Vertigo

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Vertigo is a symptom rather than a condition itself. It is a sensation of the environment moving or spinning around you. This unusual feeling can be barely noticeable, or it may be so severe that you may find it difficult to keep your balance and perform everyday tasks.

Certain attacks of vertigo can develop suddenly and last for a few seconds in some instances, or considerably longer depending on the severity. If you have severe vertigo, your symptoms may be constant and last for several days, making normal life much more difficult to manage.

Additionally, there are two main types of vertigo that present to most patients:

 

Types of Vertigo

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Central vertigo

Central vertigo occurs when there’s a glitch in the brain, particularly in an area of the brain called the cerebellum. The cerebellum is a major structure that is located near the brain stem. This part of the brain is responsible for coordinating voluntary movements. It is also responsible for a number of functions, including motor skills such as balance, coordination, and posture.

 

Peripheral vertigo

Peripheral vertigo is caused by a problem in areas of the inner ear or the vestibular nerve, which connects the inner ear and the brain. This is the most common type of vertigo.

Some studies have discovered a new type of vertigo alongside central and peripheral vertigo – known as recurrent spontaneous vertigo with head-shaking nystagmus (RSV-HSN). Scientists claim that RSV-HSN vertigo can last much longer than that of central or peripheral vertigo.

RSV-HSN involves more severe bouts of motion sickness, with symptoms, including nausea, vomiting, headaches, and intolerance of head motions. These symptoms were proven to last between a week to once a year. However, at this point, the cause of RSV-HSN remains unknown, but the condition does seem to respond well to medications used for central and peripheral vertigo.

Causes & Symptoms

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Vertigo is commonly caused by a problem with the way balance works in the inner ear, although it can also be caused by problems in certain parts of the brain.

Generally, many patients describe vertigo as feeling like their vision is spinning. It might cause you to feel like you’re tilted, rocking, unbalanced, or unsteady.

Oftentimes, these sensations worsen if you are standing up, walking, or moving your head around. Most patients also describe these feelings as physically exhausting and taxing. Sometimes, the sensations can become so severe that you feel nauseated, leading to vomiting.

Other most common causes of vertigo include:

 

Benign paroxysmal positional vertigo (BBPV) 

BBPV occurs when tiny calcium particles are dislodged from their normal location and collect in the inner ear. The inner ear sends signals to the brain about head and body movements relative to gravity. In rare cases, BBPV can happen for no apparent reason and may be associated with age.

 

Labyrinthitis

This condition (vestibular neuritis) is characterized by irritation and swelling of the inner ear. It is typically caused by an inner ear infection or virus. Sudden vertigo symptoms and hearing loss are common in people with labyrinthitis.

 

Ménière’s disease

This is an inner ear disorder thought to be caused by a buildup of fluid and changing pressure in the ear. It can cause episodes of vertigo along with ringing in the ears (also known as tinnitus) and hearing loss.

 

Vestibular neuritis or labyrinthitis

This is an inner ear problem typically related to infection. The infection causes inflammation in the inner ear around nerves that are important for helping the body sense balance.

Symptoms of vertigo include a sense of spinning, loss of balance, or whirling. These symptoms can be present even when someone is perfectly still. Movement of the head or body, such as rolling over in bed, can escalate or worsen the symptoms.

While a patient may report his / her symptoms as dizziness, it is important for a healthcare professional to understand whether the patient is describing a sensation of spinning or whether dizziness is described as another symptom like lightheadedness, fainting, or nearly passing out (also known as syncope).

Who gets Vertigo?

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Certain risk factors linked to vertigo include diabetes, allergies, pregnancy, and age, as described below:

 

  • Age – Vertigo can affect patients who are over the age of 50 – therefore, people who are younger than 50 are less prone to experience this disease. However, vertigo may still affect all ages.

 

  • Gender – Women are more likely to develop vertigo rather than men.

 

  • Excessive alcohol consumption – Patients who have a habit of drinking an excessive amount of alcohol are at a higher risk of developing vertigo.

 

  • Stress – Workers or people in general who tend to experience high levels of stress may be at risk of vertigo.

 

  • Family history – If you have had a family relative who has had vertigo in his or her past can be a sign that you may also have a chance of experiencing this disease.

 

  • Trauma – Patients who have been through trauma-related injuries (such as a car accident) are prone to developing vertigo.

 

  • Diabetes – Sometimes, complications from diabetes can cause hardening of the arteries and less blood flow to the brain, which leads to vertigo symptoms.

 

  • Pregnancy – Dizziness and vertigo may crop up during pregnancy due to hormone changes, low blood sugar levels, pressure on blood vessels caused by an expanding uterus, or the baby pressing on a vein that carries blood to the heart.

 

  • Allergies – Some people have dizziness or vertigo attacks when they’re exposed to certain allergens, such as dust, molds, pollens, dander, or foods.

How Does it Affect You? How Serious is it?

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In some cases, vertigo may be a symptom of a serious or life-threatening condition that should be evaluated immediately in an emergency setting. These complications include the following:

 

  • Brain tumor – A tumor in an area of the brain called the cerebellum can cause vertigo symptoms.

 

  • Encephalopathy – Encephalopathy can play a role alongside other symptoms occurring in the mid-phases of vertigo. Encephalopathy is a general term describing a disease that affects the function or structure of your brain.

 

  • Stroke – A blood clot or bleeding in the brain (otherwise known as a stroke) can cause further symptoms of vertigo.

