From the Guidelines
Anxiety can indeed cause vertigo, as evidenced by its inclusion in the differential diagnosis of chronic vestibular syndrome in the 2017 clinical practice guideline for benign paroxysmal positional vertigo 1. This condition, often referred to as psychogenic vertigo, arises when anxiety triggers the body's fight-or-flight response, leading to the release of stress hormones that can affect the vestibular system, which is responsible for balance. Key factors contributing to anxiety-related vertigo include hyperventilation, which reduces carbon dioxide levels in the blood, causing blood vessels to constrict and affecting blood flow to the brain, thereby worsening dizziness.
Management of Anxiety-Related Vertigo
Management strategies for anxiety-related vertigo focus on addressing the underlying anxiety. Techniques such as:
- Deep breathing exercises to stabilize breathing patterns and reduce hyperventilation
- Progressive muscle relaxation to decrease physical tension
- Mindfulness meditation to reduce anxiety levels are commonly recommended. In more severe cases, healthcare providers may prescribe anti-anxiety medications, such as benzodiazepines (e.g., lorazepam 0.5-1mg as needed) or SSRIs (like sertraline 50-200mg daily), although these should be used under medical supervision due to potential side effects 1. Vestibular rehabilitation exercises can also be beneficial in helping the brain reprocess balance signals correctly.
Importance of Medical Evaluation
It is crucial to consult a healthcare provider to rule out other potential causes of vertigo, as symptoms can overlap with conditions like BPPV, Meniere's disease, or vestibular migraines. A thorough medical evaluation will help in determining the underlying cause of vertigo and guide appropriate treatment. The 2017 guideline 1 provides a comprehensive framework for the differential diagnosis of vertigo, highlighting the importance of considering anxiety and panic disorders as potential causes of chronic vestibular syndrome.
From the Research
Anxiety and Vertigo
- Anxiety can contribute to the development of vertigo, as evidenced by a study that found patients with anxiety disorders were 2.17 times more likely to develop benign paroxysmal positional vertigo (BPPV) than control patients 2.
- The relationship between anxiety and vertigo is complex, with some studies suggesting that vestibular function plays a role in the development of anxiety disorders 3.
- Episodic vertigo syndromes, such as vestibular migraine and Menière's disease, are associated with a significant increase in psychiatric comorbidity, including anxiety and phobic disorders 3.
- Selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective in treating patients with dizziness and psychiatric symptoms, including anxiety 4, 5.
Risk Factors
- Female sex and cerebrovascular disease are independent risk factors for developing new-onset BPPV in patients with anxiety disorders 2.
- The prevalence of vestibular vertigo rises with age and is about two to three times higher in women than in men 6.
- Comorbid anxiety is common in patients with vestibular disorders, and risk factor research is ongoing to better understand the relationship between anxiety and vertigo 6.
Treatment
- SSRIs have been shown to be effective in relieving dizziness in patients with major or minor psychiatric symptoms, including those with peripheral vestibular conditions and migraine headaches 5.
- Treatment with SSRIs may be more effective than treatment with vestibular suppressants or benzodiazepines in patients with dizziness and psychiatric symptoms 5.