What is Vertigo ?

Vertigo is a feeling or a sensation that the surroundings around you are spinning.

Vertigo can also be considered as a type of dizziness. But Vertigo is not the similar kind of dizziness which we often experience during acid reflux, weakness, dehydration.

Types of Vertigo

There are 3 types of Vertigo

2. Central Vertigo

3. Cervical Vertigo

Let’s go through the causes, symptoms and treatment of each type of vertigo in detail.

1. Peripheral Vertigo

Peripheral vertigo is a condition characterized by a false sensation of spinning or movement, typically originating from disorders in the inner ear.

Peripheral Vertigo is caused due to the following reasons

BPPV is characterized by brief episodes of severe vertigo triggered by specific head movements. These movements displace tiny calcium crystals within the inner ear, leading to a false sense of spinning.

b) Meniere’s disease

Meniere’s disease is a chronic condition that causes episodic vertigo, fluctuating hearing loss, tinnitus (ringing in the ears), and a feeling of fullness in the affected ear. It is attributed to fluid and pressure imbalances within the inner ear.

c) Labyrinthitis

Labyrinthitis refers to the inflammation of the labyrinth, the inner ear’s intricate structure responsible for both hearing and balance. It can result in sudden vertigo, hearing loss, and nausea.

d) Vestibular Neuritis

Vestibular neuritis is an inflammation of the vestibular nerve, which connects the inner ear to the brain. It typically presents with intense vertigo, nausea, and difficulty maintaining balance.

Symptoms of peripheral Vertigo:

a) Nausea and Vomiting

The spinning movement in the head might cause one to experience nausea and vomiting.

b) Tinnitus and Hearing Loss

As the inner ear is infected in some cases, ringing in the ears is common. Also one may experience sensitivity to loud sound or hearing loss.

c) Imbalance and Spatial Disorientation

d) Blurred Vision

One might experience blurry vision as the crystals in the inner ear will send false signals to eyes resulting in rapid eye movement or eye strain.

Tests for peripheral Vertigo

a) Testing Balance and Eye Movements

Observing an individual’s balance and eye movements can provide valuable insights into the inner ear’s function and help assess the severity of peripheral vertigo.

b) Diagnostic Tests

Additional diagnostic tests may be necessary to corroborate the findings from the medical history and physical examination. Common tests used to diagnose peripheral vertigo include:

c) Dix-Hallpike Maneuver for BPPV

The Dix-Hallpike maneuver is used to diagnose BPPV by inducing controlled head movements that trigger vertigo and nystagmus (involuntary eye movements).

d) Electronystagmography (ENG)

ENG is a test that records eye movements to evaluate the function of the inner ear and the neural pathways associated with balance.

e) Magnetic Resonance Imaging (MRI)

In some cases, an MRI may be ordered to rule out any structural abnormalities within the brain or inner ear that could be causing peripheral vertigo.

f) Audiometry

Audiometry, or hearing tests, are often performed to assess the individual’s hearing ability and identify any potential hearing loss associated with peripheral vertigo.

Treatment for Peripheral Vertigo

a) Epley Maneuver

The Epley maneuver involves a series of head and body positioning maneuvers to guide the crystals back to their original position within the inner ear.

b) Semont Maneuver

Similar to the Epley maneuver, the Semont maneuver utilizes specific head and body movements to reposition the crystals and alleviate vertigo.

c) Medications

Certain medications can be prescribed to manage the symptoms associated with peripheral vertigo. These may include:

Antiemetic Drugs

Antiemetics, such as dimenhydrinate or ondansetron, help alleviate nausea and vomiting associated with vertigo episodes.

Diuretics for Ménière’s Disease

Diuretic medications, such as hydrochlorothiazide, are sometimes used to reduce fluid retention and control the symptoms of Ménière’s disease.

d) Lifestyle Modifications

i) Dietary Changes

Avoiding dietary triggers, such as caffeine and excessive salt, can help minimize fluid imbalances and reduce the frequency and severity of vertigo episodes.

ii) Stress Management Techniques

Stress and anxiety can exacerbate peripheral vertigo symptoms. Incorporating stress management techniques such as meditation, deep breathing exercises, or yoga can be beneficial.

e) Physical Therapy and Vestibular Rehabilitation Exercises

i) Gaze Stabilization Exercises

Gaze stabilization exercises involve focusing on a stationary object while moving the head, helping train the brain to adapt to head movements, reducing vertigo and dizziness.

ii) Balance Training

Balance training exercises, such as standing on one leg or walking on uneven surfaces, can help improve stability and reduce the risk of falls associated with peripheral vertigo.

iii) Mindfulness and Relaxation Techniques

Practicing mindfulness and relaxation techniques can help individuals better cope with the anxiety and stress associated with peripheral vertigo. Examples include:

iv) Yoga and Meditation

Yoga and meditation can help individuals develop greater body awareness, promote relaxation, and reduce stress levels, improving overall well-being.

v) Breathing Exercises

Deep breathing exercises, such as diaphragmatic breathing or alternate nostril breathing, can help promote relaxation and reduce anxiety associated with peripheral vertigo.

vi) Support Groups and Counseling

Support groups and counseling sessions can help individuals address anxiety and depression often experienced due to the chronic and unpredictable nature of peripheral vertigo.

2. Central Vertigo

Central vertigo is a perplexing condition that affects the delicate balance within our brains, resulting in a sensation of spinning or dizziness.

