Imagine the ground beneath your feet suddenly giving way and the room going into a high-intensity spin. That is what people with vertigo experience when they have their episodes.
Vertigo is characterised by a sensation of spinning or rotational movement, even when the person is stationary. “It can last for a few seconds to a few minutes depending on the exact cause,” says Dr Sanjay Saxena, senior director and HOD at the Department of Neurology, Max Super Speciality Hospital, Patparganj, Delhi.
Sangeeta Deka, 45, from Delhi had been experiencing exactly these symptoms for the past six months. It was when she had an episode during a work meeting a few weeks ago, that she decided to consult an ENT specialist.
With a detailed record of her medical history, and a thorough physical examination, her treating physician diagnosed her with vestibular migraine (a subtype of migraine that involves episodes of vertigo or dizziness without severe headache).
“I was prescribed a few medicines and was advised to take adequate rest and to avoid known triggers,” Deka says.
Types of vertigo
The types of vertigo are differentiated based on what causes it. It may be related to issues within the ear or linked to the brain.
Peripheral vertigo
Peripheral vertigo, the most prevalent form, arises from issues in the inner ear, particularly the vestibular system responsible for maintaining balance and spatial orientation. According to Dr Aniket Dev, consultant ENT surgeon, Lakhimpur, Assam, common conditions that lead to peripheral vertigo include:
- Benign paroxysmal positional vertigo (BPPV): The most prevalent type, often caused by the displacement of calcium crystals within the inner ear canals.
- Meniere’s disease: A disorder affecting the inner ear, leading to fluid build-up and pressure changes that result in vertigo episodes.
- Vestibular neuritis: Inflammation of the vestibular nerve (the vestibular nerve carries sensory information from the inner ear’s vestibular system to the brain, responsible for maintaining balance and spatial orientation) usually caused by viral infections.
Central vertigo
Central vertigo is associated with problems in the brain or central nervous system. According to Dr Dev, conditions that contribute to central vertigo include:
- Migraine-associated vertigo: Vestibular symptoms accompanying migraines, often referred to as vestibular migraines.
- Vertebrobasilar insufficiency: Reduced blood flow to the brainstem, leading to vertigo and other neurological symptoms.
- Multiple sclerosis: An autoimmune disorder that can damage nerve fibres responsible for balance and coordination.
Causes of vertigo
According to Dr Dev, the causes of vertigo are-
- Inner ear issues: The most common cause of vertigo, where disturbances in the inner ear affect the signals sent to the brain about body position and movement.
- Vestibular migraines: Migraines can trigger vertigo in some individuals due to abnormal activity in the brain’s vestibular system.
- Medications: Certain drugs, like antibiotics, antiepileptics, and high blood pressure medications, can cause vertigo as a side effect.
- Head injuries: Trauma to the head can disrupt the inner ear or brain function, leading to vertigo.
- Infections: Viral infections affecting the inner ear, such as vestibular neuritis or labyrinthitis, can result in vertigo.
- Meniere’s disease: A disorder characterised by excessive fluid accumulation in the inner ear, leading to vertigo, tinnitus, and hearing loss.
Signs and symptoms of vertigo
Dr Saxena explains the signs and symptoms:
- Spinning sensation: The primary symptom of vertigo, where individuals feel as if they or their surroundings are spinning, tilting, or swaying.
- Nausea and vomiting: Vertigo often induces nausea and vomiting due to the disorienting sensation.
- Balance problems: Difficulty maintaining balance and coordination, leading to unsteady movements.
- Nystagmus: Involuntary, rapid eye movements from side to side or up and down.
- Sensitivity to movement: Increased sensitivity to movements, especially head movements.
Diagnosis of vertigo
Dr Dev and Dr Saxena list a few diagnosis procedures:
- Medical history: The doctor enquires about the individual’s symptoms, their frequency, and any triggers that exacerbate the vertigo episodes.
- Physical examination: This includes assessing eye movements, balance, and the nervous system to identify potential causes.
- Dix-Hallpike manoeuvre: A common test used to diagnose BPPV by observing eye movements during specific head position changes.
- Audiometry: Hearing tests to rule out hearing-related issues.
- Imaging tests: MRI or CT scans may be ordered to detect any structural abnormalities in the brain or inner ear.
Treatment options for vertigo
A few treatment options according to Dr Dev are:
- Medications: Depending on the underlying cause, experts may prescribe medications to alleviate symptoms, such as anti-nausea drugs or vestibular suppressants.
- Vestibular rehabilitation: A specialised form of physical therapy that helps improve balance and reduce symptoms of vertigo. It can be provided by a physiotherapist.
- Lifestyle changes: Your doctor may suggest avoiding triggers like certain foods, stress, and caffeine, which can reduce the frequency of vertigo episodes.
- Surgical intervention: In severe cases, the doctor may recommend surgical procedures to address specific inner ear issues.
“If one experiences recurrent vertigo symptoms, it is essential to seek medical attention for a thorough evaluation and appropriate care,” wraps up Dr Dev.
Vertigo can significantly affect an individual’s quality of life, but with proper understanding of its causes, symptoms, and treatment options, effective management becomes possible. Deka can vouch for that. Appropriate medication along with lifestyle changes like meditating daily and avoiding food triggers have helped her. “The frequency of my episodes has reduced over the last few weeks,” she says.
