Vertigo: Symptoms and Causes for Effective Treatment

Authors
A cover photo of Dr. Tejaswini Boreddy

Dr. Tejaswini Boreddy

AuD (USA), Vestibular Fellowship (USA)

Director of Clinical Services, Vestibular Specialist

A Cover photo of Dr. Yugandhar Ramakrishna

Dr. Yugandhar Ramakrishna

AuD (USA), PhD (USA), CCC-A

Professor, Vestibular Neuroscientist, Doctor of Audiology

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A woman holding her head as she feels the spinning sensation called vertigo. She needs best vertigo treatment.

Table of content

What is Vertigo?

Vertigo is a feeling of spinning sensation, this could be either the environment is spinning around you or vice-versa. Remember, vertigo itself is not a disorder but just simply a symptom of some other abnormality that involve in keeping human body balanced. True vertigo, a type of dizziness where there is a sensation of spinning often accompanied by nausea or vomiting. People with vertigo generally feel all motions intensly with any head movements that could have a negative impact on everyday life.

It is important to understand that dizziness and vertigo are different, we will discuss the difference between dizziness and vertigo in the following section.

Signs and Symptoms of Vertigo

It is important to understand that Vertigo itself is a symptom of other underlying condition, however many times there are other common signs and symptoms that could be seen either post experience of vertigo or leading to vertigo. These include a spinning sensation, tilting, swaying, unbalanced feeling, and being pulled in one direction. This condition can also bring about other symptoms such as nausea or vomiting, abnormal or jerking eye movements, headaches, sweating, and tinnitus (ringing in the ear). Sometimes, people with vertigo, which is the feeling of spinning, may also experience a loss of hearing which is another cause symptom. Episodes may last from a few minutes to hours, and can be constant or periodic. The symptoms may be aggravated with any form of head movement, positional changes, or exposure to specific triggers, potentially affecting one’s daily activities or quality of life. Being informed about these symptoms, watching for their presence, and seeking timely medical consultation can play a key role in managing vertigo effectively.

What are the causes of vertigo?

Conditions such as benign paroxysmal positional vertigo (BPPV), Meniere’s disease, or vestibular neuritis can cause vertigo. BPPV is triggered when tiny calcium particles also commonly referred as crystals in ears are displaced from its original position and mostly free floating in the canals in the inner ear, causing brief episodes of mild to intense dizziness. Meniere’s disease involves a buildup of fluid or reduced recycling of fluid in inner ear and changing pressure in the ear which can cause episodes of vertigo. Vestibular neuritis, a medical condition, is an inflammation of the inner ear usually caused by a viral infection, resulting in dizziness and loss of balance. Other less common causes include migraines, certain medications, and problems in the brain, such as stroke or tumors. In rare cases, certain types of vertigo can signal serious underlying health issues like multiple sclerosis or a stroke, highlighting the importance of seeking professional medical advice when symptoms persist.

How long does vertigo last?

Vertigo, as a symptom, has varying degrees of duration and can depend heavily on its origin. In some cases, vertigo might last only a few minutes or even seconds, such as in benign paroxysmal positional vertigo (BPPV), which can cause short spurts of dizziness when you move your head in a certain way. However, when vertigo is caused by conditions such as Meniere’s disease or vestibular neuritis, it could last for several hours or even days. Meniere’s Disease, for instance, is a medical condition characterized by spontaneous episodes of vertigo that last from minutes to hours, accompanied by ear symptoms like ringing and hearing loss. Meanwhile, vertigo linked to migraines can have a much more unpredictable duration, sometimes lasting for days or coming and going over weeks. It is imperative to have a clear understanding of the cause as duration plays a key role in how vertigo is diagnosed and treated. Recently, there has been an increase in a medical condition called Persistent Postural Perceptual Dizziness (PPPD) or Chronic Subjective Dizziness, which may result in attacks of vertigo and may last even longer and becomes worse if not diagnosed appropriately and treated on time. Therefore, if you’re experiencing persistent vertigo, it’s recommended to seek help from vestibular specialists.

Different Types of Vertigo

Not all vertigo is the same, and it is further divided into two primary types –

1. Peripheral vertigo

The most common cause of vertigo, Peripheral vertigo, stems from a problem within the inner ear or the vestibular nerve which connects the inner ear’s vestibular system to the brain. Conditions such as Meniere’s disease, Vestibular Neuritis, benign paroxysmal positional vertigo (BPPV), or labyrinthitis often cause peripheral vertigo.

2. Central vertigo

On the other hand, central vertigo arises due to a problem in the brain, specifically within the cerebellum or the brainstem. This type of vertigo is less common but is typically more severe and long-lasting. Conditions like migraines, multiple sclerosis, or strokes can result in central vertigo. While the symptoms of both types are similar, the necessary treatment and underlying causes may vastly differ.

