Understanding Vertigo: Causes, Symptoms, and Remedies | Meri Sehat

Vertigo

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

Vertigo is a disconcerting and often debilitating medical condition characterized by a false sensation of spinning or movement, typically either of the individual or the surrounding environment. It is not merely a feeling of lightheadedness or imbalance but rather a severe form of <a href="https://merisehat.pk/disease/dizziness">dizziness</a> that can significantly affect one&#39;s quality of life. 
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Vertigo and dizziness are among the most frequent medical complaints, accounting for 2-3% of emergency room visits. It is a common cause of falls, especially in elderly people with chronic medical problems and neurological dysfunction. Moreover, vertigo is three times more frequent in the elderly population than in younger individuals<a href="#accordion">[1][2]</a>.

An estimated 20% to 30% of people will have vertigo or dizziness at some point in their lifetime<a href="#accordion">[1]</a>. 
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Vertigo is classified into two major types - peripheral and central vertigo.<a href="#accordion">[3]</a> 
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Peripheral Vertigo: This is the most common type of vertigo and is associated with problems in the inner ear. Conditions such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and Meniere&#39;s disease fall into this category. BPPV, in particular, is often triggered by specific head movements and is characterized by brief but intense episodes of vertigo.

Central Vertigo: Unlike peripheral vertigo, central vertigo is caused by issues within the central nervous system, usually in the brainstem or cerebellum. Conditions like vestibular migraines, <a href="https://merisehat.pk/disease/multiple-sclerosis">multiple sclerosis</a>, and tumors can lead to central vertigo. Symptoms may be more severe and persistent compared to peripheral vertigo. 
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Sign and Symptoms

The hallmark symptom of vertigo is a false sensation of spinning or movement, often described as if the world around the person is spinning, swaying, or tilting. It may feel like one is being pulled in one direction. Other symptoms include:

<ul>
	<li>Nausea And Vomiting: Vertigo can trigger severe nausea and vomiting due to the conflicting signals the brain receives from the inner ear and visual system.</li>
	<li>Balance Problems: Individuals with vertigo often struggle with balance, leading to unsteadiness and difficulty walking.</li>
	<li>Nystagmus: This is an involuntary rapid eye movement, usually horizontal, that can accompany vertigo.</li>
	<li>Sweating: Profuse sweating is common during vertigo episodes.</li>
	<li>Headaches</li>
	<li>Tinnitus (ringing in the ears)</li>
	<li>Hearing loss</li>
	<li>A Feeling Of Fullness in the ear 
	&nbsp;</li>
</ul>

Causes

The following are the most common causes of vertigo:<a href="#accordion">[2]</a> 
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<ul>
	<li>Benign Paroxysmal Positional Vertigo (BPPV): BPPV is often caused by displaced calcium crystals in the inner ear, leading to vertigo when the head is moved.</li>
	<li>Vestibular Neuritis And Labyrinthitis: These conditions are typically viral infections affecting the inner ear, leading to inflammation and vertigo.</li>
	<li>Meniere&#39;s Disease: This chronic inner ear disorder is characterized by recurrent episodes of vertigo, along with hearing loss and tinnitus. The exact cause is unknown.</li>
	<li>Migraines: Vestibular migraines can cause recurring vertigo along with severe headaches. It is also the most common cause of central vertigo.</li>
	<li>Injury Or Trauma: Head injuries can damage the inner ear or brain, leading to vertigo. 
	&nbsp;</li>
</ul>

There are no standardized screening tests for vertigo. 
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Diagnosis

Healthcare professionals employ a combination of medical history, physical examination, and occasionally specialized tests to diagnose vertigo and ascertain its underlying cause. The typical diagnostic process involves the following steps:<a href="#accordion">[4][5]</a> 
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<ul>
	<li>Medical History: The healthcare provider initiates by taking a detailed medical history from the patient. They inquire about the patient&#39;s symptoms, including their onset, duration, and any triggering or exacerbating factors. Additionally, they assess the patient&#39;s overall health, recent illnesses or injuries, and current medications.</li>
	<li>Physical Examination: A comprehensive physical examination is conducted to evaluate the patient&#39;s balance, coordination, and neurological function. The healthcare provider may perform specific tests like the Dix-Hallpike maneuver or the Head Impulse Test to assess various aspects of balance and eye movements. 
	&nbsp;</li>
</ul>

