Vertigo – Types, Symptoms, Diagnosis and Treatments

Vertigo is an unanticipated feeling of giddiness. It is a sensation that the person is whirling around when in reality, they are ideal. It is usually accompanied by nausea. Vertigo occurs as a result of an imbalance in the vestibular system.

What is Vertigo?

Vertigo is an illusion of motion, usually a sense of revolving when no movement is happening in relation to earth’s gravity.

It is commonly caused due to the troubles in the inner ear called Peripheral Vertigo or in the brain called Central Vertigo. It is considered a vestibular system disorder.

Types of Vertigo

Peripheral Vertigo

Peripheral Vertigo occurs due to impairment of the structures in the inner ear, which form the vestibular system.

The vestibular system is responsible for the body’s balance. Nausea and vomiting are commonly noticed in persons with Peripheral Vertigo.

Other symptoms include hearing impairment, the feeling of pressure or resonance in the ear, pain in the ear and tinnitus.

Central Vertigo

Central Vertigo arises as a consequence of a disease of the Central Nervous System (CNS). A lesion in the VIII ^th cranial nerve is one such cause.

Humans with Vertigo have illusions of movement in their environment. Other symptoms include hearing impairment, the feeling of pressure or resonance in the ear, pain in the ear and tinnitus. Imbalance is more noticeable in Central Vertigo.

Vertigo Causes

Vertigo is either caused due to issues in the inner ear or in the brain.

BPPV

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of Vertigo.

BPPV occurs as a consequence of the displacement of calcium carbonate crystals (otoconia) within the semicircular canals present in the inner ear. This stimulates the nerve responsible for detecting head rotation.

BPPV causes instant giddiness or Vertigo when the head is moved. It can happen while rolling over the bed or while waking up.

Meniere’s disease

Meniere’s disease is indicated by unstable hearing loss, recurrent small episodes of Vertigo, feeling of pressure or resonance in the ear, pain in the ear and tinnitus. This disease usually harms only one ear.

Though the cause of the disease is unknown, it is believed to be due to modification in the fluid in tubes present in the inner ear. Delayed Meniere’s disease is noticed in the ear that was damaged long ago due to viral or bacterial infection.

Patients with Meniere’s disease experience hearing loss from early childhood along with episodic Vertigo.

Vestibular neuritis or labyrinthitis

Vestibular neuritis and labyrinthitis occur as a result of inflammation of the nerve that connects the brain to the inner ear.

The brain gets information about the body’s balance from the inner ear through this nerve. As a result, a patient is more likely to experience prolonged Vertigo, balance disorder, tinnitus, hearing loss, nausea and vomiting.

Medications can help revert the condition.

Head or neck injury 

Cervical Vertigo is the sensation of disorientation caused as a result of injuries that affect the neck. The signals directed to the vestibular system and the brain are troubled due to the injuries in the head and neck region.

Neck posture, neck injury, trauma, slipped disks and atherosclerosis are a few causes of Cervical Vertigo.  The most common symptoms of Cervical Vertigo include dizziness and neck pain.

Diagnosing Cervical Vertigo is difficult. A process called a diagnosis of exclusion is implemented to rule out certain other possible diseases that may occur due to head and neck injuries.

Acupuncture, strength and balance exercises, massages and physical therapy are a few treatments for Cervical Vertigo.

Migraine headaches 

Vertigo is common in patients with migraine. The episodes of Vertigo range from a few minutes to hours. They are also associated with other symptoms like loss of vision, ataxia, diplopia and dysarthria.

Adolescent girls mostly get affected by basilar migraine during menstruation. Migraine causes benign paroxysmal Vertigo during childhood and benign recurrent Vertigo during adulthood.

A likely mechanism for Vertigo, along with migraine, is the vasoconstriction entailing the internal auditory artery.

Diabetes 

Hypoglycemia is commonly noticed in persons with Diabetes where the blood sugar level drops below 70 mg/dL leading to dizziness or Vertigo. This is due to the malfunction of the brain cells.

Dizziness is also seen in the case of Hyperglycemia as a result of dehydration.

Changes in hormones 

The hormonal fluctuations during menopause are said to cause BPPV. Decreased levels of oestrogen are seen during the climacteric period.

Female hormones aid in many processes in the body, including reproductive organ function, memory processing, metabolism of bones and also in hearing and other vestibular functions.

Hormonal changes also influence blood sugar levels causing dizziness. Changes in these hormones affect the functions of the vestibular system causing Vertigo.

Anxiety or panic attacks 

Vertigo is a predisposing factor for anxiety and panic attacks. The fear of leaving the house is common due to previous experiences faced by the patient, which also worsens the symptoms.

A person with Vertigo suffers emotionally, physically and psychologically, making it difficult to overcome the issue.

