Vertigo: Symptoms, Causes, Treatment, and More

Vertigo is a sensation of feeling unbalanced. It gives one a false impression that either they or the room or everything around them is spinning or moving in circles. This sensation can be hardly detectable or might be extremely severe for an individual to maintain their balance or carry out everyday activities. Though it may seem like motion sickness, this condition is not similar to dizzy spells. Many define these reactions as physically exhaustive and draining. In a few cases, the experiences are so strong that one feels nauseous or pukish.

Common reasons behind this condition are any issue of balance in the inner ear, and problems of the nervous system, or brain. Vertigo is an indication of various ailments, but not a sickness. Attacks of this condition might begin unexpectedly and continue for some seconds or hours. It could also be persistent and remain for a longer duration like multiple weeks or months. This is a frequent problem, as around 40% of Americans suffer from this condition minimum once in their life.

Vertigo which involves dizziness can affect people irrespective of their age. However, it commonly strikes women and old people above 65 years. In the case of the former, those 50 and above are at risk. This short-term or chronic condition can be experienced by pregnant women or anyone with Ménière's disease. This can also happen when an individual is looking downward from a higher altitude. The term vertigo is used by people about a phobia of height, but it is incorrect. 

Though vertigo might be fearful, however, the disorder on its own is considered nothing serious. Nevertheless, it can be connected to certain possibly harmful medical conditions. Due to this, one should tell their doctor if they experience persistent vertigo episodes. Feeling dizzy and having vertigo are both regarded as balance issues, yet these conditions are not the same. A general feeling of being imbalanced is dizziness. In the case of vertigo, one feels as if they are moving or everything surrounding them is rotating.

Symptoms of Vertigo

Common symptoms of vertigo can differ from one individual to another. Based on the cause that is leading to this condition, the signs may be moderate or severe. Most of the time it is provoked due to a change in the head posture. Feeling dizzy is a very typical symptom of vertigo that is aggravated due to movement of the head. While vertigo itself is a symptom, it might also cause or coexist with different symptoms.

These are some signs of vertigo-

• Losing balance. It can make standing or walking a challenge.
• To be sick or feel like that
• Feeling dizzy
• Feeling that everything is rotating
• Feeling tilted, swayed
• Pushed in a certain direction
• Feeling nauseous
• Vomiting tendency
• Jerky or involuntary eye motions (Nystagmus)
• Migraine
•  Excess sweat
• Humming or ringing or tinkling sound in ears
• Loss of hear
• Motion sickness
• A sensation of ear fullness
• Dual vision
• Problem in swallowing
• Paralysis in face
• Unsteady speech
• Weakness in limbs

Causes of Vertigo

Let’s look at the various causes of vertigo.

Benign Paroxysmal Positional Vertigo (BPPV)

In this case, certain head movements, like hitting the head, etc lead to vertigo. It is caused by the accumulation of microscopic calcium carbonate crystals (canaliths) inside the inner ear (semicircular canals) after they become displaced from their normal position.

Inside, when movement occurs, every crystal particle makes contact with sensory hair cells. During this, our brain gets incorrect information regarding the position of that person. As a result, he/she feels dizzy. These vertigo attacks persist for less than 60 seconds, but nausea and other conditions might happen too.

Otolith organs inside the inner ear store fluid and these crystals. Our brain receives signals from the inner ear regarding the movements of the head and body in relation to gravity. It assists one in keeping their balance. BBPV might happen without reason and can be affected by the aging process.

In short, problems in the inner ear result in the brain receiving messages sent by the inner ear that does not coincide with the information received by eyes and sensory receptors. This is one frequent cause of vertigo that induces a severe and short sensation of rotating or moving in a person. Those suffering from this condition commonly experience vertigo while lying somewhere, sitting straight, and rolling over in bed.

Meniere's Disease

It is a problem in the inner ear that is suggested to occur because of fluid accumulation and shifting pressure inside the ear. This could lead to vertigo attacks with sounds in the ear, a feeling of fullness in the ear, or even hearing loss. In cases when excess fluid gets collected in the inner ear, the consequence can result in expected vertigo, lasting for a longer time. Individuals around 40-60 years are prone to experience this condition more.

Based on the estimation of the National Institute on Deafness and Other Communication Disorders, in America, around 615,000 people recently have been diagnosed with Meniere's disease. Doctors are detecting around 45,500 new incidents every year. Though the particular reason behind this is not known, the narrowing of a blood vessel, virus infection, or autoimmune response may lead to this. In the case of some, this might be even genetic.

