Vertigo is the sensation a person feels in which they or the environment around them is moving or spinning. It can affect any age group and is a symptom of an underlying medical condition rather than a condition itself.
Among younger people, the cause of vertigo is usually found to be associated with the middle ear. In the elderly, a detailed assessment must be done to understand the cause as there is a high risk of falls and further complications.
Depending on the cause, vertigo can be:
- Peripheral vertigo
- Central vertigo
Vertigo is not a serious condition by itself. An episode of vertigo can occur quickly, and last for a few seconds to a few hours or days. The attack may be mild, or severe enough that one may lose their balance. This may make it difficult to perform even routine tasks.
Along with vertigo, individuals may experience the following:
- A loss of balance
- Feeling of sickness with high temperature
- Double vision, or loss of vision or hearing
- Weakness in the arms or legs, along with tingling or numbness
Peripheral vertigo is more common and is mostly associated with problems in the inner ear, a part of which is responsible for balance. Some of the common problems are –
- Benign paroxysmal positional vertigo (BPPV) – This is a common cause for vertigo and occurs during specific movements of the head like standing suddenly or bending down or even turning in bed. These episodes are short, recurrent and may result in the eyes moving uncontrollably, a condition called nystagmus. BPPV is caused due to small crystals that enter one of the fluid-filled canals in the inner ear. When the head is moved in certain ways, these crystals flow along the canals and disturb the normal signalling system to the brain, causing vertigo. It is usually seen after 50 years of age, with no specific cause. It can also arise due to an infection or surgery of the ear.
- Head injury – Vertigo or dizziness following a head injury requires immediate medical attention.
- Labyrinthitis – It is a viral infection of the inner ear, particularly the labyrinth that is filled with fluid to help in hearing and balance. The infection of the labyrinth causes vertigo, nausea, vomiting, hearing loss, and ringing in the ear (tinnitus).
- Vestibular neuritis – It is a viral infection leading to inflammation of the nerve connecting the inner ear to the brain.
- Meniere’s disease – It is a rare condition of the inner ear that causes vertigo, loss of hearing, and a feeling of pressure in the ear.
Central vertigo occurs due to problems in the cerebellum of the brain, or in the brainstem which connects the brain to the spinal cord. These problems include:
- Migraines – Severe headaches causing throbbing pain, commonly affecting adults.
- Brain tumour that grows on the nerve that controls hearing and balance, or a tumour in the cerebellum.
- Stroke which occurs due to disruption in the blood supply to the brain.
- Medications that are prescribed for convulsions and psychological disorders could sometimes cause vertigo.
A detailed description of the symptoms is generally taken to diagnose vertigo, and whether there are accompanying signs like tinnitus, nausea, and fullness of the ear. It is important to understand what triggers episodes of vertigo, and if it is severe enough to affect routine activities. Moreover, it is done note how and when the attacks stop.
The ears and eyes are checked thoroughly, along with the individual’s sense of balance.
If required, other tests may have to be carried out:
- Hearing tests including audiometry and tuning fork tests.
- Videonystagmography to check for signs of nystagmus, that indicates a problem with organs that help to maintain balance.
- Posturography, where a machine is used to test balance by providing information about vision, sensations from the legs, and messages from the ear to the brain.
- Computed tomography (CT) scans or magnetic resonance imaging (MRI) may be used to rule out tumours in the brain.
Since vertigo by itself is a symptom of several conditions, it is necessary to manage it according to the cause.
Vestibular or inner ear conditions causing acute episodes of vertigo can be suppressed with the use of medicines like antihistamines, benzodiazepines and antiemetics that may be prescribed by a doctor.
BPPV often clears up without treatment, however, this can take up to several weeks. It subsides when the small fragments are either dissolved or moved into a place where they are rendered harmless. Medical professionals most often prescribe a series of four separate head movements each of which is held for 30 seconds. These head positions are called the Epley manoeuvre and require a few repetitions to achieve results.
Meniere’s disease can be treated with a combination of a low-salt diet and antivertigo drugs to prevent and treat attacks, sound therapy for tinnitus, hearing aids for loss of hearing, and physiotherapy to manage problems with balance.
Vestibular rehabilitation training can be used to train the brain through special exercises that make the brain adaptable and receptive to the abnormal messages coming from the ears. It involves making the brain rely not only on the signals from the ears, but also on those coming from the eyes, legs, and the rest of the body. The individual is made to keep moving even during episodes of vertigo and dizziness, and eventually the brain adjusts to such scenarios.
There are two commonly prescribed medicines to treat vertigo due to vestibular neuritis or Meniere’s disease –
- Antipsychotics to relieve nausea and vomiting . It blocks the effect of dopamine but can cause side effects like tremors and involuntary body movements.
- Antihistamines for milder cases of vertigo. They work by blocking the effects of the chemical histamine.
Both these medicines can make the patient sleepy and should be used with care.
One of the important issues to be considered for persons with vertigo is their personal safety. This is important in the context of some jobs that involve operating machinery, driving and so forth.
People who are affected by vertigo are advised to follow certain precautions –
- Lying still during an episode, or to sit down if they feel dizzy
- Using a walking stick to maintain balance and reduce the risk of falling
- Sitting down on the bed for a few minutes after waking up and then getting up slowly
- Avoiding stress and anxiety