Counselling therapies, relaxation techniques and meditation are a few ways to manage anxiety and panic attacks.

Vertigo Symptoms 

The change in the head position triggers Vertigo. Vertigo is itself considered a symptom of certain diseases. Some symptoms of Vertigo include:

• Sense of movement
• Spinning
• Dizziness
• Hearing loss
• Headache
• Nausea
• Vomiting
• Nystagmus
• Tinnitus
• Pain in the ear

Vertigo diagnosis

Diagnosis of Vertigo starts with understanding the medical history of the patient. The description of the sensation, frequency and symptoms experienced by the individual helps in diagnosing Vertigo.

Physical examination is done to look for causes and symptoms of Vertigo. Hearing tests, rotational chair testing, eye movement testing, MRI scans and neurological testing are tests done to diagnose Vertigo.

Videonystagmography testing is another examination that is used to test the function of the inner ear through visual and sensory tests.

When to seek doctor assistance 

Visiting a doctor is mandatory when there is repeated, extreme and prolonged Vertigo in a person.

Medical attention is necessary when a person with Vertigo experiences one or more of the following symptoms:

• Breathing difficulty
• Arrhythmia
• Severe, sudden headache
• Seizures
• Paralysis of arms or legs
• Fainting
• Difficulty walking
• Sudden hearing loss
• Chest pain
• Double vision
• Slurred speech
• Unequal pupil size
• Inability to stand even while holding an object

When an individual with Vertigo encounters severe symptoms, including difficulty in standing or walking, doctor consultation is necessary.

Consulting a neurologist may be more helpful since he may be able to diagnose better and can treat the root cause.

Vertigo treatment 

Symptoms of Vertigo subside over time in certain patients.

If Vertigo is frequent and prolonged, then proceeding to consult a doctor and getting treated will be beneficial. The treatment for Vertigo depends on its cause.

Vestibular rehabilitation 

Vestibular rehabilitation helps to treat Vertigo caused due to inner ear problems. It is a treatment based on exercises that are designed by vestibular physical therapists. These exercises benefit persons with Vertigo by improving balance and reducing issues related to dizziness.

The goal of the treatment is to design a personalised exercise program in view of the cause of Vertigo, thereby improving the quality of life.

A few examples of exercises include vision stability training, stretching, strengthening exercises, posture training and balance training.

Canalith repositioning manoeuvre

Vertigo is sometimes caused due to displacement of calcium carbonate crystals within the inner ear.

The method used to remove these crystals present in the semicircular canals is called the Canalith repositioning procedure (CRP). It is used to treat only BPPV and not any other Vertigo.

Two common types of CRP include Semont-Liberatory manoeuvre and Epley manoeuvre.

Medicine 

Medicines used to suppress Vertigo are usually recommended for short durations, which can be taken only during short Vertigo attacks to avoid effects on the Central Nervous System.

Some commonly used medicines for treating Vertigo are:

• Prochlorperazine
• Antihistamines such as cinnarizine, cyclizine or promethazine.
• Betahistine
• Benzodiazepines – like chonazepam, diazepam, lorazepam
• Promethazine
• Ondansetron
• Piracetam
• Dimenhydrinate
• Meclizine

Surgery 

Surgeries are performed in very few and rare cases to correct Vertigo.

• Perilymph fistula – This procedure helps in preventing and blocking leaks occurring in the inner ear.
• Shunt surgery – This surgery is done to treat Meniere’s disease by improving the plumbing in the inner ear.
• Acoustic Neuroma – Acoustic tumour is removed through this surgery, thus eliminating Vertigo.
• To treat Microvascular Compression Syndrome, a blood vessel on the vestibular nerve is moved with the help of surgery.

Home remedies for Vertigo

There aren’t enough studies to suggest that alternative therapy can help with Vertigo. However, intake of herbal supplements like turmeric, ginger root and cayenne are said to help relieve the symptoms.

Epley manoeuver

Epley manoeuver is a variety of exercise done at home to relieve symptoms of Benign Paroxysmal Positional Vertigo like dizziness.

The following are the steps to perform Epley manoeuver at home.

• The patient should sit upright with their legs extended in the front.
• They must lie down and tilt their head (45 degrees) in one direction and hold in the position for about 30 seconds to 2 minutes.
• Then, the head must be tilted in the opposite direction. They must hold in the position for about 30 seconds to 2 minutes.
• Now, the patient has to roll in the same direction they are facing and revert to a sitting position.
• The procedure is performed up to three times to help relieve the symptoms.

If the symptoms of dizziness persist, consulting a health professional is mandatory.

Semont-Toupet manoeuver

Semont manoeuver is done to treat BPPV. This helps in moving the canaliths in the inner ear thereby alleviating Vertigo.