Migraine

Extreme headache episodes can lead to vertigo which may linger for some minutes or hours. This could happen before the headache starts, throughout the headache phase, or generally, at the time when the headache is over. One should remember, few people suffer from vertigo as their predominant sign of migraine and not a continuous pain in the head.

Vestibular Neuronitis

It happens when the vestibular nerve (which assists our body in sensing balance) swells up in the inner ear, caused by infection (mostly virus). This inflammation could result in vertigo. Vestibular neuronitis and labyrinthitis are alike, but the former doesn’t affect a person’s hearing. Those suffering from this problem might have vertigo, impaired vision, a sense of spinning, and nausea.

Injury in the Head or Neck

Vertigo commonly occurs in case of a severe head or neck injury, particularly if the vestibular system is damaged.

Labyrinthitis

This is a condition when the labyrinth in the inner ear gets infected or inflamed due to a cold or virus. The vestibulocochlear nerve situated inside the ear labyrinth sends information to our brain about sound, location, and motion of the brain. Those experiencing labyrinthitis commonly suffer from head and ear pain, distorted vision, ringing in the ears, or loss of hearing.

Cholesteatoma

Repeated infections in the ear might lead to a noncancerous growth of skin inside the middle ear. As this develops beneath the eardrum, it might result in damaging the bony parts, leading to hearing loss or a feeling of being dizzy.

Side Effects of Medicines

Some medicines (like aminoglycoside antibiotics, salicylates, diuretics, or cisplatin) might also lead to vertigo and various symptoms like tinnitus, loss of hearing, etc.

Other factors that can also cause vertigo are-  problems in the brain like stroke or tumors, disease in blood vessels, arrhythmia, diabetes, surgery in the ear, continuous bed rest, shingles inside the ear or close by, Perilymphatic fistula (when the liquid inside inner ear leaks into the middle ear as a result of a break in any one of the two membranes which connect both the segments of the ear), and hyperventilation.

Other reasons may include- low levels of blood pressure, weakness in muscles, syphilis, otosclerosis (a bone development condition troubling the middle ear), brain disorder, several sclerosis, sound-related neuroma, disease in the brain stem, etc.

Types of Vertigo

There are two significant types of vertigo-

Peripheral Vertigo

This is caused due to any problem inside the inner ear (semicircular canals) or vestibular nerve (this links the brain with the inner ear, and helps in controlling balance). Around 80% of vertigo cases are of this kind.

Small structures inside the inner ear react to gravitation, and the individual’s posture by communicating information to the brain using nerve impulses. This procedure helps people in keeping their balance while standing up. Any problem in this process causes vertigo. Inflammation and BPPV and swelling are frequent reasons. Additional reasons are Ménière’s disorder and acoustic neuroma.

Central Vertigo

This happens because of any brain-related disorder. Tumors in the brain, severe brain injury, infection, or stroke are some probable causes. This condition is also associated with issues in the central nervous system. It generally occurs from a problem in the cerebellum or brain stem.

Around 20% of vertigo reports are of this category. Potential causes include demyelination, stroke, infection, several sclerosis, illness in blood vessels, specific drugs like alcohol, aspirin, and anticonvulsants, vestibular migraine, and malignant growth in the damaged nervous system areas. An issue in the cervical spine might also result in vertigo.

Investigators have found a unique sort of vertigo recently. In a research paper published in the journal Neurology, in June 2018, scientists termed it ‘recurrent spontaneous vertigo with headshaking nystagmus’ (RSV-HSN).

The findings showed individuals having this kind of vertigo reported longer eye movements, called ‘nystagmus’, compared to others having normal vertigo. They experienced head pain, and vomiting, and couldn't tolerate head movements. RSV-HSN leads to more extreme attacks of motion sickness. Its root cause is still unknown, however, medication is effective in this condition.

Is Vertigo Hereditary?

The symptom of vertigo is not always hereditary. Although, it might result from several genetic disorders or symptoms. This is the reason why any doctor might enquire a vertigo patient regarding his family history of health problems. Currently, scientists have found 6 gene variants that are associated with vertigo. These are responsible for growth, care, and issues in the inner ear.

