What Makes Vertigo a Frigthening Experience?

Vertigo is the sense of the world spinning, rotating, or rocking that is experienced even when a person is not moving at all.

Some patients use the term vertigo interchangeably with dizziness to describe a variety of symptoms, ranging from balance disorders and difficulty with walking to motion sickness or lightheadedness.

However, most health care professionals consider vertigo to be a specific complaint that involves the balance centers of the inner ear and the brain.

The inner ear is not involved with hearing. It is composed of three semicircular canals, positioned at right angles to each other, that are lined with sensitive nerve cells, which act like a gyroscope for the body.

This system provides instantaneous feedback to the brain, along with vision in the body, regarding our position in space.

Dizziness is the sensation of feeling lightheaded as if you are weak and will pass out. Lightheadedness is often caused by a decrease in blood supply to the brain.

Vertigo is a feeling that you are dizzily turning around or that your surroundings are turning around you.

Vertigo is medically distinct from dizziness, lightheadedness, and unsteadiness in that vertigo involves the sensation of movement.

Vertigo may be caused by disturbances of the inner ear and the balance centers of the brain.

What are the signs and symptoms of vertigo?

The symptoms of vertigo include a sense of spinning, whirling, or loss of balance. These symptoms can be present even when someone is perfectly still.

Movement of the head or body, like rolling over in bed, can escalate or worsen the symptoms. Many people experience associated nausea or vomiting.

While a patient may use the word dizziness, it is important for a health care professional to understand whether the patient is describing a sensation of spinning (vertigo) or whether dizziness is describes another symptom like lightheadedness, fainting, or nearly passing (syncope, near-syncope).

Physical examination often shows signs of abnormal eye movements (called nystagmus).

Health care professionals may try to reproduce the symptoms by abrupt movements of the patient's body or head, looking for nystagmus that can be produced by these maneuvers.

The patient may be asked to perform coordination tasks to make certain that the brain performs normally.

What causes vertigo?

There are a number of different causes of vertigo. Vertigo can be defined based upon whether the cause is peripheral or central.

Central causes of vertigo arise in the brain or spinal cord, while peripheral vertigo is due to a problem within the inner ear.

Peripheral causes:

The structures in the inner ear may become inflamed spontaneously. Small crystals or stones found normally within the inner ear can become displaced and cause irritation to the small hair cells within the semicircular canals, leading to vertigo. This is known as benign paroxysmal positional vertigo (BPPV).

Infection of the vestibular nerve can cause dizziness, or vertigo. This is called vestibular neuronitis, vestibular neuritis, or labyrinthitis.

Fluid buildup within the inner ear or the endolymphatic system causes Ménière's disease, vertigo that also includes hearing loss and tinnitus (ringing in the ear). The cause of this fluid accumulation is unknown.

Acoustic neuromas, tumors of the vestibular nerve, may also present with these three symptoms.

Central causes:

Concussion or traumatic brain injury may be associated with vertigo.

Strokes may cause vertigo and loss of coordination.

Multiple sclerosis

Tumors of the brain and spinal cord

Some patients with a type of migraine headache called vestibular migraine may develop vertigo as a symptom.

What are the risk factors for vertigo?

Head injuries may increase the risk of developing vertigo. Ear infections may impact the vestibular nerve, leading to development of labyrinthitis.

Vertigo may be a side effect of many medications, including some antiseizure medications, blood pressure medications, antidepressants, and even aspirin. For some people, drinking alcohol can cause vertigo.

How do medical professionals diagnose vertigo?

During an evaluation for vertigo, the health care professional usually asks questions to take a history of the events and symptoms associated with vertigo.

This includes medications taken (even over-the-counter medications), recent illnesses, and prior medical problems. Even seemingly unrelated problems may provide a clue as to the underlying cause of the vertigo.

After getting the person's medical history, a medical professional then performs a physical examination. This often involves a full neurologic exam to evaluate brain function and determine whether the vertigo is due to a central or peripheral cause.

Signs of nystagmus (abnormal eye movements) or incoordination can help pinpoint the underlying problem.

A physician then performs a test to try to reproduce vertigo. This test involves abruptly repositioning the patient's head and monitoring the symptoms that might be provoked.

Some cases of vertigo may require an MRI or CT scan of the brain and inner ears to exclude a structural problem like stroke, multiple sclerosis, or acoustic neuroma, a non-malignant tumor.

Some of the most effective treatments for peripheral vertigo include particle repositioning movements.

The most well-known of these treatments is the Epley maneuver or canalith repositioning procedure.

During this treatment, specific head movements lead to movement of the loose crystals (canaliths) within the inner ear. By repositioning these crystals, they cause less irritation to the inner ear and symptoms can resolve.

Because these movements can initially lead to worsening of the vertigo, they should be done by an experienced health care professional or physical therapist.

Medications may provide some relief but are not recommended for long-term use. Medical professionals often prescribe meclizine for persistent vertigo symptoms that may be effective.

Benzodiazepine medications like diazepam (Valium) are also effective but may cause significant drowsiness as a side effect. Other medications may be used to decrease nausea or vomiting.

Medications treat the symptoms but do not "cure" the vertigo.

For individuals with Ménière's disease, a consistent low-salt (low-sodium) diet is often recommended. This helps to decrease some of the fluctuations of fluid within the vestibular system, diminishing some of the symptoms caused by Ménière's disease.

If a medical professional diagnoses peripheral vertigo, then performing vestibular rehabilitation exercises routinely may help prevent recurrent episodes.

When vertigo persists, evaluation for any underlying structural problems of the brain, spinal canal, or inner ear may be necessary.