Vertigo: Causes and Treatments
Vertigo causes dizziness, balance issues but can be overcome
Vertigo causes dizziness, balance issues but can be overcome
You’re dizzy and the room is spinning. Or you might feel off-balance as if you were swaying while standing still. You don’t know what caused it, how long it will last or how to stop it. These are common signs of vertigo.
Vertigo is more than just feeling dizzy. It is a specific kind of dizziness that makes you feel like you are moving. Many people struggle to keep their balance. They often feel sick and may get motion sickness. Walking or doing daily tasks can become difficult.
Vertigo episodes can vary in duration, depending on the underlying cause. They can last from a few seconds to a few minutes. In severe cases, they may last for hours or more.
“Vertigo, in general, is the sensation of movement and disorientation in space,” says Hessam Khalili Tabrizi, MD, a family medicine physician at Scripps Coastal Medical Center Solana Beach. “It can be a diagnosis, and it can be a symptom.”
Make an appointment with your doctor if you have vertigo and it is getting worse. Avoid driving and activities that require full balance, such as climbing a ladder, if you have symptoms.
What are types of vertigo?
Vertigo has two main causes: inner ear problems (peripheral vertigo) and brain disorders (central vertigo). Treatment depends on the type of vertigo diagnosed.
Why is the inner ear so important?
Vertigo is often caused by an inner ear problem and triggered by head movements. The inner ear contains the vestibular system, which plays a central role in our sense of balance and spatial orientation.
The vestibular system consists of five structures. Three are called semicircular canals and are involved in rotational movement. The other two are called otolith organs, consisting of the utricle and saccule. They are involved in horizontal (forward and reverse) and vertical (up and down) movement.
When the vestibular system functions properly, it helps us maintain balance, stand upright and move easily. It works closely with our eyes and muscles to keep us stable and coordinated.
When this system does not work properly, it can cause dizziness, vertigo and balance issues. Many people may not realize that their symptoms are related to an inner ear problem.
Peripheral vertigo
Peripheral vertigo is the most common type of vertigo. It is caused by inner ear issues that disrupt the brain’s ability to process balance and spatial orientation.
What is BPPV?
The most common cause of peripheral vertigo is benign paroxysmal positional vertigo (BPPV). It can cause dizziness, a spinning sensation, lightheadedness, loss of balance and nausea.
BPPV is usually triggered by certain head movements that cause displacement of calcium carbonite crystals, called otoconia.
These crystals play a crucial role in the body’s ability to sense gravity and linear acceleration. When they enter the semicircular canals, they disrupt the normal fluid flow that the canals use to sense head rotation.
This disruption causes the brain to get incorrect information about head position and movement and can lead to brief episodes of vertigo, especially with changes in head position. Common triggers include turning over in bed, bending down or looking up.
It’s not always clear why these crystals get dislodged. It may be related to aging, minor head injuries or other inner ear problems.
In many cases, BPPV resolves on its own. In other cases, a technique called the Epley maneuver can treat the condition using a series of guided head movements. They are designed to move the displaced crystals back to their original location, where they do not cause symptoms.
What is Meniere’s disease?
Meniere’s disease, an inner-ear disorder that causes peripheral vertigo, typically affects adults. It happens when fluid builds up in the inner ear’s labyrinth and disrupts the normal balance and hearing signals between the ear and the brain.
Meniere’s disease can cause severe vertigo, nausea, hearing loss, tinnitus or ringing in the ear and pressure in the ear. After an episode, hearing may get better for a while, but the symptoms often come back.
This condition is often managed with changes to diet and lifestyle. Eating less sodium can help reduce fluid buildup in the inner ear. Diuretic medications also may be effective. Surgery may be considered as a last resort.
What is labyrinthitis?
Labyrinthitis is inflammation of the labyrinth, often triggered by an infection. This infection is usually viral but can be bacterial too. Symptoms include severe vertigo, dizziness, balance issues, headaches, ear pain, vision disturbances, tinnitus and hearing loss.
What is vestibular neuritis?
Vestibular neuritis is inflammation of the vestibular nerve, often caused by a viral infection. This nerve sends balance and position information from the inner ear to the brain. This condition leads to severe dizziness and balance problems but does not impact hearing.
Both labyrinthitis and vestibular neuritis usually improve on their own, though recovery can vary. They can also be treated with medicine to reduce inflammation or relieve nausea and physical therapy.
Central vertigo
Central vertigo is less common than peripheral vertigo and stems from problems in the central nervous system, such as stroke, multiple sclerosis or brain tumors. Symptoms may also include slurred speech, double vision or coordination problems.
Treatment depends on the cause and may include medication, surgery or physical therapy.
Diagnosing vertigo
Your primary care physician can conduct initial evaluations to determine why you feel dizzy or have balance issues. “It’s super important to determine what type it is before we get to the treatment,” Dr. Tabrizi says.
Evaluations often involve checking for dizziness triggered by specific eye or head movements. If the cause of vertigo is not clear, they may order further tests, including imaging tests.
Your doctor may also refer you to an ear, nose and throat doctor for more specific diagnostic tests.
A test called electronystagmography uses electrodes to detect abnormal eye movement. This can help determine if symptoms are related to an inner ear disease. Another test, called videonystagmography, uses special goggles with a camera to record eye movements.
A caloric test is part of both tests. It involves introducing warm or cool water into the ear canal to help assess how well the inner ear’s balance system is working.
A neurologist may get involved if a neurological condition is suspected as the cause of a patient’s symptoms.
Home treatments
There are several home treatments and exercises that can help with vertigo symptoms. The Epley maneuver is usually done by a health care provider. However, you can also do it at home with proper instructions. This maneuver helps with vertigo caused by BPPV.
Sometimes, dehydration or diet can make vertigo worse. Drinking enough fluids and avoiding caffeine, alcohol and nicotine may help reduce symptoms. Resting and managing stress can also ease symptoms. Fatigue and stress can make the condition worse.
It’s important to talk to your doctor before starting any self-treatment for vertigo. They can confirm your diagnosis and provide guidance for safe and effective treatment at home.