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 naturally present in the canals of the inner ear, dislodge, and move abnormally when the head is tilted, pushing 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
  • Labyrinthitis (Vestibular Neuritis)—inflammation of the inner ear, often follows an upper respiratory infection

Benign Paroxysmal Positional Vertigo

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Meniere's Disease—This condition results 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—This is a slow-growing, noncancerous tumor of the acoustic nerve. The tumor can press against the nerves of hearing which can lead to hearing loss and tinnitus (ringing in the ear).

Vertebrobasilar Insufficiency—This refers to 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—Examples include:

  • 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.

Risk factors include:

  • Age
  • Family history
  • 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, medication intake, and medical history, and perform a physical exam. In addition, the following tests may be performed:

  • Vestibular maneuvers
  • Auditory tests
  • Blood pressure test, both lying down and standing up
  • Electronystagmogram (ENG)—to check for nystagmus
  • Magnetic resonance imaging (MRI)—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

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).

Treatments include:

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—The patient is moved rapidly from lying on one side to the other (also called liberatory maneuver).

Epley Maneuver—This maneuver involves head exercises to move the loose particles to a place in the ear where they won't cause dizziness. A recent study suggested that patients who demonstrate involuntary eye movements (nystagmus) in the same direction through two steps of the maneuver tend to recover better than those whose eyes move in a different pattern or do not move at all.*

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

Physical therapy can also be helpful.

Surgery

If symptoms persist for a year or more and cannot be controlled by the maneuvers, several surgical procedures can be performed. 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. Gentamycin injections can also be done. Talk with your doctor to learn more about these injections.

Treatment of the Underlying Cause

Vertigo can be a symptom of another medical condition, such as a heart problem or a 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, in sports activities, or positions where your head is flat or extended.