Introduction

Have you ever felt the unsettling sensation of your surroundings swirling around you, leaving you dizzy and disoriented?

Many individuals experience vertigo, a sensation that you, everything around you, or your environment is spinning or moving.^1,2 This feeling could be hardly noticeable or so severe that it becomes challenging to maintain equilibrium and do daily duties. Rather than being an actual illness, vertigo is a symptom.² Although stress may not directly induce vertigo, research suggests it may impact your vestibular system, which controls your balance and coordination, worsening your vertigo symptoms.³

This article explores the intricate relationship between vertigo and stress, exploring how stress can worsen symptoms of vertigo and providing helpful strategies for its management and relief.

Understanding vertigo

Types of vertigo

Peripheral and central vertigo are two distinct types of vertigo.⁴ Issues associated with the parts of the inner ear that regulate balance cause peripheral vertigo.⁴ These regions are referred to as semicircular canals or the vestibular labyrinth.⁴ The nerve which connects the brain stem to the inner ear, known as the vestibular nerve, can also be involved in the problem. In contrast, central vertigo arises due to issues in the brain, typically in the brain stem or cerebellum.⁴ 

Causes of vertigo

Causes of peripheral vertigo

• Benign positional vertigo or benign paroxysmal positional vertigo, where certain head movements cause vertigo⁴
• Medications that are harmful to the structures of the inner ear, like aminoglycoside antibiotics, cisplatin, diuretics, or salicylates 
• Injury to the head
• Neuronitis, also known as an inflammation of the vestibular nerve
• Labyrinthitis, also known as an irritation and swelling of the inner ear 
• Pressure on the vestibular nerve, typically caused by a non-cancerous tumour such as a Schwannoma or meningioma
• A rare inner ear condition called Ménière’s disease.⁴

Causes of central vertigo 

Causes of central vertigo include blood vessel disease, the use of medicines like anticonvulsants or aspirin, alcohol consumption, multiple sclerosis, seizures, stroke, tumours, and vestibular migraine.⁴

Symptoms of vertigo

Vertigo goes beyond simply feeling lightheaded or dizzy.¹ An episode of vertigo may linger for several seconds or hours.¹ Severe vertigo could persist for a few days or even months. The sensation that you or the area around you are moving or spinning is the main symptom of vertigo. Additional common symptoms include sweating, headaches, difficulty focusing the eyes, ringing in the ears (tinnitus), hearing and balance loss, nausea and vomiting.⁴

The connection between stress and vertigo

Vertigo, however, may not necessarily have a physical cause. Instead, it is often connected to our emotions. For many people, stress can either cause vertigo or exacerbate its pre-existing symptoms.⁵

Mechanisms by which stress can worsen Vertigo

Direct effect of stress hormones 

When you are under stress, your breathing and heart rate may quicken. This is because stress causes the release of stress hormones such as cortisol and adrenaline.³ These stress hormones trigger Your autonomic nervous system, preparing your body for a fight-or-flight response. Even though they are beneficial in a critical situation, these hormones and other stress-inducing chemicals such as histamine can interfere with the signals that travel from your brain to your inner ear and alter your brain and ear nerves' ability to interpret balance-related impulses. In this way, affecting your sense of equilibrium and your body's exact position.³ 

 Modifications in brain activity 

The brain networks that control stress and balance are interconnected.⁶ This might account for the relationship between stress and vertigo: increased activity in one area of the brain stimulates activity in the other. According to this theory, experiencing stress can interfere with your brain's ability to interpret balance, and conversely, experiencing vertigo or feeling unsteady can directly lead to stress. This may be the reason why t individuals with stress and anxiety problems experience vertigo more frequently.⁶

 A slower rate of damage recovery 

A different theory suggests that stress may impede the healing process following damage to the vestibular system which regulates balance.³ The vestibular system could be damaged by factors like an inner ear infection, fluid accumulation in the ear, head injury, tumours, Meniere's disease, and ageing.³ The vestibular system usually heals itself. However, stress is believed to impact the body's capacity to adapt, extending the duration of vertigo symptoms following an injury.³ For instance, in a 2016 study, researchers found that lowering the stress hormone vasopressin helped lower vertigo in people with Ménière's disease.⁷

Vertigo and stress diagnosis 

For stress, there are no particular diagnostic standards. Numerous symptoms, including exhaustion, headaches, mood swings, difficulty sleeping, problems focusing, trouble deciding, being easily irritated, and feeling abnormally hungry, can be experienced when under stress.⁸

Dix-hallpike examination 

The Dix-Hallpike test is one tool used by doctors to identify positional vertigo. You will be placed in a posture that could lead to vertigo during the exam.⁹ The doctor will then check your eyes for any signs of vertigo when you start experiencing symptoms. This test is employed to identify benign positional vertigo, a frequent cause of vertigo.