Several common tests and maneuvers are used to diagnose vertigo and determine its underlying cause. These tests are performed to assess the function of the vestibular system (the inner ear and associated structures responsible for balance and spatial orientation) and to differentiate between different types of vertigo. 
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<ul>
	<li>Dix-Hallpike Maneuver: This maneuver is primarily used to diagnose benign paroxysmal positional vertigo (BPPV), one of the most common causes of vertigo. It involves a sequence of head and body movements to provoke vertigo and characteristic nystagmus (involuntary eye movements) in patients with BPPV. 
	&nbsp;</li>
	<li>Videonystagmography (VNG): VNG is a specialized test that uses video recording to analyze eye movements, particularly nystagmus, in response to various stimuli. It helps assess the function of the inner ear and can aid in diagnosing different types of vertigo. 
	&nbsp;</li>
	<li>Electronystagmography (ENG): Similar to VNG, ENG measures eye movements in response to different stimuli to evaluate inner ear function. It is often used to diagnose BPPV, Meniere&#39;s disease, and other vestibular disorders. 
	&nbsp;</li>
	<li>Rotary Chair Test: During this test, the patient sits in a rotating chair, and their eye movements are monitored. It helps assess how well the vestibular system is working and can provide valuable information about the cause of vertigo. 
	&nbsp;</li>
	<li>Vestibular Evoked Myogenic Potentials (VEMP): VEMP testing measures the response of specific neck and eye muscles to sound or vibration, helping to assess the function of the vestibular system. It is often used to diagnose certain vestibular disorders. 
	&nbsp;</li>
	<li>Head Impulse Test: The head impulse test is a bedside examination technique that assesses the function of the vestibulo-ocular reflex (VOR), which is responsible for stabilizing gaze during head movements. Abnormal results can indicate a peripheral vestibular disorder. 
	&nbsp;</li>
	<li>HINTS Test (Head Impulse-Nystagmus-Test for Skew): This combination of tests includes the head impulse test, examination of nystagmus, and assessment of skew deviation. It helps differentiate between central and peripheral causes of vertigo. 
	&nbsp;</li>
	<li>MRI (Magnetic Resonance Imaging): MRI may be used to rule out structural abnormalities in the brain or inner ear, especially when central causes of vertigo are suspected. It is important for diagnosing conditions like vestibular schwannoma or stroke. 
	&nbsp;</li>
	<li>Blood Tests: Blood tests can be performed to check for underlying conditions, such as diabetes, anemia, or infections, which can contribute to dizziness and vertigo. 
	&nbsp;</li>
	<li>Pure Tone Audiometry: This hearing test assesses hearing loss and can help identify certain vestibular disorders that are associated with hearing loss, like Meniere&#39;s disease. 
	&nbsp;</li>
</ul>

Once all pertinent information is gathered through medical history, physical examination, and any requisite tests, the healthcare provider arrives at a diagnosis. The specific diagnosis hinges on the underlying cause of the patient&#39;s vertigo, which could range from benign paroxysmal positional vertigo (BPPV) and Meniere&#39;s disease to vestibular neuritis or another medical condition. 
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Treatment

The treatment of vertigo depends on its underlying cause. Here are some general treatment options often recommended for managing vertigo:<a href="#accordion">[3][5]</a> 
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<h5>Epley Maneuver (Canalith Repositioning Procedure)</h5>

Used to treat benign paroxysmal positional vertigo (BPPV), one of the most common causes of vertigo. It involves a series of head and body movements to reposition calcium deposits in the inner ear. While the maneuver is performed by a trained healthcare professional, it can also be done at home under supervision. The Epley Maneuver is typically performed as follows:

<ul>
	<li>The patient begins by sitting on a bed or examination table, with their legs extended straight out in front of them.</li>
	<li>The healthcare provider turns the patient&#39;s head 45 degrees toward the side that triggers vertigo (the affected ear).</li>
	<li>The patient is then gently laid down onto their back, keeping their head at a 45-degree angle. This position is held for about 30 seconds.</li>
	<li>Next, the patient&#39;s head is rotated 90 degrees in the opposite direction (opposite to the affected ear), while keeping the head at a 45-degree angle. Again, this position is held for about 30 seconds.</li>
	<li>The patient is then rolled onto their side, so they are facing the floor. This position is maintained for another 30 seconds.</li>
	<li>Finally, the patient is slowly brought back to an upright sitting position. 
	&nbsp;</li>
</ul>

<h5>Medications</h5>

Medications may be prescribed to alleviate vertigo symptoms during acute episodes. Common medications include antihistamines (e.g., meclizine), benzodiazepines, and antiemetics. Some medications can help reduce dizziness and nausea associated with vertigo. 
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<h5>Vestibular Rehabilitation</h5>

