Vertigo is one of the most common medical complaints. Vertigo is the feeling that you are moving when you are not. Or it might feel like things around you are moving when they are not. Vertigo can feel similar to motion sickness. Patients generally refer to vertigo as “feeling dizzy.” Vertigo is not the same as lightheadedness.
The most common causes of vertigo are benign paroxysmal positional vertigo (BPPV), Meniere’s disease, and acute onset vertigo.
Treatment depends on the cause. Popular treatments include special medications called vestibular blocking agents.
The outlook for vertigo-associated disease (VAD) depends on the cause. Acute onset vertigo attacks generally last 24 to 48 hours. Meniere’s disease does not have a cure.
There are two categories of vertigo. Peripheral vertigo occurs as a result of a problem in the inner ear or the vestibular nerve. The vestibular nerve connects the inner ear with the brain. Central vertigo occurs when there is a problem in the brain, especially the cerebellum. The cerebellum is the part of the hindbrain that controls coordination of movements and balance.
Causes of Peripheral Vertigo
According to research published in Australian Family Physician, 93 percent of vertigo cases are peripheral vertigo caused by one of the following (Kuo et al., 2008):
- benign paroxysmal positional vertigo (BPPV): vertigo brought on by specific changes in the position of your head—it is caused by calcium stones floating in the semicircular canals of the ear
- Meniere’s disease: an inner ear disorder that affects balance and hearing
- acute peripheral vestibulopathy (APV): inflammation of the inner ear causing sudden onset of vertigo
Rarely, 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
- otosclerosis: abnormal bone growth in the middle ear
Causes of Central Vertigo
Causes of central vertigo include
- a tumor in the cerebellum
- multiple sclerosis
Vertigo feels similar to motion sickness.
Symptoms of VAD include:
- stumbling while walking
Diagnosis of VAD depends on:
- whether or not you have true vertigo
- whether the cause is peripheral or central
- whether life-threatening complications are present.
Doctors can separate dizziness from vertigo by asking a simple question: “Is the world spinning, or are you lightheaded?” If the world appears to be spinning, you have true vertigo. If you are lightheaded, you are experiencing dizziness.
Tests to determine the type of vertigo include:
- head-thrust test (the patient looks at the examiner’s nose; the examiner makes a quick head movement to the side and looks for correct eye movement)
- Romberg test (the patient stands with feet together and eyes open, then closes eyes and tries to maintain balance)
- Fukuda-Unterberger test (the patient is asked to march in place with eyes closed without leaning from side to side)
Imaging tests for VAD include:
- computed tomography (CT) scan
- magnetic resonance imaging (MRI)
Warning signs of serious complications include:
- sudden vertigo not affected by change of position
- vertigo associated with neurological signs such as severe gait and truncal ataxia (lack of muscle coordination)
- vertigo associated with deafness and no history of Meniere’s disease
Treatment depends on the cause. Vestibular blocking agents (VBAs) are the most popular type of medication used.
Vestibular blocking agents include:
- antihistamines (promethazine, betahistine)
- benzodiazepines (diazepam, lorazepam)
- antiemetics (prochlorperazine, metoclopramide)
Treatments for specific causes of vertigo include:
- acute vertigo attack: bed rest, VBAs, antiemetic medications
- BPPV: Epley repositioning maneuver, a specific movement which loosens the calcium crystals and clears them from the ear canal
- acute peripheral vestibulopathy: bed rest, VBAs
- Meniere’s disease: bed rest, antiemetic medications, and VBAs
Factors that increase your risk of VAD include
- cardiovascular diseases (especially in elderly people)
- recent ear infection (causes imbalance in the inner ear)
- history of head trauma
- medications (antidepressants, antipsychotics, etc.)
The outlook for VAD depends on the cause. APV usually lasts 24 to 48 hours. Meniere’s disease has no cure. You will need to manage the symptoms.