Management and preventive measures

The best way to reduce your chance of worsening vertigo symptoms due to stress is to actively control and minimise stress in your life.

Psychotherapy 

Cognitive-behavioural therapy (CBT) is one of the leading forms of psychotherapy supported by research on stress management. Additionally, research has found that this form of therapy is a great way to control symptoms of dizziness.¹⁰

Lifestyle changes to reduce stress

The most effective strategies to control your stress levels are: 

Exercise

There has long been a connection between exercise and lower stress levels. It has been proven that exercise helps elevate your mood and lower stress levels. Regular physical exercise can help release endorphins- the body's natural feel-good chemicals-  boost mood and reduce stress. Examples of such activities include walking, running, yoga, and dancing.^11,12

Getting enough sleep

To perform at their best, adults should aim for an average of seven to eight hours of sleep every night. Under stress, this becomes even more vital. Establish a relaxing bedtime routine and create a comfortable sleep environment to promote restful sleep.^13,12

Getting rid of stressors

Reducing the stressors in your life can help you better control your stress levels. Setting limits, avoiding stressful circumstances, and getting expert assistance when necessary are some examples of how to do this.¹²

Social support

Continue to stay in touch with loved ones, friends, and support networks. Stress levels can be lowered by talking to people about your worries and experiences, which can offer perspective and emotional support.¹⁴

Mindfulness and meditation

You may lower your stress levels by engaging in mindfulness and meditation practices. Try practising yoga and breathing exercises, as well as other relaxation techniques like listening to relaxing and calming music.¹⁵ 

Seeking professional assistance

You might think about consulting a therapist or counsellor if your stress levels are too high or excessive. Therapy can offer coping mechanisms, encouragement, and direction in managing difficult circumstances.¹⁶

Hobbies and leisure activities

Take part in enjoyable and relaxing activities, such as artistic endeavours, hobbies, or time spent in nature. Spending time engaging in interesting activities can lower stress and enhance general well-being.¹²

Healthy lifestyle choices

Maintain a balanced diet and stay hydrated. Avoid excessive caffeine, alcohol, high-sugar, and processed foods, as they can all exacerbate stress.¹⁷

Actions to alleviate vertigo symptoms 

You might alleviate your symptoms and lessen the frequency of your vertigo by yourself :¹

• When you feel lightheaded, sit down right away
• To lessen the sensation of spinning, lie still in a calm, dark area
• When engaging in regular activities, move your head gently and cautiously 
• Take your time getting out of bed, and take a minute or two to sit on the side of the bed before standing up 
• If you wake up in the middle of the night, turn on the lights 
• Sleep with your head supported on two or more pillows
• Remain calm and relaxed, since tension can exacerbate vertigo
• Instead of bending down to pick things up, lower yourself by squatting 
• Avoid extending your neck, for instance, while reaching up to a high shelf

However, if you experience severe, inexplicable, recurring, and long-lasting vertigo, it's a good idea to see a doctor.¹

Summary 

Many people experience vertigo, the feeling of spinning or moving when still.

While vertigo is not a disease, it is frequently associated with problems in the brain or inner ear. Stress can prompt or worsen vertigo symptoms by interfering with the vestibular system which is in charge of balance and coordination. Stress does so by inducing the release of stress hormones, altering brain activity, and/or delaying the healing process after a vestibular injury.  Assessing vertigo symptoms and employing tests like the Dix-Hallpike manoeuvre are common steps in the diagnosis of vertigo. The worsening of vertigo symptoms due to stress can be reduced by managing stress through therapy, getting rid of stressors, lifestyle changes, dietary adjustments, relaxation methods, and social support. However, if you experience prolonged vertigo or stress, you may need to seek professional help.