Vertigo:
(Dizziness)
by Karen Schroeder, MS, RD

Definition:
Vertigo is a feeling of spinning or whirling when you are not moving. Or, it can be an exaggerated feeling of motion without moving your body. It is the most common form of dizziness, but is different from lightheadedness (the feeling of nearly passing out).

Causes:
Vertigo is usually caused by problems in the nerves and structures of the inner ear, called the vestibular system. This system senses the position of your head and body in space as they move.

Vertigo can occur with the following conditions:

Benign Paroxysmal Positional Vertigo (BPPV) – tiny particles collect in the canals of the inner ear and push ear fluid against hair-like sensors in the ear. BPPV may result from:

Head injury
Viral infection
Disorders of the inner ear
Age-related breakdown of the vestibular system
Labyrinthitisin (Vestibular Neuritis) – inflammation of the inner ear. This often follows an upper respiratory infection.

Meniere's Disease – a condition resulting from fluid buildup in the part of the inner ear called the labyrinth. This vertigo usually occurs along with hearing loss and tinnitus.

Acoustic Neuroma – slow-growing, noncancerous tumor of the acoustic nerve. This condition often occurs with hearing loss and tinnitus (ringing in the ear).

Vertebrobasilar Insufficiency – diminished blood flow to the base of the brain often caused by atherosclerosis (deposits of fat in the arteries). It is usually accompanied by other neurological symptoms.

Medications and Other Substances such as:

Aspirin
Streptomycin
Gentamicin
Caffeine
Alcohol
Anticonvulsants
Antihypertensives
Tranquilizers

Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition.

Head injury
Viral upper respiratory infection
Cerebrovascular disease - deposits of fat in blood vessels leading to the brain

Symptoms:
Most cases of vertigo occur with nystagmus, an abnormal, rhythmic, jerking eye movement. Other symptoms depend on the condition causing the vertigo.

BPPV – symptoms may last only a few seconds, but may come and go for weeks or even years.

Sudden, short (15-30 seconds), intense bursts of dizziness when you move your head a certain way, roll over in bed, or tip your head back to look up. Symptoms do not occur when the head is held still.
Feeling like the room is spinning
Lightheadedness
Imbalance
Nausea and/or vomiting
Lingering fatigue

Viral Labyrinthitis (Vestibular Neuritis): Sudden, intense vertigo, lasting for several days to one week and often occurring with nausea and vomiting

Meniere's Disease: sudden vertigo attacks lasting between minutes and hours and typically occurring with prominent hearing loss and tinnitus

Vertebrobasilar Insufficiency –

True vertigo
Visual disturbances
Difficulty speaking
Disorientation
Incoordination

Diagnosis:
The doctor will ask about your symptoms and medical history, and perform a physical exam. In addition, the following tests may be performed:

Vestibular maneuvers
Suditory tests
Blood pressure test, both lying down and standing up
ENG (electronystagmogram) – to check for nystagmus
MRI (magnetic resonance imaging) – to look for problems in the brain, such as a stroke or brain tumor
Rotatory chair test in certain situations (for difficult cases)
Auditory evoked potential studies – to check for nerve conduction in the brain auditory nerve and brain stem (severe or persistent cases)

Treatment options:
Vertigo due to BPPV, labyrinthitis, or vestibular neuritis may subside on its own, usually within six months of onset (but it may sometimes take longer). The most common treatment used is by medications.

To treat vertigo and nausea:

Meclizine (Antivert, Bonine, Dramamine, Meclicot, Medivert)
Dimenhydrinate (Calm X, Dinate, Dramamine, Dramanate, Hydrate, Triptone)
Promethazine (Anergan, Antinaus, Pentazine, Phenazine, Phencen, Phenergan, Phenerzine, Phenoject, Pro-50, Promacot, Pro-Med 50, Promet, Prorex, Prothazine, Shogan, V-Gan)
Scopolamine (Transderm-Scop)
Atropine
Diazepam (Diastat, Diazepam Intensol, Dizac, Valium)

To treat Meniere's disease:

Low-salt diet
Diuretics
Sedatives
Antihistamines
Antibiotics injected into the middle ear

Maneuvers most often used to treat BPPV:

Semont maneuver – rapidly moving the patient from lying on one side to the other (also called liberatory maneuver)

Epley maneuver – head exercises to move the loose particles to a place in the ear where they won't cause dizziness (also called modified liberatory maneuver)

If you continue to experience vertigo, the maneuvers can be repeated, or more difficult maneuvers such as Brandt-Daroff exercises can be done.

Surgery: If symptoms persist for a year or more, and cannot be controlled by the maneuvers, a surgical procedure called "canal plugging" may be recommended. Canal plugging completely stops the posterior semicircular canal's function without affecting the functions of the other canals or parts of the inner ear. This procedure poses a small risk to hearing. Other surgical procedures include removing parts of the vestibular nerve or semicircular canals in the inner ear.

Treatment of the underlying cause: Vertigo can be a symptom of another medical condition, such as a heart problem or neurological problem. Once that condition is treated, vertigo should stop. Or in this case the underlying medical problem should be treated to help relieve the vertigo.

Prevention:
If you are prone to vertigo, the following precautions may help prevent an episode:

Rest your head on two or more pillows while sleeping.
Avoid sleeping on the "bad side" of your head.
In the morning, get up slowly and sit on the edge of the bed for a minute before standing.
Avoid bending down to pick items up.
Avoid extending your neck, such as to get something out of a cabinet.
Be careful at the dentist's office, hair salon, or in sports activities or positions where your head is flat or extended.

Organizations:

Vestibular Disorders Association

MEDLINEplus: Dizziness and Vertigo

Sources:

American Academy of Family Physicians

Vestibular Disorders Association

Last reviewed May 2003 by Elizabeth Smoots, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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