Introduction

In today's digital era, people have easy access to various amounts of information online. As a result, many individuals turn to the internet to self-diagnose based on their symptoms. For instance, if someone experiences a sensation of their head spinning, they might quickly search for information and conclude that they have vertigo. But do we really understand what vertigo actually is? 

What is Vertigo?

Vertigo is an illusory sensation of motion of either the self or the surroundings in the absence of true motion.¹ When it happens, the attack can last from only a few seconds to hours, for a severe attack it can even up to many days or months.² In most cases vertigo does not require any treatment and gets better itself, however, but if the symptoms appears frequently its best to seek advice from the doctor.  

Causes of Vertigo^3,4

There are two types of vertigo, peripheral and central.

• Peripheral Vertigo occurs due to a disturbance in the part of the inner ear that controls your balance called semicircular canal, it may also involve vestibular nerve. It might be caused by: 
  • Benign Positional Vertigo/Benign Paroxysmal Positional Vertigo (BPPV)
  • Injury,such as head injury
  • Inflammation of the vestibular nerve (vestibular neuritis)
  • Irritation and swelling of the inner ear (labyrinthitis)
  • Meniere disease
  • Certain medicines, such as antibiotics, cisplatin, diuretics, or salicylates, which are toxic to the inner ear structures
  • Pressure on the vestibular nerve, usually from a noncancerous tumor such as a meningioma

• Central vertigo is due to a problem in the brain, usually in the brainstem or cerebellum. It might be caused by:
  • Blood vessel disease
  • Stroke
  • Certain drugs : anticonvulsant, aspirin
  • Seizures
  • Multiple Sclerosis
  • Tumour (cancerous or non cancerous)

Symptoms of Vertigo^5,6

The main symptom is a spinning sensation that is usually triggered by movement or when changing head position. The difference with other headaches is the sensation that you or the things around you are moving. Other symptoms can include:

• Nausea
• Vomiting
• Nistagmus
• Tinnitus
• Blurred/double vision (diplopia)
• Slurred speech (dysarthria)
• Weakness on the limbs
• Facial paralysis

Vertigo Management^8,9

• In most cases, many people with vertigo get better without treatment. However, some cases require additional tests to identify the underlying condition, ensure the correct treatment, and help with recovery.
• Vertigo can also be treated with medication, for example your doctor might prescribe prochlorperazine and antihistamine like betahistine, or medication to treat the symptoms of nausea and vomiting such as ondansetron, promethazine and dimenhydrinate, and might also prescribe sedative such as diazepam or lorazepam that are commonly used to treat anxiety, but can also help relieve vertigo.Doctor might also give antibiotic or steroid to treat infection and reduce swelling.
• The Epley maneuver, a physical therapy involving head and body movements, is performed while sitting on a bed. Sit on the bed with your legs straight in front of you and your head tilted back. Place a pillow to support your neck. This manoeuvre will help to resolve symptoms of benign positional vertigo. Another manoeuvre is Semont manoeuvre and Half-somersault manoeuvre.
• Vestibular Rehabilitation Therapy (VRT).This therapy is performed if the complaint is dizziness and difficulty maintaining body balance. It is a type of physical therapy that is designed to strengthen the vestibular system.
• Surgical procedures can be an alternative when other methods of treatment are no longer effective. 

Self Care

When you are experiencing vertigo at home, there are several ways to prevent worsening the symptoms, including:^2,10

• Lay still in a quiet and dark room to reduce the spinning feeling
• Avoid sudden change in position
• Avoid reading when the symptom occurs
• Try to sit or lay down when the attack/symptom occurs. You can also try to ease the dizziness attacks by keeping your head elevated above your body while lying down
• Move your head slowly and carefully when doing activities
• Avoid bright light
• Avoid bending over when reaching for objects on the floor
• Not stretching your neck or making sudden head movements
• Get up slowly when getting out of bed and sit on the edge of the bed for a few minutes before standing
• Lifestyle adjustment.¹¹

It is important to maintain certain things in your daily routine, and also to know things that can trigger the dizziness so that you can prevent it from happening, that can include:

• Reduce intake of caffeine, alcohol, sugar, chocolate, and cigarettes
• Eat well (balance nutrition) and do not skip meals
• Stay hydrated
• Exercise regularly/moderate exercise, for example : brisk walking, yoga, etc.
• Limit your intake of salt to reduce the volume of fluid retained in the body
• Have enough sleep
• Have your vision and hearing checked
• Avoid stress and anxiety, spend more time with your loved ones, and listen to calming music
• Ensure your vitamin D levels are not low

Be knowledgeable: find information that will be beneficial to help you with your vertigo, or any support group where you can get in touch with people with the same condition.

Safety 

When you have vertigo, there are some safety issues that you might need to consider to keep yourself safe. You can minimise your risk of injury when experiencing vertigo by following these suggestions:

• Avoid driving
• Avoid working at height
• Wear shoes with low heels and non-slip soles
• Make adjustments to make your home safer, for example : use non-skid mats, use night light, keep floors dry to prevent slipping, store household items on the low shelves, keep driveways, sidewalks, and interior walkways clear of anything that might cause you to trip
• Avoid walking in unfamiliar areas that are not lit
• If you live alone, you might want to consider wearing a device that will bring help just in case you fall and cannot get up, or you can take your mobile with you from room to room so that you can quickly call for help if you need it
• Always keep in touch with at least one family member once a day. Have one person who is informed about your whereabouts.Tell family or friends or relatives about your vertigo and information related to it, therefore they will be aware of what they can do to help you when the attack happens

When to contact your Doctor^5,10

You should see your GP and make an emergency appointment if you:

• Have vertigo that will not go away or keeps coming back
• Severe headache
• Vomiting that will not stop and feeling very sick
• Have a high temperature or feel hot and shivery

Your GP might take history of your condition and do some tests. They might also refer you to a specialist, such as an ENT specialist.

You should go to Emergency Department if you have vertigo and:

• Double vision or loss of vision
• Chest pain
• Hearing loss
• Having trouble speaking
• Swallowing problem
• Facial droop
• Having weakness or numbness on leg or arm

You should also seek help immediately if you have vertigo that lasts for several minutes or more if you:

• Are 60 years or older
• Have a history of stroke in the past
• Have risk factors for stroke (high blood pressure, diabetes, or smoking)

Conclusion

Living with vertigo can be a daunting experience, especially when the attack comes unexpectedly. However, with the right strategies, it is possible to manage the symptoms and maintain a good quality of life. Coping with vertigo can be done through varieties of ways including controlling underlying condition, modifying lifestyle changes, such as dietary adjustments and physical therapy, and utilising techniques like the Epley manoeuvre, or medical intervention, individuals can significantly reduce the impact of vertigo. Additionally, seeking medical advice for appropriate medications and treatments, along with building a strong support system, can provide further relief and encouragement. While vertigo may present challenges, understanding and employing effective strategies can lead to a more balanced and fulfilling life.