Vertigo

Vertigo creates a false sensation of movement, typically spinning, when there is no actual motion. Unlike general dizziness or lightheadedness, vertigo specifically involves a perception of movement - either of yourself or your surroundings. This distinction is important for proper diagnosis and treatment.

The sensation occurs when there's a problem with the body's balance system, which involves the inner ear (vestibular system), eyes, sensory nerves, and brain. The inner ear contains tiny calcium crystals and fluid-filled canals that help detect motion and changes in position. When these systems malfunction or send conflicting signals to the brain, vertigo results.

Vertigo can be temporary, lasting seconds to minutes, or persist for hours, days, or even longer in some cases. It may occur as an isolated symptom or be accompanied by other symptoms like nausea, hearing changes, or headaches. Understanding the pattern, triggers, and associated symptoms helps determine the underlying cause and appropriate treatment.

Peripheral Vertigo

Most common type, caused by inner ear problems:

Benign Paroxysmal Positional Vertigo (BPPV)

• Most common cause of vertigo (50% of cases)
• Brief episodes triggered by head movements
• Caused by calcium crystals (otoliths) in wrong part of ear
• Often occurs when rolling over in bed or looking up
• Usually lasts less than a minute
• Highly treatable with repositioning maneuvers

Meniere's Disease

• Episodes lasting 20 minutes to several hours
• Associated with hearing loss and tinnitus
• Feeling of fullness in the ear
• Caused by fluid buildup in inner ear
• May progressively worsen over time

Vestibular Neuritis/Labyrinthitis

• Sudden, severe vertigo lasting days
• Often follows viral infection
• Labyrinthitis includes hearing loss
• Vestibular neuritis doesn't affect hearing
• May take weeks to fully recover

Central Vertigo

Less common, caused by brain problems:

• Vestibular migraine: Vertigo with migraine headaches
• Multiple sclerosis: Can affect balance centers
• Stroke or TIA: Especially in brainstem or cerebellum
• Brain tumors: Rare cause, usually with other symptoms
• Medication side effects: Various drugs can cause vertigo

Other Classifications

By Duration

• Seconds: Usually BPPV
• Minutes to hours: Meniere's disease, migraine
• Days: Vestibular neuritis
• Constant: Central causes, anxiety

By Trigger

• Positional: BPPV
• Spontaneous: Meniere's, vestibular neuritis
• Head movement: Various causes
• Visual: Visual vertigo

Symptom Patterns by Condition

BPPV Pattern

• Brief episodes (seconds to minute)
• Triggered by specific head positions
• Worse in morning
• No hearing symptoms
• May have nausea but brief

Meniere's Disease Pattern

• Episodes last 20 minutes to 24 hours
• Fluctuating hearing loss
• Tinnitus and ear fullness
• Severe nausea and vomiting
• Unpredictable attacks

Vestibular Neuritis Pattern

• Sudden onset, severe vertigo
• Lasts days to weeks
• Gradually improves
• No hearing loss (unless labyrinthitis)
• May follow upper respiratory infection

Central Vertigo Pattern

• May be constant
• Often with neurological symptoms
• Less nausea than peripheral causes
• May have vision changes
• Coordination problems

Inner Ear Causes (Peripheral)

Benign Paroxysmal Positional Vertigo (BPPV)

• Calcium carbonate crystals (otoconia) displacement
• Age-related degeneration
• Head injury
• Prolonged bed rest
• Inner ear disorders
• Post-viral infection

Meniere's Disease

• Excess fluid (endolymph) in inner ear
• Autoimmune factors
• Genetic predisposition
• Viral infections
• Allergies
• Head trauma

Vestibular Neuritis/Labyrinthitis

• Viral infections (most common)
• Bacterial infections (rare)
• Autoimmune disorders
• Reduced blood flow to inner ear

Brain-Related Causes (Central)

