Vertigo

Vertigo is a dizzy, spinning feeling that you or the space around you is moving when it is not. It is similar to motion sickness.

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Causes and types of vertigo

The two main types of vertigo are peripheral vertigo and central vertigo.

Peripheral vertigo

Peripheral vertigo is a problem with the inner ear or vestibular nerve, which connects the inner ear to the brain.

Peripheral vertigo makes up the vast majority of vertigo cases. Its typical causes include:

  • Acute peripheral vestibulopathy (APV). Inflammation of the inner ear, which causes a sudden onset of vertigo.
  • Benign paroxysmal positional vertigo (BPPV). The most common reason for vertigo, it is brought on by head movements that can affect calcium crystals floating in the semicircular canals of the ear, such as turning your head, moving it up and down or rolling over in bed. A blow to the head can also cause BPPV. There’s often no known cause other than head movement, called idiopathic BPPV.
  • Meniere’s disease. An inner ear disorder that affects balance and hearing.

In rare cases, peripheral vertigo is caused by perilymphatic fistula (abnormal communication between the middle ear and the inner ear), cholesteatoma erosion (erosion caused by a cyst in the inner ear) or otosclerosis (abnormal bone growth in the middle ear).

Central vertigo

Central vertigo results from a problem in the brain, particularly the cerebellum, the part of the hindbrain that controls coordination of movements and balance.

Causes of central vertigo include:

Central vertigo is not very common, and treatment would focus on the underlying condition to address vertigo and all other symptoms.

Signs and symptoms of vertigo

(and when to see your primary care provider)

Symptoms

When you have a bout of vertigo, you feel like you or the space around you is spinning and moving, when in fact everything is still.

The most common type of vertigo, BPPV, may also cause symptoms such as:

  • Dizziness.
  • Feeling of being pulled down or in one direction.
  • Floating or rocking sensation.
  • Loss of balance or unsteadiness.
  • Nausea and/or vomiting.

These symptoms usually last less than 1 minute, and they come and go.

When to see your provider

You should see your primary care provider for a check-up if your symptoms keep recurring, do not go away or they last for a while when they occur.

You should seek immediate medical attention if you have vertigo plus any of these symptoms:

  • Double vision or loss of vision.
  • Falling or difficulty walking.
  • Fever.
  • Leg or arm weakness.
  • Loss of consciousness.
  • Hearing loss.
  • New, different or severe headache.
  • Numbness or tingling.
  • Trouble speaking.

Treatment options for vertigo

Your primary care provider can form the right treatment plan for your vertigo symptoms and any underlying condition. Your plan may include bed rest, medications, physical therapy or a procedure.

Medications

  • Diuretics. Prescribed for Meniere’s disease along with other medications.
  • Vestibular blocking agents (VBAs). A commonly prescribed type of medication, including:
    • Antiemetics (prochlorperazine, metoclopramide).
    • Antihistamines (promethazine, betahistine).
    • Benzodiazepines (diazepam, lorazepam).

Rehabilitation therapies

Vestibular rehabilitation therapy (VRT). Uses head and body exercises plus eye movement to retrain your brain to recognize and process signals from the vestibular system, coordinating them with vision and proprioception.

BPPV procedures

BPPV (benign paroxysmal positional vertigo) usually goes away on its own, but your provider may recommend one of these procedures to help with your symptoms:

  • Canalith repositioning. This is first done in your provider’s office, then you can do it at home. You will learn head movements that will move particles from the fluid-filled semicircular canals of your inner ear into a tiny bag-like open area that houses one of the otolith organs in your ear.
  • Home Epley maneuver. A similar type of exercise that you do at home, where a series of head movements dislodges the crystals from the semicircular canals and moves them back to the utricle (a nearby part of the ear) where they belong.

If these aren’t effective, your provider may recommend a surgical procedure in which a bone plug is used to block the portion of your inner ear that is causing the dizziness.

The right diagnosis leads to the right treatment

Your primary care provider will work with you to identify the cause of your vertigo, and will discuss the best treatment options for your case.

Treating the underlying condition that results in vertigo may involve a referral to a specialist. It is time to stop vertigo from interfering with your life.

References

National Library of Medicine. Vertigo (https://www.ncbi.nlm.nih.gov/books/NBK482356/)

MedlinePlus: National Library of Medicine. Vertigo-associated disorders (https://medlineplus.gov/ency/article/001432.htm)