Vertigo is a feeling of spinning or whirling when you are not moving. It can also be an exaggerated feeling of motion without moving your body. It is the most common form of dizziness, but it is different from light-headedness (the feeling of nearly passing out).
Vertigo is often caused by problems in the nerves and structures of the inner ear, called the vestibular system. This system senses the position of your head and body in space as they move.
Vertigo can be due to the following conditions:
Benign Paroxysmal Positional Vertigo (BPPV)
Tiny particles naturally present in the canals of the inner ear dislodge and move abnormally when the head is tilted, pushing ear fluid against hair-like sensors in the ear. BPPV may result from:
-
Head injury
- Infections
- Disorders of the inner ear
- Age-related breakdown of the vestibular system
- Idiopathic (no obvious cause)
Labyrinthitis
Labyrinthitis
(vestibular neuritis) is inflammation of the inner ear. This often follows an upper respiratory infection.
Meniere's Disease
Meniere's disease
results from fluid buildup in the part of the inner ear called the labyrinth. This vertigo usually occurs along with hearing loss and
tinnitus (ringing in the ear).
Acoustic Neuroma
Acoustic neuroma
is a slow-growing, noncancerous tumor of the acoustic nerve. The tumor can compress the nerves responsible for hearing and balance. This can lead to hearing loss, tinnitus, and vertigo.
Vertebrobasilar Insufficiency
This refers to diminished blood flow to the base of the brain often caused by
atherosclerosis
(deposits of fat in the arteries) or other causes of narrowing of blood vessels. It is usually accompanied by other neurological symptoms.
Medications and Other Substances
Examples include:
Risk Factors
Risk factors include:
- Age
- Family history
- Head injury
- Viral upper respiratory infection
- Cerebrovascular disease—deposits of fat in blood vessels leading to the brain
- Brain stem tumor
Symptoms
Many cases of vertigo occur with
nystagmus. This is an abnormal, rhythmic, jerking eye movement. Other symptoms depend on the condition causing the vertigo.
BPPV
Symptoms may last only a few seconds, but may come and go for weeks or even years.
- Sudden, short (15-30 seconds), intense bursts of dizziness when you move your head a certain way, roll over in bed, or tip your head back to look up. Symptoms do not occur when the head is held still.
- Feeling like the room is spinning
- Light-headedness
- Imbalance
- Nausea and/or vomiting
- Lingering fatigue
Viral
Labyrinthitis
(Vestibular Neuritis)
Sudden, intense vertigo lasting for several days to one week and often occurring with nausea and vomiting.
Meniere's Disease
Sudden vertigo attacks lasting between minutes and hours and typically occurring with prominent hearing loss and tinnitus.
Vertebrobasilar Insufficiency
- Vertigo
- Visual disturbances
- Difficulty speaking
- Disorientation
- Incoordination
- Weakness/numbness
-
Dysphagia
(difficulty swallowing)
Diagnosis
The doctor will ask about your symptoms, medicine intake, and medical history, and do a physical exam. In addition, the following tests may be done:
- Vestibular maneuvers (Dix-Hallpike maneuver)
- Auditory tests
- Blood pressure test, both lying down and standing up
- Electronystagmogram (ENG)—to check for nystagmus
-
Magnetic resonance imaging (MRI)
—to look for problems in the brain, such as a
stroke
or
brain tumor
- Rotatory chair test in certain situations (for difficult cases)
- Brainstem auditory evoked potential studies (BAEPS or BAERs)—to check for nerve conduction in the brain auditory nerve and brain stem (severe or persistent cases)
Treatment
Vertigo due to BPPV, labyrinthitis, or vestibular neuritis may subside on its own, usually within six months of onset (but it may sometimes take longer).
Treatments include:
Medications
To treat vertigo and nausea:
-
Meclizine
(Antivert, Bonine, Dramamine, Meclicot, Medivert)
-
Dimenhydrinate
(Calm X, Dinate, Dramamine, Dramanate, Hydrate, Triptone)
-
Diphenhydramine
(Benadryl)
-
Promethazine
(eg, Anergan, Antinaus, Pentazine)
-
Scopolamine
(Transderm-Scop)
-
Atropine
-
Diazepam
(Diastat, Diazepam Intensol, Dizac, Valium)
To treat Meniere's disease:
Maneuvers
Most often used to treat BPPV:
- Semont maneuver—The patient is moved rapidly from lying on one side to the other (also called liberatory maneuver).
- Epley maneuver—This maneuver involves head exercises to move the loose particles to a place in the ear where they won't cause dizziness. A recent study suggested that patients who have nystagmus in the same direction through two steps of the maneuver tend to recover better than those whose eyes move in a different pattern or do not move at all.
If you continue to experience vertigo, the maneuvers can be repeated, or more difficult maneuvers, such as Brandt-Daroff exercises, can be done.
Physical therapy can also be helpful.
Surgery
If symptoms persist for a year or more and cannot be controlled by the maneuvers, surgical procedures can be performed. A surgical procedure called canal plugging may be recommended.
Canal plugging completely stops the posterior semicircular canal's function without affecting the functions of the other canals or parts of the inner ear. This procedure poses a small risk to hearing. Other surgical procedures include removing parts of the vestibular nerve or semicircular canals in the inner ear. Gentamycin injections can also be done. Talk with your doctor to learn more about these injections.
Treatment of the Underlying Cause
Vertigo can be a symptom of another medical condition, such as a heart problem or a neurological problem. Once that condition is treated, vertigo should stop, or, in this case, the underlying medical problem should be treated to help relieve the vertigo.
Prevention
If you are prone to vertigo, the following precautions may help prevent an episode:
- Rest your head on two or more pillows while sleeping.
- Avoid sleeping on the bad side of your head.
- In the morning, get up slowly and sit on the edge of the bed for a minute before standing.
- Avoid bending down to pick items up.
- Avoid extending your neck, such as to get something out of a cabinet.
- Be careful at the dentist's office, hair salon, sports activities, or positions where your head is flat or extended.