• Migraine: Vestibular migraine
• Stroke/TIA: Especially posterior circulation
• Multiple sclerosis: Demyelinating lesions
• Acoustic neuroma: Benign tumor on vestibular nerve
• Brain tumors: Affecting balance centers
• Cerebellar disorders: Various conditions

Other Causes

Medications

• Aminoglycoside antibiotics
• Loop diuretics
• Aspirin (high doses)
• Antiseizure drugs
• Antidepressants
• Blood pressure medications
• Sedatives

Medical Conditions

• Low blood pressure
• Cardiovascular disease
• Anemia
• Hypoglycemia
• Dehydration
• Anxiety disorders
• Panic attacks

Lifestyle Factors

• Alcohol intoxication
• Motion sickness
• Stress and fatigue
• Changes in barometric pressure
• Dehydration

Age-Related Factors

• Increased risk after age 50
• Age-related inner ear degeneration
• Higher medication use in elderly
• More prone to BPPV with age

Medical History

• Previous episodes of vertigo
• Head injury or concussion
• Ear infections or surgery
• Family history of Meniere's disease
• Migraine headaches
• Cardiovascular disease
• Diabetes

Lifestyle Factors

• High stress levels
• Poor sleep habits
• Sedentary lifestyle
• Excessive alcohol use
• Smoking
• High salt diet (Meniere's)

Occupational Risks

• Jobs requiring height work
• Operating heavy machinery
• Professional drivers
• Pilots
• Construction workers

Diagnosing vertigo involves determining whether symptoms are due to peripheral or central causes and identifying the specific condition responsible.

Medical History

• Detailed description of symptoms
• Duration and frequency of episodes
• Triggers and positions
• Associated symptoms
• Medications
• Past medical history
• Head trauma history

Physical Examination

Neurological Exam

• Cranial nerve testing
• Coordination tests
• Gait assessment
• Romberg test
• Reflexes

Ear Examination

• Otoscopy
• Hearing assessment
• Tympanic membrane evaluation

Specific Diagnostic Tests

Dix-Hallpike Maneuver

• Gold standard for BPPV diagnosis
• Reproduces vertigo and nystagmus
• Identifies affected ear
• Guides treatment approach

Head Impulse Test

• Tests vestibulo-ocular reflex
• Helps differentiate peripheral vs central
• Quick bedside test

Nystagmus Assessment

• Direction and pattern of eye movements
• Video-oculography for detailed analysis
• Helps localize the problem

Laboratory Tests

Vestibular Function Tests

• Electronystagmography (ENG): Records eye movements
• Videonystagmography (VNG): Video recording of eyes
• Rotary chair testing: Assesses balance system
• VEMP testing: Vestibular evoked potentials
• Posturography: Balance assessment

Hearing Tests

• Audiometry
• Tympanometry
• Acoustic reflex testing
• Otoacoustic emissions

Imaging Studies

• MRI: For central causes, acoustic neuroma
• CT scan: Temporal bone abnormalities
• MRA/CTA: Vascular causes

Blood Tests

• Complete blood count (anemia)
• Glucose levels
• Thyroid function
• Vitamin B12 levels
• Syphilis testing (if indicated)

Treatment depends on the underlying cause of vertigo. Many cases resolve on their own, while others require specific interventions.

Treatment for BPPV

Canalith Repositioning Procedures

• Epley maneuver: Most common, 80-90% effective
• Semont maneuver: Alternative technique
• Half somersault maneuver: Can be done at home
• Brandt-Daroff exercises: Home exercises
• May need multiple sessions
• Can be taught for home use

Medications

For Acute Symptoms

• Antihistamines: Meclizine, dimenhydrinate
• Anticholinergics: Scopolamine
• Benzodiazepines: Diazepam (short-term)
• Antiemetics: For nausea/vomiting
• Corticosteroids: For vestibular neuritis

For Specific Conditions

• Meniere's disease: Diuretics, betahistine
• Vestibular migraine: Migraine preventives
• Anxiety-related: SSRIs, therapy

