From the Guidelines
Vertigo is primarily caused by problems with the inner ear or brain that affect balance and spatial orientation, with the most common causes being benign paroxysmal positional vertigo (BPPV), Meniere's disease, vestibular neuritis or labyrinthitis, and migraines. The sensation of spinning occurs because the brain receives conflicting signals from the sensory systems about the body's position and movement, creating a mismatch between visual input and vestibular system information 1.
Common Causes of Vertigo
- Benign paroxysmal positional vertigo (BPPV): occurs when 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: inner ear infections 1
- Migraines: can cause vertigo, often accompanied by headache and photophobia 1
Other Potential Causes
- Head or neck injuries
- Certain medications
- Stroke
- Brain tumors
- Multiple sclerosis
Diagnosis and Treatment
Diagnosis is based on a thorough medical history, physical examination, and sometimes additional tests such as audiometry or imaging studies 1. Treatment depends on the underlying cause and may include specific head movements (like the Epley maneuver for BPPV), medications such as meclizine (Antivert) 25mg every 4-6 hours as needed for symptoms, vestibular rehabilitation exercises, or addressing the primary condition 1.
Management During an Episode
During an episode of vertigo, it helps to sit still, focus on a stationary object, and avoid sudden movements. If vertigo is severe, persistent, or accompanied by other symptoms like hearing loss, headache, or neurological problems, medical attention should be sought promptly 1.
Given the complexity and variability of vertigo causes, a comprehensive approach considering the patient's specific symptoms, medical history, and diagnostic findings is essential for effective management and improvement of quality of life 1.
From the Research
Causes of Vertigo
The causes of vertigo can be categorized into four broad groups:
- 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
- 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 of Vertigo
Some specific causes of vertigo include:
- Benign paroxysmal positional vertigo (BPPV), which is the most common cause of vertigo 3, 4, 5
- Ménière's disease, which is a disorder of the inner ear that can cause vertigo 2, 3, 6
- Vestibular neuritis, which is a viral infection of the vestibular nerve or ischemia of the anterior vestibular artery that can cause vertigo 2, 3, 6
- Vestibular migraine, which is a type of migraine that can cause vertigo 2, 3
- Stroke, which can cause central vertigo 2, 3
Diagnosis and Treatment of Vertigo
The diagnosis and treatment of vertigo depend on the underlying cause. For example:
- BPPV can be effectively treated with positioning maneuvers such as the canalith repositioning maneuver 4, 5
- Ménière's disease can be treated with salt restriction, diuretics, and vestibular suppressants such as anticholinergics and benzodiazepines 2
- Vestibular neuritis can be treated with symptomatic therapy, specific drug therapy, and vestibular rehabilitation therapy 6