From the Guidelines
Persistent vertigo is most commonly caused by benign paroxysmal positional vertigo (BPPV), Meniere's disease, vestibular neuritis or labyrinthitis, vestibular migraine, and acoustic neuroma, as well as other conditions such as multiple sclerosis, head injuries, and certain medications. The causes of persistent vertigo can be complex and multifaceted, involving various systems and structures within the body. According to the clinical practice guideline on benign paroxysmal positional vertigo (update) 1, patients with persistent symptoms after initial treatment of BPPV are classified as treatment failures and require reevaluation to identify underlying peripheral or CNS disorders.
Some of the key causes of persistent vertigo include:
- Benign paroxysmal positional vertigo (BPPV), where calcium crystals in the inner ear become dislodged 1
- Meniere's disease, characterized by fluid buildup in the inner ear 1
- Vestibular neuritis or labyrinthitis, resulting from viral infections that inflame the inner ear 1
- Vestibular migraine, a neurological condition causing vertigo episodes 1
- Acoustic neuroma, a noncancerous tumor on the vestibular nerve 1
- Multiple sclerosis, head injuries, certain medications (like aminoglycoside antibiotics, anti-seizure drugs, and some antidepressants), and anxiety disorders 1
Treatment depends on the underlying cause and may include:
- Vestibular rehabilitation exercises
- Medications like meclizine (25-50mg every 4-6 hours as needed) or diazepam (2-10mg daily) for symptom relief
- Specific treatments like the Epley maneuver for BPPV 1
- For persistent symptoms, a thorough evaluation by a healthcare provider is essential, as they may need to order tests such as MRI, CT scans, or specialized vestibular testing to determine the exact cause and appropriate treatment plan 1.
From the Research
Causes of Persistent Vertigo
The causes of persistent vertigo can be categorized into several types, including:
- Otological vertigo, which includes disorders of the inner ear such as Ménière's disease, vestibular neuritis, benign paroxysmal positional vertigo (BPPV), and bilateral vestibular paresis 2
- Central vertigo, which includes entities such as vertigo associated with migraine and certain strokes 2, 3
- Psychogenic vertigo, which occurs in association with disorders such as panic disorder, anxiety disorder, and agoraphobia 2
- Undetermined and ill-defined causes of vertigo, which make up a large remainder of diagnoses 2
Specific Causes
Some specific causes of persistent vertigo include:
- Benign paroxysmal positional vertigo (BPPV), which is the most common cause of vertigo 3, 4
- Vestibular migraines, which can cause vertigo and are often treated with prophylactic agents such as L-channel calcium channel antagonists, tricyclic antidepressants, and beta-blockers 2, 3
- Meniere's disease, which is a disorder of the inner ear that can cause vertigo, tinnitus, and hearing loss 2, 3
- Anxiety disorders, which can cause psychogenic vertigo 2, 3
- Persistent Postural Perceptual Dizziness (PPPD), which is a chronic functional vestibular disorder that can arise in patients suffering from episodic vestibular disorders such as BPPV, Vestibular Migraine (VM), and Meniere Disease (MD) 5
Risk Factors
Certain factors can increase the risk of developing persistent vertigo, including:
- A history of multiple vestibular comorbidities, such as BPPV, VM, and MD 5
- The presence of underlying neurological or orthopaedic problems, such as visual problems, proprioceptive deficit, or additional neurological or orthopaedic problems 6
- Lack of mobility or confidence, such as fear of falling or psychological disorders 6