Vertigo vs. dizziness

Vertigo and dizziness are two terms commonly interchanged, but they denote distinct conditions. Vertigo pertains to the feeling of spinning or moving even though you’re stationary. It is usually caused by issues in the inner ear or brain and is characteristically associated with balance disorders like labyrinthitis or Meniere’s disease. On the other hand, dizziness refers to a range of sensations including being light-headed, unsteady, or disoriented. Unlike vertigo, it doesn’t involve a rotational component. Dizziness might often be a symptom of dehydration, low blood sugar, or changes in blood pressure. Even though vertigo and dizziness could possibly overlap, it is crucial to differentiate between them for accurate diagnosis and treatment plans. Consulting with vestibular and balance specialist becomes necessary especially when these symptoms persist or severely restrict daily life, as these could be indicators of underlying health conditions that require immediate attention. Misinterpretation or ignoring these symptoms could lead to adverse health implications.

How Is Vertigo Diagnosed properly?

Diagnosing vertigo accurately remains a significant challenge, even in the 2020s. This is primarily due to a shortage of medical physicians specializing in vestibular issues and the high cost of diagnostic equipment. The conventional diagnostic approach relies heavily on the patient’s symptom description, medical history, and physical examination. Doctors may conduct neurological exams to assess balance, eye movement, and coordination, and recommend imaging tests like MRI or CT scans to examine the brain and inner ear structures. However, this often leads to misdiagnoses, as most vestibular disorders are functional, not organic, and thus, cannot be detected through imaging.

The correct diagnosis of vertigo or dizziness requires a functional assessment of the vestibular and associated senses, including the oculomotor (visual system), spinal system, cervical system, proprioceptive information, vascular information, and more. For an accurate diagnosis, it’s essential to consult a Vestibular or Audio-Vestibular specialist who can assess all these systems together and plan treatment based on the findings and underlying involvement.

Vestibular Specialists use a variety of tests depending on the patient’s issue, ranging from a simple test for BPPV to more complex tests such as Videonystagmography (VNG), Calorics, Video Head Impulse Testing (vHIT), Dynamic Visual Acuity (DVA), Rotational Testing, Computerized Dynamic Posturography (CDP), and other balance testing that could last for more than three hours. Based on the test results, the vestibular specialist can diagnose the underlying condition and plan the treatment appropriately, involving or referring to the respective physician or specialist as needed.

What are the available treatment options for Vertigo

When it comes to treating vertigo, there are several options available depending on the underlying cause. Medication is prescribed to alleviate symptoms and reduce the frequency and severity of vertigo episodes in few vestibular disorders. Vestibular Rehabilitation Therapy (VRT) is one of the most beneficial treatment options for many vertigo and associated disorders, as it focuses on compensating by retraining the brain to interpret balance signals correctly that help improve balance and reduce dizziness. In cases where the vertigo is caused by other inner ear problems, and in brain such as tumors or vascular issues, those will be treated appropriately either by surgery or medications. In cases like Meniere’s Disease and PPPD, changing lifestyle and food may help improve everyday activity and prevent future attacks of vertigo.

The Most Effective Vertigo Treatments, According to Experts

It’s crucial to understand that not all treatments are equally effective for every patient experiencing vertigo or dizziness. The key to a successful treatment outcome lies in an accurate diagnosis, which involves identifying the root cause of the vertigo. This diagnosis, along with factors such as the onset, duration, and severity of the condition, and the patient’s lifestyle and needs, informs the formulation of an appropriate treatment plan.

Often, the most effective treatment involves a combination of approaches. For instance, in the case of a sudden episode of vestibular neuritis triggered by a viral infection, the initial treatment focuses on combating the virus with medications, potentially involving intratympanic injections within the first few days to weeks. This helps prevent further vestibular complications and facilitates at least partial, if not complete, recovery.

Subsequently, vestibular rehabilitation, tailored to each patient based on their results and conditions, becomes a crucial treatment option to restore normal balance, even in challenging situations.

On the other hand, the treatment for vestibular and balance disorders isn’t always straightforward. Resorting to over-the-counter medications or those readily available in pharmacies can undermine the underlying condition and may even lead to psychogenic issues like Persistent Postural-Perceptual Dizziness (PPPD).

Vertigo as a Symptom of Other Conditions

Vertigo in Pregnancy

Vertigo can also occur during pregnancy, and it is important for pregnant individuals who experience vertigo to understand the causes, treatment options, and ways to manage their symptoms. During pregnancy, the hormonal changes may affect the inner ear balance, leading to benign positional vertigo. The good news is that most cases of vertigo in pregnancy are temporary and resolve on their own after childbirth. However, it is important to consult with a healthcare provider to ensure the safety of treatment options during pregnancy. Staying hydrated, avoiding triggers, and practising relaxation techniques may help in managing symptoms of vertigo, a symptom, during pregnancy.

