescription sedative medicines, such as diazepam (sample brand name: Valium), lorazepam (sample brand name: Ativan), or clonazepam (sample brand name: Klonopin). These medicines are commonly used to treat anxiety, but can also help relieve vertigo.

Most of these medicines make you sleepy, and you should not take them before you work or drive. You should only take prescription medicines to treat severe vertigo symptoms, and you should stop the medicine when your symptoms improve (usually within a day or two). Continuing to take these medications can interfere with long-term recovery.

Vestibular rehabilitation — Most people with vertigo feel better if they keep their head still. However, lying still and not moving your head can actually delay recovery in the long term. Vestibular rehabilitation can help people recover from vertigo that is caused by a problem within the vestibular system.

Vestibular rehabilitation works by helping your brain adjust its responses to changes in the vestibular system. It can also help train your eyes and other senses to "learn" how to adapt. This therapy is most helpful when it is started as soon as possible after you develop vertigo.

During rehabilitation, you will work with a physical therapist who will teach you exercises you can do at home. For example, you might start by focusing on an object with a blank background and move your head slowly to the right and left and up and down. You would perform this exercise for several minutes two to three times per day.

If you have trouble standing or walking because of vertigo, this increases your risk of falling. This is particularly a concern for older adults, as falls can lead to serious complications, such as a broken hip. Talk to your doctor, nurse, or therapist if you are worried about falling. To reduce the risk of falls, remove hazards in your home, such as loose electrical cords, slippery rugs, and clutter; wear sturdy shoes; and avoid walking in unfamiliar areas that are not lighted.

Overall health

Have you ever experienced vertigo? What has helped you through it?