Certain disorders which might activate vertigo and possibly have genetic aspects are- Episodic ataxia in the family, migraine-induced vertigo, bilateral vestibular hypofunction, and Ménière’s disease in family history. Consequently, genetic characteristics may have a role in frequent vertigo attacks. Familial benign recurrent vertigo, also known as hereditary vertigo, is a type of migrainous vertigo which is highly connected to migraine episodes. 

Can Stress Lead To Vertigo?

Though stress is not directly responsible for vertigo, it might be the reason behind certain disorders in the inner ear that may result in vertigo. Around 5% of adults in America suffer from vertigo if they are nervous or feeling stressed. Moreover, a 2016 study has shown that extreme stress can increase the danger of having a stroke which might give rise to vertigo.

How Is Vertigo Diagnosed?

It is not always easy to diagnose vertigo. This can be challenging and complex as individuals feeling dizzy usually face trouble in explaining their particular symptoms. Doctors may perform certain physical tests, enquire regarding the symptoms of the patient and his family medical history, and may also suggest getting some examinations done to support the diagnosis. Depending on the possible reason behind vertigo, every individual could need separate kinds of tests,  including-

• Fukuda-Unterberger’s Test- The patient is instructed to march still by closing their eyes for 30 seconds. If they spin or slant to a side, this might indicate an issue inside the inner ear labyrinth, resulting in peripheral vertigo.
• Romberg’s Test- In this examination, the patient is requested to shut their eyes and stand with their legs closed and hands on their side. If they start feeling imbalanced or unsteady this might indicate an issue in their central nervous system.
• Head Impulse Test- Here the doctor would tilt the patient’s head in a gentle manner to every side while the latter focuses on a fixed object, like a point on a wall or the nose of their doctor. The physician aims to check how the system of balance in the inner ear is functioning to assist in controlling the eye movements of the patient, while their head is moving.
• Vestibular Test Battery- This process includes several tests that will help detect a problem in the ear. Goggles are put over the eyes for monitoring the movement of eye reactions while following a target with the eyes, when moving the body and head, and also after putting hot and cold water inside the ear canal. 

Along with these tests, doctors might also recommend CT (computed tomography) scans and magnetic resonance imaging (MRI) to get further information. Other tests can also be conducted for detecting vertigo like- a blood test, brainstem auditory evoked response (BAER) test, caloric stimulation, electroencephalogram (EEG), electronystagmography, lumbar puncture, and walking test.

The doctor may also do some specific head movements on the patient, like head-thrust or the Dix-Hallpike maneuver examination where the patient is rapidly made to lie down while they are sitting. This is done for recreating the symptoms of vertigo. These evaluations aid in differentiating between peripheral and central vertigo.

Treatment of Vertigo

Treatments available for vertigo depend on its root cause. Certain kinds of vertigo resolve naturally without any medical assistance. However, those individuals experiencing repeated attacks of vertigo for several months or years, require proper treatment. Several options are-

• Using medicines- Meclizine, an antihistamine, can effectively treat vertigo and motion sickness. Nevertheless, it can cause confusion or partial or total loss of memory in elderly people. Treatment of the actual cause behind vertigo will help to reduce the symptoms. Like, if vertigo is caused by infection, doctors might recommend antibiotics. Inflammation can also be reduced using steroids.

Medicines like antihistamines and antiemetics help in reducing symptoms of peripheral vertigo like nausea, vomiting, etc. In the case of Meniere's disease, doctors can prescribe diuretics (water tablets) for decreasing pressure due to the buildup of fluid. Prochlorperazine and some antihistamines are overly helpful during the initial phases or in maximum instances of vertigo. Other medications used are Dramamine, Antivert, and Valium.

• Canalith Repositioning Maneuvers- Also called the Epley maneuver, it is used for relieving symptoms of benign paroxysmal positional vertigo (BPPV). Based on the guidelines of the American Academy of Neurology, a range of certain head and movements of the body are advised for BPPV. It is a well-known therapy that includes exercises (particularly head movements) for repositioning canaliths (calcium crystals) from the canal and inside the chamber of the inner ear where it is taken in by the body.

One can experience symptoms of vertigo, because of the movements of the canalith during this process. This is safe and has an 80% rate of success in treating individuals with the most typical reason for vertigo. Four postures are held, each for 30-60 seconds, during every therapy session, and these are repeated multiple times as required. A physician will guide the patient about each movement during the treatment. Moreover, they also give extra information regarding how patients can do this process at home.