Vestibular Rehabilitation

• Physical therapy for balance
• Gaze stabilization exercises
• Balance training
• Habituation exercises
• Customized to individual needs
• Improves compensation

Lifestyle Modifications

For Meniere's Disease

• Low-salt diet (less than 2g/day)
• Limit caffeine and alcohol
• Stress management
• Regular sleep schedule
• Avoid triggers

General Recommendations

• Move slowly when changing positions
• Use handrails and grab bars
• Good lighting at home
• Remove trip hazards
• Stay hydrated
• Manage stress

Surgical Options

Reserved for severe, refractory cases:

• Endolymphatic sac surgery: For Meniere's
• Vestibular nerve section: Severe cases
• Labyrinthectomy: Destroys balance function
• Intratympanic injections: Gentamicin or steroids

Alternative Therapies

• Acupuncture
• Tai chi for balance
• Yoga
• Ginger for nausea
• Meditation for stress

During an Episode

• Sit or lie down immediately
• Keep eyes open and focus on stationary object
• Avoid sudden head movements
• Move slowly when episode subsides
• Have someone with you if possible
• Don't drive or operate machinery

Safety Precautions

Home Safety

• Install grab bars in bathroom
• Use non-slip mats
• Keep floors clear
• Good lighting, especially at night
• Keep phone accessible
• Consider medical alert system

Daily Activities

• Rise slowly from lying or sitting
• Turn whole body, not just head
• Use cane or walker if needed
• Wear low-heeled, non-slip shoes
• Avoid looking up or down rapidly

Work and Social Life

• Inform employer about condition
• Request accommodations if needed
• Take breaks during episodes
• Avoid heights and ladders
• Plan for transportation alternatives
• Educate family and friends

Driving Considerations

• Don't drive during episodes
• Know your triggers
• Pull over if symptoms start
• Consider driving restrictions
• Discuss with doctor
• Check local regulations

Exercise and Activity

• Continue regular exercise when able
• Start slowly after episodes
• Balance exercises helpful
• Swimming with supervision
• Avoid contact sports during active symptoms
• Tai chi and yoga beneficial

General Prevention

• Manage underlying health conditions
• Stay hydrated
• Get adequate sleep
• Manage stress effectively
• Avoid rapid position changes
• Limit alcohol consumption
• Regular exercise for balance

BPPV Prevention

• Sleep with head elevated
• Avoid sleeping on affected side
• Rise slowly from bed
• Be cautious with head positions
• Regular repositioning exercises if prone

Meniere's Disease Management

• Strict low-sodium diet
• Avoid MSG
• Limit caffeine and alcohol
• Quit smoking
• Manage allergies
• Reduce stress

Medication Precautions

• Review medications with doctor
• Report vertigo as side effect
• Don't stop medications suddenly
• Be aware of ototoxic drugs
• Monitor for interactions

Physical Complications

• Falls and injuries
• Fractures, especially in elderly
• Head injuries from falls
• Accidents while driving
• Dehydration from vomiting
• Hearing loss (Meniere's)

Psychological Impact

• Anxiety about future episodes
• Depression
• Social isolation
• Fear of leaving home
• Reduced quality of life
• Loss of independence

Work and Economic Impact

• Missed work days
• Reduced productivity
• Job loss or career change
• Disability in severe cases
• Medical expenses

General Outlook

• Most cases of vertigo are treatable
• Many resolve without treatment
• Prognosis depends on underlying cause
• Early treatment improves outcomes
• Most people return to normal activities

Condition-Specific Prognosis

BPPV

• Excellent prognosis
• 80-90% success with treatment
• May recur in 30-50% within 5 years
• Easily retreatable

Vestibular Neuritis

• Usually resolves in weeks
• Complete recovery in 60%
• Some have residual imbalance
• Compensation improves function

Meniere's Disease

• Variable course
• May "burn out" after years
• Hearing loss may be permanent
• Treatment controls symptoms in most