From the Guidelines
Vertigo is a sensation of spinning or dizziness where you or your surroundings seem to be moving when they are not, and it is often caused by problems with the inner ear which controls balance. According to the clinical practice guideline: benign paroxysmal positional vertigo (update) 1, vertigo is defined as an illusory sensation of motion of either the self or the surroundings in the absence of true motion. Common causes of vertigo include benign paroxysmal positional vertigo (BPPV), where tiny calcium particles dislodge in the inner ear; Meniere's disease, characterized by fluid buildup; vestibular neuritis or labyrinthitis, typically from viral infections; and less commonly, migraines, head injuries, or certain medications.
Some key points to consider:
- Vertigo is a symptom rather than a condition itself, and treatment depends on the underlying cause.
- BPPV is a common cause of vertigo, and it can be treated with bedside repositioning exercises, such as the Epley maneuver, which have high success rates 1.
- Meniere's disease is another common cause of vertigo, and it is characterized by episodic attacks of vertigo, hearing loss, tinnitus, and aural fullness 1.
- Vestibular rehabilitation exercises and medications like meclizine (Antivert) 25mg every 4-6 hours as needed for acute symptoms can also be used to manage vertigo symptoms.
During an episode of vertigo, sitting down immediately, avoiding sudden movements, and focusing on a stationary object can help manage symptoms. Vertigo occurs because the brain receives conflicting signals about your body's position in space from your eyes, inner ear, and sensory nerves, creating the disorienting spinning sensation. It is essential to consult a healthcare professional for proper diagnosis and treatment of vertigo, as it can have a significant impact on quality of life and increase the risk of falls, especially in older adults 1.
From the Research
Definition of Vertigo
- Vertigo is a common symptom in everyday clinical practice, characterized by a sensation of false movement, generally described as a rotation, or sometimes as a sensation of tilt 2.
- It is a type of dizziness with dysequilibrium, presyncope, and lightheadedness, but is distinct from other types of dizziness, such as giddiness 2.
- Vertigo indicates a disturbed relation to surrounding objects in space, with feelings of rotation or whirling, and can be caused by defects in the labyrinth, visual system, or central nervous system 3.
Types of Vertigo
- Central vertigo is a consequence of a central nervous system lesion, often associated with a focal neurological deficit 4.
- Peripheral vertigo is secondary to dysfunction of the peripheral vestibular system, usually characterized by an acute vertigo with loss of balance, sensation of spinning, and is exaggerated with changes of head and body position 4.
- Benign paroxysmal positional vertigo (BPPV) is a common peripheral vestibular disorder, accounting for 20% of all vertigo cases 5.
Causes and Treatment of Vertigo
- The treatment of vertigo depends on the specific etiology, and may include drugs with different mechanisms of action, physical therapy, psychotherapy, and surgery 4.
- Betahistine is a drug that may be effective in reducing vertigo symptoms, particularly in patients with BPPV 6, 5.
- Epley's maneuver is a canal repositioning maneuver that can be effective in treating BPPV, and may be used in combination with betahistine 5.
- A detailed history and physical examination are essential in the diagnosis of vertigo, and investigations such as pure tone audiogram and speech discrimination testing may be necessary in some cases 3.