This is a form of physical therapy that includes exercises to improve balance and reduce vertigo symptoms. It helps the brain adapt to abnormal signals from the inner ear. These are exercises are performed under the guidance of a trained physical therapist. 
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<h5>Lifestyle Modifications</h5>

This includes avoiding triggers that exacerbate vertigo, such as alcohol and caffeine. Managing stress and anxiety, as emotional factors can also impact vertigo symptoms. 
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<h5>Treatment Of Underlying Conditions</h5>

If vertigo is caused by an underlying medical condition (e.g., Meniere&#39;s disease, vestibular neuritis), treatment aims to manage that condition. This may involve dietary changes, medication, or other specific therapies. 
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<h5>Surgical Options</h5>

Considered in cases of intractable vertigo or when other treatments are ineffective. Surgical procedures may include canal occlusion or nerve transection but carry risks and are typically reserved for severe cases. 
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Note: It&#39;s important to note that the choice of treatment depends on the specific diagnosis and the severity of vertigo. Individuals experiencing vertigo should consult with a healthcare provider for a thorough evaluation and personalized treatment recommendations. The treatment plan will be tailored to address the underlying cause and manage vertigo symptoms effectively. 
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The following are the possible complications of vertigo:

<ul>
	<li>Injuries: Individuals with vertigo are at an increased risk of falls and injuries, which can range from minor bruises to more severe fractures.</li>
	<li>Emotional Impact: Persistent vertigo can lead to anxiety, depression, and a decreased quality of life.</li>
	<li>Social Isolation: Vertigo can limit an individual&#39;s ability to participate in social activities and lead to social isolation.</li>
	<li>Chronic Conditions: Some underlying causes of vertigo, such as Meniere&#39;s disease or vestibular migraines, are chronic and can lead to long-term complications like hearing loss.</li>
	<li>Reduced Independence: Severe vertigo can limit an individual&#39;s ability to perform daily tasks independently. 
	&nbsp;</li>
</ul>

The following factors increase the risk of vertigo:<a href="#accordion">[1][3]</a>

<ul>
	<li>Age: Older individuals are more prone to certain causes of vertigo, such as BPPV and Meniere&#39;s disease.</li>
	<li>Gender: Some studies suggest that women may be more susceptible to certain types of vertigo, including vestibular migraines.</li>
	<li>Trauma: Head injuries, particularly those that affect the inner ear or brain, can increase the risk of vertigo.</li>
	<li>Family History: Some vestibular conditions, like Meniere&#39;s disease, may have a genetic component.</li>
	<li>Certain Medications: Some medications can affect the inner ear and increase the risk of vertigo as a side effect. 
	&nbsp;</li>
</ul>

The following measures are advised to prevent any complications and frequent vertigo episodes.

<ul>
	<li>Fall Prevention: Reducing the risk of falls is crucial. This includes keeping walkways clear, using handrails, and using assistive devices if needed.</li>
	<li>Stress Management: For individuals with vestibular migraines, stress management techniques can help reduce the frequency and severity of vertigo episodes.</li>
	<li>Hydration And Diet: For conditions like Meniere&#39;s disease, reducing salt intake and staying well-hydrated can help manage symptoms.</li>
	<li>Avoiding Triggers: Identifying and avoiding personal triggers, such as certain foods or activities, can help prevent vertigo episodes.</li>
	<li>Regular Check-Ups: Individuals with a family history of vertigo or other risk factors should have regular check-ups to monitor their ear and overall health. 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Vertigo is characterized by a false sensation of spinning or movement and can be caused by various underlying conditions.</li>
	<li>There are two main types of vertigo: peripheral (inner ear-related) and central (central nervous system-related).</li>
	<li>Common symptoms include rotational sensation, nausea, vomiting, balance problems, and nystagmus.</li>
	<li>Diagnosis involves a thorough evaluation, medical history, and various tests.</li>
	<li>Treatment options range from medications to surgical interventions, depending on the underlying cause.</li>
	<li>Vertigo can lead to complications such as injuries, emotional distress, and reduced quality of life.</li>
	<li>Risk factors include age, gender, trauma, family history, and certain medications.</li>
	<li>Preventive measures include fall prevention, stress management, diet modification, trigger avoidance, and regular check-ups.</li>
</ul>

[1] Teggi, R., Manfrin, M., Balzanelli, C., Gatti, O., Mura, F., Quaglieri, S., Pilolli, F., de Zinis, L. R., Benazzo, M., & Bussi, M. (n.d.). Point prevalence of vertigo and dizziness in a sample of 2672 subjects and correlation with headaches. PubMed Central (PMC). DOI:10.14639/0392-100X-847