Central Vertigo is caused due to the following reasons

a) Migraine

Migraine-associated vertigo (MAV) is another culprit, as migraines can disrupt the normal functioning of the brain and induce vertigo.

b) Sclerosis

Multiple sclerosis (MS) damages the protective covering of nerves, leading to faulty signaling that results in vertigo.

c) Tumors

Brainstem lesions, often caused by trauma or tumors, can disrupt the central nervous system’s ability to maintain balance.

d) Stroke

Cerebral vascular accidents (CVAs), also known as strokes, can trigger central vertigo by affecting the blood supply to specific brain regions.

Symptoms of Central Vertigo

a) Dizziness

A detailed analysis of vertigo episodes is crucial in understanding central vertigo’s manifestations. Patients often describe a sensation of spinning, accompanied by feelings of unsteadiness and lightheadedness. These episodes can vary in intensity and duration, disrupting everyday activities and affecting overall quality of life.

b) Eye coordination issues

Challenges with eye movements, known as nystagmus, are common in central vertigo. Abnormal flickering or rhythmic oscillations of the eyes occur due to the brain’s inability to properly coordinate visual input.

c) Hearing issues

In addition to vertigo and nystagmus, central vertigo can present with hearing impairment and coordination issues. These additional symptoms further complicate the condition, requiring comprehensive management strategies.

Tests for Central Vertigo

a) Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI) provides intricate images of the brain, highlighting any abnormalities or lesions that may be contributing to central vertigo.

b) Computerized tomography (CT)

Computerized tomography (CT) scans are used to assess the structure of the brain and detect any potential underlying causes.

c) Electroencephalogram (EEG)

Electroencephalogram (EEG) records brain wave patterns and can help identify abnormal electrical activity that may be associated with vertigo.

Treatment of Central Vertigo

a) Medications

Medications play a key role in managing central vertigo by targeting the underlying neurological disorders. These medications aim to stabilize the central nervous system and alleviate vertigo symptoms.

b) Vestibular rehabilitation

Vestibular rehabilitation therapy, as mentioned earlier, is an effective non-pharmacological approach that focuses on physical exercises and balance retraining. This therapy aims to strengthen the vestibular system and improve overall balance and coordination.

c) Surgery

In some cases, surgical interventions may be necessary to address the specific causes of central vertigo. These procedures target the underlying neurological issues and can offer long-term relief.

d) Lifestyle Changes

While central vertigo may not always be preventable, adopting a healthy lifestyle and prioritizing neurological disease prevention can significantly minimize the risk. Regular exercise, a balanced diet, and stress management techniques can promote overall well-being and reduce the likelihood of developing conditions that contribute to central vertigo.

3. Cervical Vertigo

Cervical Vertigo is caused due to the following reasons

a) Forward Head Posture

Forward head posture is on e of the leading cause for Cervical Vertigo. In case of forward head posture the normal curvature of the cervical spine is lost which leads to cervical vertigo.

b) Neck Injury

In case of any accidents, whiplash and sudden movements of head , the neck might suffer and face internal injuries later resulting in cervical vertigo.

Cervical Vertigo Symptoms

a) Occipital Neuralgia

Occipital Neuralgia is caused when the occipital nerve which is present in the back side at the base of the skull is damaged or injured or not working as expected.

b) Loss of balance

People might experience loss of balance as the nerves in the neck and the nerves in the base of skull coordinate with brain and eyes for proper balance. Since these nerves are not working properly as expected one can fell loss of balance while waking up from a sleeping position or when extra strain in given on the neck.

c) Light Sensitivity and Blurred Vision

During cervical vertigo the nerves that connect the base of the skull and the eyes are damaged or the nerves are tight due to the cervical instability. This results in certain vision related issues like blurred vision or light sensitivity.

Tests for Cervical Vertigo

a) MRI SCAN

MRI Scan is usually the first scan that comes to mind to detect any cervical issue. In the MRI scan one can check if the cervical spine has and herniated disc or bulging disc which results in pinching of the nerve.

b) Rotational Chair

In this test the patient is made to sit over a rotational chair. The patient is asked to close his eyes and keep the neck straight while moving only the body to 90 degree. If the patient reports of any dizziness or nausea at this time then the patient is said to have cervicogenic dizziness.

Cervical Vertigo Treatment

a) Physical Therapy and Rehabilitation

b) Exploring Medication Therapies and Their Effectiveness

Commonly prescribed medications for symptom relief

Antiemetics: Medications such as Meclizine or Promethazine can help alleviate nausea and vomiting associated with vertigo episodes.

Benzodiazepines: Drugs like Diazepam or Alprazolam may be prescribed to reduce anxiety and promote relaxation during vertigo episodes.

Vestibular suppressants: Medications like Betahistine or Cinnarizine may be used to suppress the activity of the vestibular system, reducing vertigo symptoms.

c) Posture

Posture is one of the leading causes of all cervical problems. Forward head posture causes muscle stiffness in the occipital region leading to cervical vertigo. Also weak back, chest and neck muscles contribute to poor neck posture.

d) Cervical Collar

Cervical collar is one of the most highly ignored treatment when it comes to neck posture. Cervical collar is highly recommended when it comes to correcting neck posture. As the cervical collar supports the neck for long periods of time , getting back the cervical posture would be easy over time. Make sure to remove the collar after 40min of use and take a break of 10min before reusing it.

e) Vitamins

When is comes to vitamins and supplements. Vitamin D is highly recommended in case of cervical vertigo. Also vitamin B-Complex is recommended.

f) Surgery

Surgery would be the final option in severe cases. Success ratio of surgery is good but the chances of cervical problem reappearing is always there.