Vertigo

Definition

Vertigo is a feeling of spinning or whirling when you are still. It is a symptom that can be caused by many different issues.

Vertigo is different from passing dizziness or lightheadedness.

Causes

The inner ear and nerves sense the position of your head and body in space. Vertigo is often caused by problems with these nerves and structures. It may also be due to problems in the brain but this is rare.

There are two main types of vertigo including:

Vertigo of Peripheral Origin

Problems of the inner ear are cause of this kind of vertigo. It is the most common type of vertigo. Causes may include:

• Benign paroxysmal positional vertigo (BPPV)
• Meniere disease
• Perilymphatic fistula—an abnormal canal or connection in the inner ear
• Ototoxic medications—some medications can disrupt the inner ear's ability to balance
• Infection
• Acoustic schwannoma (also known acoustic neuroma —a benign tumor of the nerve involved in hearing and balance
• Reduced blood flow
• Injury
• Otosclerosis —a bony growth near the middle ear

Vertigo of Central Origin

This type is less common but more serious. Changes in the brainstem or the cerebellum cause this type of vertigo. These parts of the brain control balance. Changes can be caused by:

• Brain lesion (from diseases such as multiple sclerosis or stroke) or tumors
• Stroke
• Migraine headaches
• Nervous system disorders such as Parkinson disease or multiple sclerosis
• Epilepsy
• Excessive exposure to alcohol, heavy industrial metals, or poisons
• Injury

Risk Factors

The conditions above will increase your risk of vertigo.

Symptoms

Common vertigo symptoms include:

• Sensation of rotation
• Illusion of movement
• Sensation of feeling pulled in one direction
• Feeling of being off-balance

Vertigo is different than lightheadedness. With lightheadedness, there is no feeling of movement.

Diagnosis

You will be asked about your symptoms and past health. A physical exam will be done. Tests may be done to look for a cause. Tests may include:

• Blood tests
• Head maneuvers—the doctor will move your head is specific ways. Your response may help to relieve symptoms.
• Hearing and vision tests
• Blood pressure test, both lying down and standing up
• Electronystagmogram (ENG)—to check for nystagmus , an abnormal, rhythmic, jerking eye movement
• MRI scan
• Rotatory chair test
• Brainstem auditory evoked potential studies (BAEPS or BAERs)—to check for nerve conduction in the brain auditory nerve and brain stem

Treatment

Treatment will focus on the cause of the vertigo. Treating the cause may stop the vertigo. Medicine may help to lessen or stop the vertigo. Options include one or more of the following:

• Antihistamines
• Benzodiazepines
• Anticholinergics
• Antiemetics

In some cases, you may need to stop taking medications that may be causing your vertigo.

Lifestyle Changes

Living with vertigo can be hard but not impossible. Try these tips:

If you are out in public:

• Use a cane to help with balance.
• Sit at one end of the sports field or theater. Avoid moving your head back and forth.
• Bring a stool or chair so you can sit down when you need to.
• Try to avoid peak times when places are crowded.

Other tips:

• Don't read or work on a computer if you are moving.
• Don't fly if you have sinus or ear problems due to an infection.
• Avoid loud background music and harsh lighting.
• Try to eat smaller meals throughout the day.
• Drink plenty of fluids.
• Avoid tobacco, alcohol, and caffeine.

Prevention

There are no current steps to prevent vertigo.