What Is Vertigo

Introduction

Vertigo is a type of dizziness characterized by the false perception of spinning, swaying, staggering, or rocking, even when the person is perfectly still.¹ Vertigo is not a standalone ailment but rather a symptom indicating an underlying health issue. It is more than just feeling dizzy; it often brings about feelings of nausea, vomiting, and an overpowering sense of loss of balance.

Vertigo can stem from a wide range of causes, ranging from problems within the inner ear to neurological disorders, medication side effects, or even migraines. It can affect people of all ages, but it is more common in women as compared to men.² 

Understanding vertigo is vital for several reasons. Firstly, misdiagnosis or the absence of proper treatment can result in severe consequences, including accidents, falls, and a decreased ability to perform daily tasks. Secondly, the psychological toll of living with persistent vertigo can lead to anxiety, depression, and a diminished overall quality of life.³

By delving into its causes, symptoms, and treatment options, we can empower individuals to navigate the challenges posed by vertigo with greater understanding and effectiveness.

What is vertigo?

The term "vertigo" comes from the Latin word "vertere," meaning "to turn," which explains the sensation of spinning or swaying that individuals with vertigo often experience. Vertigo is a specific type of dizziness characterized by a false sensation of spinning or movement, either of the individual or their surroundings. It often feels like the person or their environment is rotating, tilting, or swaying when, in reality, there is no actual movement occurring. Vertigo is typically associated with problems in the inner ear or the vestibular system, which is responsible for maintaining balance and spatial orientation.²

Symptoms of vertigo

The key symptoms of vertigo include:

1. Spinning Sensation

The hallmark symptom of vertigo is a spinning or whirling sensation as if the affected person or their surroundings are moving or rotating.³

2. Nausea and Vomiting

Vertigo can be accompanied by severe nausea and vomiting, particularly when the spinning sensation is intense.³

3. Loss of Balance

People with vertigo often experience difficulties maintaining their balance and may stumble or fall.³

4. Visual Disturbances

Visual disturbances such as nystagmus (involuntary eye movements) and blurred vision can occur during a vertigo episode.³

5. Trigger Factors

Certain head movements or changes in body position, such as getting out of bed or looking up, can trigger or worsen vertigo.³

6. Duration

Vertigo can vary in duration from seconds to minutes to hours, depending on the underlying cause.³

7. Tinnitus

Ringing or buzzing in the ears may occur along with vertigo.³

Types of vertigo

Vertigo is classified into various types based on the underlying conditions that cause it. The types of vertigo include:

1. Peripheral Vertigo: Peripheral vertigo is a type of vertigo that originates in the inner ear or vestibular nerve rather than in the brain.⁴
   • Benign Paroxysmal Positional Vertigo (BPPV): BPPV is one of the most common causes of vertigo. It occurs when tiny calcium particles in the inner ear become dislodged and disrupt the normal balance signals sent to the brain. Certain head movements trigger brief episodes of intense vertigo.⁴
   • Meniere's Disease: This inner ear disorder is characterized by vertigo, tinnitus (ringing in the ears), hearing loss, and a feeling of fullness in the affected ear. The cause of Meniere's disease is often attributed to fluid buildup in the inner ear.⁵
   • Labyrinthitis or Vestibular neuronitis: Labyrinthitis is typically caused by a viral infection of the inner ear. It can lead to vertigo, hearing loss, and imbalance.⁵
2. Central Vertigo
   • Vestibular Neuritis: Vestibular neuritis is similar to labyrinthitis but primarily affects the vestibular nerve. It is often caused by a viral infection and can result in prolonged vertigo.⁶
   • Migraine-Associated Vertigo: Some individuals with migraines experience episodes of vertigo, which can be triggered by specific migraine-related factors.⁶
   • Brainstem or Cerebellar Disorders: Certain brainstems or cerebellar disorders, such as multiple sclerosis or tumours, can lead to central vertigo due to their impact on the brain's balance centres.⁶
3. Non-vestibular Causes
   • Orthostatic Hypotension: Changes in blood pressure, particularly a drop in blood pressure upon standing (orthostatic hypotension), can cause dizziness and vertigo.⁵
   • Medication-Induced Vertigo: Certain medications, such as anticonvulsants, can affect the inner ear or central nervous system, which leads to vertigo as a side effect.²

Diagnosing vertigo

There are several diagnostic methods that healthcare professionals may use to identify the cause of vertigo. These methods include:

Medical history and physical examination

The first step in diagnosing vertigo often involves a thorough medical history and physical examination. The doctor will ask about your symptoms, how long they have been occurring, and any associated factors. They will also perform a physical examination, including checking your eye movements, balance, and neurological functions.²

Dix-hallpike test

This is a specific manoeuvre used to diagnose benign paroxysmal positional vertigo (BPPV), one of the most common causes of vertigo. During this test, the doctor moves your head and body into different positions to see if it triggers vertigo.²

Videonystagmography (VNG)

Videonystagmography is a test that measures eye movements using a video camera to diagnose various types of vertigo, including BPPV and vestibular disorders.⁷ 