 

  • Cholesteatoma – This condition is characterized by irregular skin growth in the middle ear, behind the eardrum. It can be brought on by repeated, chronic ear infections.

 

  • Acoustic neuroma – This is a noncancerous tumor that develops on the main nerve leading from your inner ear to your brain.

 

  • Multiple sclerosis – Many patients with multiple sclerosis experience vertigo episodes at some point.

 

  • Medication – Dizziness and vertigo are sometimes side effects of medicines. Anti-seizure drugs, antidepressants, sedatives, blood pressure meds, and tranquilizers are all common drugs that can lead you to experience vertigo attacks.

Recommended Treatment & Rehabilitation

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In order to diagnose vertigo, your doctor will begin by asking about your medical history, including details about your symptoms.

He/she may ask what the sensation of movement or dizziness feels like, how often it occurs, whether it occurs more frequently when you move a particular way or at certain times of the day, and whether you also experience hearing loss of ringing in the ears. Your doctor may also ask if anyone else in your family has ever been diagnosed with a condition affecting balance or hearing. He/she may want to know if you have had an infection, injury, or surgery in the ear or brain.

After processing your medical history, an otolaryngologist will perform a physical exam to look for signs and symptoms of the cause of vertigo. Your doctor will use delicate instruments to magnify and examine the ear canal and eardrum. Then, he / she will examine your eye movements or ask you to track an object from one point in space to another.

Additional tests of the inner ear may be suggested to rule out other conditions. Here are two tests that may be used in cases of a patient living with vertigo:

 

Magnetic Resonance Imaging (MRI)

In some patients with vertigo, doctors may recommend an MRI scan to obtain a closer look at the inner ear and surrounding structures. MRI scans use a magnetic field and radio waves to create computerized, three-dimensional images of the ear and the nerve that carries signals from the inner ear to the brain.

 

Neurological testing

If hearing or sensory tests indicate vertigo of central origin, doctors may refer you to a specialist for neurological testing and treatment.

After a diagnosis has been done, a physiotherapist will design a specific treatment plan depending on the causes associated with your vertigo attacks. If you still have ongoing dizziness and balance problems after vertigo stops, your physiotherapy can target those problems. Some examples include:

 

Lessening your dizziness

If performing certain activities or chores at home cause you to become dizzy, your physiotherapist will show you how to do them in a different way to help reduce dizziness.

 

Regain focus

If simple activities become difficult, or cause fatigue and more dizziness, your physiotherapist will help you work through them. This training will help you get moving again and return to your home and work activities.

Physiotherapy treatments for dizziness can take many types of forms. The types of exercises that your physiotherapist design for you will depend on your unique problems, therefore, here are some exercise examples you can try to help improve symptoms linked to vertigo:

 

Foster maneuver

Firstly, kneel down and place your hands on the floor. Secondly, tilt your head up and back as you wait until any dizziness passes. Place your forehead on the floor, tucking your chin toward your knees. Turn your head 45 degrees to face your left elbow. Hold this position for 30 seconds, then, while keeping your head 45 degrees, raise your head until it’s level with your back and shoulders. Finally, hold for 30 seconds, then raise your head to the fully upright position. Perform this stretch 3 times a day.

 

Epley maneuver

Sit upright in bed. Place your legs straight and put a pillow behind you. Afterward, turn your head 45 degrees to the left. Lie back quickly until your shoulders are on the pillow. Wait for your dizziness to subside, then turn your head 90 degrees to the right without lifting it; holding this position for 30 seconds. Turn your body until you’re lying on your right side. Wait for the dizziness to subside, then sit upright on the right edge of the bed. Repeat this exercise 3 times a day.

 

Brandt-Daroff exercise

Sit in the middle of a bed with your feet on the floor. Turn your head 45 degrees to the right. Without moving your head, lie down on your left side. Wait for the dizziness to pass, then wait 30 more seconds before returning to the starting position. Next, turn your head 45 degrees to the left, then return back to your starting position. Complete this exercise with 1 set of 5 repetitions on each side.

Alternative & Homeopathic Treatment

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Some people with vertigo claim that natural or homeopathic treatments can improve the spinning and dizzy sensations they experience. Some people with vertigo may also benefit from altering their diet. For example, those with Ménière’s disease may find that avoiding certain types of foods or substances can promote fluid balance in the ears and body.

Common culprits that could aggravate vertigo in certain people include salty foods, sugary foods, alcohol, and caffeine. Other studies have shown that a lack of vitamin D can worsen vertigo symptoms in some people. You can increase your levels of vitamin D by taking a supplement, getting more sunlight, or eating foods rich in vitamin D.

Some patients claim that using essential oils, like peppermint, lavender, lemon balm, and ginger can all help improve symptoms of vertigo. While there is some evidence that certain oils have medicinal benefits, the results are often mixed.

Yoga is another good way to improve flexibility and balance, strengthen muscles, and reduce stress. Simple yoga poses (with a yoga mat for added support) may also help symptoms of vertigo. However, you will want to avoid any positions that require sudden forward bends, as these may worsen vertigo symptoms.

Additionally, studies have shown acupuncture may be a safe and effective way to treat vertigo. Acupuncture involves inserting tiny needles into the skin to stimulate certain points on your body.

Other simple remedies include the following below:

 

  • Rest – Sleep deprivation can trigger episodes of vertigo. Try to get at least 7-8 hours of sleep at night to help ease this specific symptom.

 

  • Hydration – It is always recommended to drink enough fluids (either water or beverages contained with electrolytes) to stay hydrated. Some causes of vertigo are linked to dehydration.

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