Vertigo is a sensation of spinning, falling, or tumbling, which can be subjective or objective. Vertigo is a symptom (not sign) which means the person complains about whirling and losing balance. It is a troublesome condition and sometimes can be the symptom of underlying medical illness. Vertigo can be accompanied by tinnitus, headache, sweating, nausea, vomiting, and nystagmus. The terms vertigo and dizziness are usually used interchangeably, but a difference relies on the point that dizziness is an overall feeling of loss of control. In contrast, vertigo can be a feeling of being unbalanced or the objects moving around.
Vertigo is classified into two types.Central Vertigo: This type of vertigo is due to the dysfunction of vestibular controlling centers in the central nervous system (brain). Patients complain of heads revolving around while they are still. It may result from traumatic brain injury, infection, multiple sclerosis, stroke, brain tumor, migraine.
Peripheral Vertigo: This is a very common type of vertigo that can be due to structural abnormalities in the inner ear or sensitivity of the vestibular nerve, which plays a major role in equilibrium. Some causes of peripheral vertigo are benign paroxysmal positional vertigo (BPPV), Labyrinthitis, Meniere's disease, Perilymph fistula, Superior semicircular canal dehiscence syndrome (SSCDS)
The causes of vertigo can be described according to their type.Peripheral vertigo
Vertigo is a very common complaint. Every person experiences vertigo once in their life. It affects females more than males. Its incidence increases with age.
Following risk factors make you susceptible to vertigo.
A person may feel;
Diagnosis is made based on history and physical examination. Several tests have been evolved to check for vertigo and differentiate between peripheral and central vertigo that can be performed at the bedside. Blood tests and imaging can be performed to rule out serious causes of vertigo.These tests usually involve eliciting vertigo to be checked. These tests include electronystagmography (ENG), rotation tests, Dix-Hallpike maneuver, head-thrust test, caloric reflex test, and computerized dynamic posturography (CDP).
The HINTS test combines three physical examination tests, namely the horizontal head impulse test, observation of nystagmus on primary gaze, and skew test. This test helps differentiate between central and peripheral causes of vertigo and can be performed at the bedside.
Other diseases that may present like vertigo are;
It is necessary to make a precise diagnosis of the causative factor to treat vertigo. Due to unknown causes, Vertigo usually goes with time and doesn’t require any specific treatment. This is possible with an active compensatory mechanism of the brain, which adapts to the changes in the inner ear and maintains equilibrium, and as a result, vertigo goes away itself.Some forms of treatments include:Vestibular Rehabilitation( also called Balance therapy):- It is an exercise program that aims to energize the vestibular system and has been a very effective method in people with complaints of inner ear conditions like vestibular neuritis. It enhances specific signaling to the brain, which trains compensatory sensory mechanisms to maintain balance and control vertigo.
2. Head Position Maneuvers(also called Canalith repositioning or Epley Maneuver):-is remarkable to resolve benign paroxysmal positional vertigo. An audiologist or physiotherapist follows particular head positioning techniques that mobilize canolith ( calcium carbonate crystals )particles obstructed in the inner ear causing vertigo. One session lasts for 15 minutes. The burst of shaky spells can occur after the procedure, so staying seated for 10 minutes after the procedure is suggested.
Medication is prescribed for active symptom relief, usually taken for 3 to 14 days. If vertigo is due to nausea or motion sickness, then prochlorperazine or antihistamine is a good choice. Prochlorperazine is prescribed for severe sickness as it blocks dopamine, whereas antihistamine for mild vertigo and vomiting. Betahistine is thought to improve blood flow around the inner ear to prevent recurrent vertigo attacks due to Ménière’s disease. Additionally, low salt intake and increased urine output may also be helpful. Antibiotics are prescribed if vertigo is due to an underlying infection. Steroids have profound oud effects on controlling swelling due to infection and preventing aggravated vertigo.
Depending upon the causes of vertigo, the treatment and course differ. Some people need no treatment and heal on their own. While in others, vertigo is quite a disturbing disease and refractory to treatment. Measures should be taken to take every possible step to treat and prevent the next episodes.
Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 10, 2023.