Electronystagmography (ENG)

Electronystagmography is a similar test to VNG that measures eye movements but uses electrodes placed around the eyes to record responses to various stimuli.⁷

Magnetic resonance imaging (MRI)

An MRI of the brain and inner ear may be recommended to rule out structural problems such as tumours or other abnormalities that could be causing vertigo.⁴

CT Scan

A computed tomography (CT) scan may also be used to visualize the head and inner ear structures, especially if an MRI is contraindicated or unavailable.²

Audiometry

Hearing tests, such as pure-tone audiometry, may be conducted to evaluate any hearing loss associated with vertigo.²

Blood tests

In some cases, blood tests may be ordered to check for metabolic or systemic conditions that could be contributing to vertigo.³

Posturography

This test uses a machine to evaluate your balance by measuring the input from the inner ear, vision and the sensations from feet and joints.⁷

Treatment options for vertigo

The treatment of vertigo depends on its underlying cause. Vertigo is often a symptom of an underlying medical condition, and addressing the root cause is crucial. Here are some common treatment options for vertigo:

Vestibular rehabilitation therapy (VRT)

This is a form of physical therapy performed by an audiologist or physiotherapist to improve balance and reduce dizziness. It involves a series of exercises that help the brain adapt to abnormal signals from the inner ear by listening to the signals coming from the eyes or legs.⁷

Medications

Depending on the underlying cause, a doctor may prescribe medications to relieve symptoms of vertigo. Common medications include:

• Antihistamines: These are often used to treat benign paroxysmal positional vertigo (BPPV) and Meniere's disease.⁷
• Anti-nausea drugs: These can help manage nausea and vomiting associated with vertigo.⁷
• Vestibular suppressants: Medications like meclizine or diazepam may be prescribed to reduce dizziness and improve comfort.²,³

Epley maneuver

This is a specific manoeuvre used to treat BPPV by repositioning the displaced calcium crystals in the inner ear.²

Canalith repositioning procedures

Similar to the Epley manoeuvre, these procedures are used to reposition displaced inner ear crystals in cases of BPPV.⁴

Surgery

In some cases, when other treatments are ineffective or for specific conditions like Meniere's disease, surgery may be recommended. Surgical options can include:

• Endolymphatic sac surgery: Used for Meniere's disease to reduce fluid buildup in the inner ear.⁵
• Labyrinthectomy: Removal of the inner ear structures to address severe and recurrent vertigo.⁵
• Vestibular neurectomy: Surgery of the vestibular nerve to alleviate vertigo symptoms.⁵

Lifestyle and dietary changes

In cases of Meniere's disease or other conditions related to fluid balance in the ear, dietary modifications (such as reducing salt intake) and lifestyle changes (like stress reduction) may be recommended to manage symptoms.⁵

Treatment of underlying conditions

If vertigo is a symptom of an underlying condition like migraine or multiple sclerosis, treating the primary condition is essential.³

It is essential to consult a healthcare professional who can provide a diagnosis and prepare a treatment plan specific to your needs. Additionally, some forms of vertigo, like sudden and severe vertigo, may require immediate medical attention.

Prevention of vertigo

Here are some of the general tips you can follow to prevent vertigo (NHS)–

• Remain still in a dark and quiet room
• Move your head slowly during routine activities
• Use a walking stick if you're prone to falling
• Try to relax, as anxiety can worsen the symptoms
• Sleep with your head raised using pillows

Summary

Vertigo is a specific type of dizziness characterized by a false sensation of spinning or movement while stationary. It stems from inner ear or vestibular system issues, impacting balance and spatial orientation. The primary form, benign paroxysmal positional vertigo (BPPV), arises when small ear particles dislodge, causing sudden dizziness episodes. Symptoms include intense spinning, nausea, vomiting, and balance difficulties. Vertigo can be temporary or linked to conditions like Meniere's disease or vestibular neuritis. Treatment varies depending on the cause and may involve physical therapy, medication, or surgery. Accurate diagnosis and management are essential to manage vertigo.

FAQ

What is the main cause of vertigo?

Vertigo, often a result of inner ear issues, is primarily caused by benign paroxysmal positional vertigo (BPPV), Meniere's disease, vestibular neuritis, or labyrinthitis. BPPV is the most common, stemming from displaced inner ear crystals. These conditions disrupt the body's balance system, leading to dizziness and spinning sensations.

What are the first signs of vertigo?

The initial signs of vertigo typically include sudden dizziness or a spinning sensation, often triggered by head movements. Accompanying symptoms may include nausea, vomiting, unsteadiness, and difficulty maintaining balance. These episodes can be brief but intense, causing a feeling of disorientation and a risk of falling.

What can trigger vertigo?

Vertigo can be triggered by various factors, including inner ear problems like benign paroxysmal positional vertigo (BPPV), Meniere's disease, viral infections affecting the inner ear, head injuries, migraines, and certain medications. Additionally, stress, dehydration, and changes in head position or posture can exacerbate or bring on vertigo episodes.