Vertigo is a special type of dizziness that creates a false perception of motion and rotation. You may feel that your head is spinning, or you are static but the room is revolving around you. This is different from other forms of dizziness such as feeling faint or lightheaded. With severe vertigo it will be difficult to keep balance and nausea and vomiting will accompany. Sudden movements of the head may trigger an episode. Severe vertigo is an unsettling experience.
Mechanism and Types of Vertigo
It goes without saying that ears are meant for hearing. Our ears have another very important function: balance.
The inner ear not only contains the sensory receptors for hearing, it lodges the body’s apparatus for balance.
Important components of this apparatus are the semicircular canals. Information regarding balance is transmitted from the inner ear along a nerve to the brainstem and onwards to the brain.
Problems at any of these levels can disturb balance and give rise to the sensation of vertigo.
When the cause is in the inner ear or along the nerve it is termed peripheral vertigo. When the origin is in the brainstem or higher up, it is called central vertigo. The majority of people with the condition have peripheral vertigo.
Causes of vertigo
Causes of peripheral vertigo include:
- Benign paroxysmal positional vertigo (BPPV)
- Trauma
- Infections
- Meniere’s disease
- Medicines
- Nerve tumour
Causes of central vertigo include:
- Stroke
- Trauma
- Intracranial tumour
Symptoms
Vertigo is not a disease per se, but a symptom of an underlying pathology.
If it is severe and depending upon the cause, concomitant symptoms may include:
- Nausea
- Vomiting
- Falls
- Headache
- Vision problems
Central vertigo may present with neurological deficits such as:
- Speech problems
- Difficulty swallowing
- Weakness on one side of the body
The more common causes, such as benign paroxysmal positional vertigo (BPPV), infections and inflammation give rise to self-limiting attacks that will resolve over time. In most cases the resolution will be for good. BPPV can be recurrent but is still considered benign. Central causes, though less common, manifest as a more intractable vertigo.
Treatment and Management principles for Vertigo
Vertigo management will first focus on taking care of treatable causes. Once little else can be done in that regard, further efforts will be directed at symptomatic relief of the vertigo itself. Treatments can include:
The Epley manoeuvre, a type of canalith repositioning procedure, has an encouragingly high cure rate for BPPV. Since BPPV is one of the most common causes of vertigo, the Epley manoeuvre is good news for many.
Inner ear infection and inflammation will resolve either spontaneously or with appropriate medication. Patients in the meantime are counselled to decrease activity levels and head movements.
Medicines for the symptomatic relief of vertigo include prochlorperazine, antihistamines such as promethazine and benzodiazepines such as diazepam.
These medicines are recommended for short term use only.
Vestibular rehabilitation training (VRT) attempts to train your brain to adapt to and ignore the abnormal sensation and use other signals to maintain balance.
References
- Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2008;139:S47–81.
- Thompson TL, Amedee R. Vertigo: A review of common peripheral and central vestibular disorders. Ochsner J. 2009;9:20–6.
- Hilton M, Pinder D. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews. 2004;(2)CD003162.
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