• Surgery- In case of vertigo occurring from a critical health condition like a brain tumor or injury in the neck, surgery might be needed.
• Vestibular Rehabilitation- This sort of physical treatment might be helpful for reducing the symptoms if they are frequent. Vestibular rehabilitation makes the other senses stronger via several exercises so that they can make up for the vertigo attacks. It assists in strengthening one's vestibular system which informs the brain regarding the motions of the head and body in relation to gravity. 

This usually involves marching still or maintaining certain postures for keeping balance. This therapy includes exercises based on every distinct person and the symptoms they are experiencing. Following a detailed medical examination, any one of the three main approaches is used-

• Habituation is helpful for a person feeling dizzy.
• Stabilization of gaze strengthens movements of the eye for clear vision while moving the head.
• Balance training improves stability.

Other treatment methods include pressure pulse remedy where a device is fitted to the ear. Also, doctors might opt for injecting corticosteroids or antibiotics inside the middle ear.

Home Remedies for Vertigo

One can tackle their vertigo symptoms themselves by following these simple steps but they should inform their doctors before doing anything. 

• Start with easy exercises to relieve symptoms.
• Try to sleep with the head lifted a bit using some pillows.
• While rising from the bed, do it slowly, and try sitting on the corner of the bed for a few minutes before standing up.
• Do not bend over for picking up objects, instead squat.
• Try not to extend the neck while doing regular chores.
• Slowly and cautiously move the head while doing any activity.
• Carry out exercises that aggravate vertigo. This will help the brain get accustomed to them and decrease the symptoms. This is recommended to do only after assuring that one wouldn't fall and has assistance if required.
• Lie down still in a calm dark room, for reducing the extreme spinning sensations.
• Immediately sit down when the experience of dizziness begins.
• Take more time and care while performing activities that trigger vertigo like standing, staring upward, or moving the head.
• While walking, use a cane to prevent falling.
• Make necessary modifications at home.
• Switch on the lights while stepping out of bed at night.
• Avoid risky actions like driving or using ladders, and heavy machines till a week after the indications have stopped.
• Practice relaxation methods as anxiety worsen vertigo.
• Reduce the consumption of sodium, sugar, chocolate, alcohol, tobacco, and high levels of caffeine.
• Maintain good hydration.
• Yoga, tai chi, and enough sleep can help in improving balance and avoiding a vertigo attack.
• Try not to make rapid changes in positions.
•  When symptoms happen, don’t attempt to read.
• Keep bright lights out.
• Use essential oils like lavender, it might be helpful in stopping dizziness and nausea.

Some common herbal treatments for vertigo are herbal supplements like-

• The root of ginger.
• Turmeric.
• Cayenne pepper.
• Ginkgo biloba.
• Gongjin-dan.

According to a 2015 research, acupuncture, an alternative therapy, for 30 minutes was useful in reducing symptoms in the case of 60 people who went to the emergency ward experiencing vertigo and dizzy spells. Nevertheless, more study is needed for confirming the effectiveness of this approach.

Conclusion

Hence, several conditions like infections, trauma, migraine, and numerous other health issues can lead to vertigo. The best strategy to reduce uncomfortable symptoms and give long-lasting relief from vertigo is to treat the primary cause of it.

The above-mentioned medicines, exercises, and home treatments can be helpful in this condition. Occasionally, vertigo goes away on its own. However, it is advisable to consult a doctor if the symptoms are persistent or severe. This is needed for determining the underlying reason and finding the best-suited treatment options and lifestyle changes.

Thank you for reading!

References

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• ‘Vertigo’ by Joseph V. Campellone. Penn Medicine, September 11, 2021. Available from: < https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/vertigo >
• ‘Vertigo’ by Cleveland Clinic medical professional. Cleveland Clinic, September 9, 2021. Available from: < https://my.clevelandclinic.org/health/diseases/21769-vertigo >
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• ‘What Is Vertigo? Symptoms, Causes, Diagnosis, Treatment, and Prevention’ by Julie Lynn Marks. Everyday Health, March 19, 2021. Available from: < https://www.everydayhealth.com/vertigo-signs-symptoms-latest-treatments-home-remedies-tests-more/ >
• ‘Vertigo: Symptoms, Causes, Treatment, and More’ by Lydia Krause and Dana Robinson. Healthline, November 30, 2021. Available from: < https://www.healthline.com/health/vertigo#treatment >
• ‘Everything you need to know about vertigo’ by Markus MacGill. Medical News Today, January 6, 2022. Available from: < https://www.medicalnewstoday.com/articles/160900#in-pregnancy >