The following are the steps to perform the Semont manoeuver at home.

• The patient is advised to sit at the edge of the bed and tilt the head at a 45-degree angle, opposite to the side troubled by BPPV.
• Then, the person has to lie down with the head facing the ceiling.
• The patient has to move back to the sitting position and turn to the other side, repeating the procedure while facing the floor.
• Slowly, they must return to the upright sitting position.
• If, at any point, the patient experiences Vertigo/dizziness, they must wait until the symptoms disappear.
• The results of the exercise may be seen after repeating the exercise 3-4 times until the person doesn’t have Vertigo for 24 hours straight.

Brandt-Daroff exercise 

The Brandt-Daroff are set of exercises performed to relieve patients affected with certain types of Vertigo, especially BPPV by helping break the canaliths.

The following are the steps to perform the Brandt-Daroff:

• The patient is advised to sit at the edge of the bed and tilt the head at a 45-degree angle, opposite to the side troubled by Vertigo.
• The body has to be lowered down with the head held in the same position for about 30 seconds or until Vertigo subsides. The person has to return to the upright position after that.
• The procedure is repeated on the other side.
• In a single session, these exercises are repeated 3-5 times.

The advantage of the Brandt-Daroff exercise compared to other exercises to treat Vertigo is that they are safe to be performed and can help ease the symptoms of Vertigo.

Gingko Biloba 

Ginkgo Biloba is a Chinese herb that is used to treat symptoms of Vertigo. It relieves dizziness and balance problems by controlling blood flow to the brain and also acting as an antioxidant.

A study has reported that the effect of Gingko Biloba is similar to that of the medicine betahistine in the treatment of Vertigo. 240 milligrams of Gingko biloba can be taken per day. It is said to reduce the Vertigo symptoms.

Stress management 

Stress can trigger some disorders that cause Vertigo like Meniere’s disease.

Developing coping methods to combat stressful situations may help a person experience fewer Vertigo attacks.  

Meditation and deep breathing exercises are very effective in managing stress. Awareness of the source of stress is very much important to help alleviate Vertigo symptoms.

Yoga and Tai chi 

Traditional exercises like yoga and tai chi are quickly gaining popularity among those who suffer from dizziness caused due to vestibular diseases.

Tai chi and yoga are good for balancing the mind and body. Focus, breathing and body movements are used in both yoga and tai chi to relax the patient.

Yoga or tai chi practice will improve balance and gait by strengthening the synchronisation of vestibular, visual and motor skills.

Adequate amount of sleep 

Sometimes an adequate amount of sleep is all that the body wants to stay balanced and relieve Vertigo symptoms.

Sleep is linked to stress, and sleep deprivation can trigger Vertigo caused due to stress. Getting adequate sleep must be the priority for people with Vertigo.

Hydration 

Dehydration causes Vertigo in some people. The most effective approach to staying hydrated is to drink enough water.

Keeping track of one’s water intake every day will prove to be beneficial for a dehydrated person.

Simply being mindful of how much water a person is drinking may help to reduce Vertigo attacks.

Vitamin D 

Vitamin D deficiency can elevate the symptoms in certain cases of Vertigo.

Consuming vitamin D rich foods along with calcium and adequate exposure to the sun may prove to be helpful. Vitamin D supplementation is also said to be beneficial to those with BPPV.

It is recommended that people with Vertigo get themselves tested to find the vitamin D level in the blood to identify the cause.

Avoiding alcohol 

Alcohol is found to alter the constituents of the fluid in the inner ear in addition to causing dizziness. Alcohol causes dehydration and causes imbalance. Reduced alcohol use or even complete abstinence may relieve the symptoms of Vertigo.

Risk factors of Vertigo  

Vertigo is sometimes an indication of a more serious medical problem. Difficulties in the inner ear, known as peripheral Vertigo, or problems in the brain or neurological system, known as central Vertigo, are the most common causes of Vertigo.

Some risk factors that increase the chances of Vertigo are:

• Otosclerosis
• Stroke
• Multiple Sclerosis
• Perilymphatic Fistula
• Parkinson’s disease
• Air pressure changes
• Women are more prone to Vertigo than men
• Aged people older than 50 years may experience Vertigo at a higher rate
• Head injury
• Taking drugs like antidepressants or antipsychotics
• Any diseases that affect balance or the ears
• Previous episode of Vertigo
• Having a family member who has Vertigo
• Having an inner ear infection
• High levels of stress
• Drinking alcohol

Conclusion

Vertigo is the illusion of motion. It can be either caused due to problems in the inner ear or the brain. Peripheral and Central Vertigo is their two types.

Vestibular rehabilitation, medicines, surgery and home remedies such as Epley manoeuver, Semont manoeuver and Brandt-Daroff exercises are the best treatment for Vertigo.

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