In certain instances, symptoms of vertigo, including lightheadedness and dizziness, may continue even after childbirth. In such situations, it’s crucial for the patient to seek advice from a vestibular and balance specialist. This will facilitate a quicker recovery and help prevent any complications like causes inflammation inside your ear which could arise from delayed treatment.

What is Vestibular Migraine

An Illustration of a human with high activity of brain leading to Migraines and and Vertigo called Vestibular Migraine

Also known as migrainous vertigo, a vestibular migraine is a type of migraine that primarily affects the balance and spatial orientation of an individual, making them feel dizzy. The vestibular system, which includes parts of the inner ear and brain, regulates our balance and eye movements. A migraine affecting the central nervous system, which is part of the brain, can result in a vestibular migraine, a type of dizziness. Symptoms can vary from person to person; however, they typically involve dizziness, vertigo, unsteadiness, or problems with balance and coordination. Some individuals may experience visual disturbances or sensitivity to light and sound. Unlike other migraines, vestibular migraines may not always involve a headache. The cause of vestibular migraines, which is a common cause of vertigo, isn’t fully understood, although it’s believed that changes inside your ear combined with changes part of the brain caused by a migraine are responsible. Treatment usually involves medication to control symptoms and prevent future episodes of migraines and, in some cases, vestibular rehabilitation, mindfulness-based techniques and lifestyle change to help cope with balance issues.

Vertigo post Head injury

Vertigo due to head injury is a common neurological problem often encountered in emergency departments. It presents as a spinning sensation that is caused when there is damage or disruption to the inner ear or brain areas that process balance and spatial orientation. This disorientating condition may be accompanied by nausea, vomiting, difficulty in standing or walking and in severe cases, loss of consciousness. Following a head injury, bruising or swelling in these areas can disturb the sense of balance, leading to vertigo. The severity and duration of vertigo post head injury, which is a common cause of vertigo, can vary greatly between individuals, depending on the extent of the damage. A comprehensive evaluation including a physical and neurological examination is normally conducted to assess the injury and prescribe appropriate treatment. Rehabilitation exercises often play a crucial role in recovery, improving balance and minimizing the disruptive impact of vertigo on patients’ daily activities. However, if symptoms persist, additional interventions such as medication or surgery may be required. It is vital to seek immediate medical attention following a head injury to assess any potential complications and ensure proper treatment.

When Should You Call Your Doctor About Your vertigo and dizziness Symptoms?

It’s normal to experience occasional spells of vertigo and dizziness due to things like exhaustion, dehydration, or sudden changes in movement. However, if these symptoms persist or become more severe, it’s important to consult your doctor or vestibular specialist. Also, reach out to your doctor if your vertigo and dizziness get worse despite resting and taking over-the-counter medication. If you are struggling to perform daily tasks or your symptoms are causing significant distress, don’t wait to seek help from your doctor or by vestibular specialist.

When should you Seek Out Emergency Care for vertigo or dizziness?

Vertigo or dizziness can often be harmless, but in certain instances, it may necessitate emergency medical attention. If dizziness or vertigo symptoms are accompanied by other severe symptoms such as headache, chest pain, difficulty breathing, fainting or sudden loss of balance, immediate emergency care should be sought. This could indicate more serious conditions like a stroke or heart attack. If you’re experiencing recurrent or persistent bouts of vertigo or feeling dizzy, it’s warranted to consult with a healthcare professional. Additionally, if you notice any changes in speech, vision, or motor control, including difficulty walking or sudden clumsiness, a visit to the ER (Emergency) becomes crucial. These could indicate neurological conditions that require immediate intervention. Also, if the vertigo or dizziness follows a head injury, trip to an emergency room is necessary. Hence, it’s critical to be vigilant about these symptoms and understand when to treat dizziness as an emergency rather than dismissing it as a minor concern.

Conclusion

Vertigo is the feeling of spinning and is typically a symptom of an underlying condition, rather than a disease within itself. Its primary causes are usually conditions related to the inner ear or brain, which are critical for maintaining body balance. After exhaustive tests and investigations, depending on the cause, various treatment approaches are recommended ranging from simple exercises, dietary changes, medication, to surgery in extreme cases. The conclusion of vertigo often varies greatly with individuals. Some experience sporadic or mild episodes which diminish over time, while others grapple with severe vertigo impacting their daily life. Lifestyle and dietary modifications along with therapeutic interventions can usually eliminate vertigo, the symptom that can cause symptoms of imbalance and dizziness. However, in severe or persistent cases, further medical or surgical interventions might be necessary. It is important to consult healthcare professionals to understand the unique condition and an appropriate treatment plan. The definitive conclusion of vertigo is often holistic treatment with the aim of relieving symptoms, addressing underlying causes and improving the quality of life.

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