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When most of us think of vertigo, dizziness and spinning comes to mind. But where does the off balance really come from? Dr. Sheila Wijayasinghe educates us on the dizzy symptoms of vertigo and shares tips on how to treat it.
What is vertigo?
Vertigo refers to a sense of spinning dizziness. It’s a symptom of a range of conditions and it can happen when there’s a problem with the inner ear, brain, or sensory nerve pathway.
Vertigo is a sensation of spinning dizziness. It is not, as many people maintain, a fear of heights.
It’s often associated with looking down from a great height but can refer to any temporary or ongoing spells of dizziness caused by problems in the inner ear or brain, but there are many conditions that can cause vertigo.
- Dizziness is a general term that describes any sensation of tilting/spinning or a feeling of lightheadedness/ or that you are about to pass out.
- Vertigo is a specific type of dizziness that is characterized by the sudden sensation that you are spinning or that the world around you is spinning You may feel like you are moving or the room is turning around you. It is not lightheadedness.
- Vertigo itself is not a condition but a symptom of an underlying disease. It can be caused by a number of different problems involving the inner ear, brain or medication side effects. While the majority of conditions that cause vertigo are benign, some can be serious.
What are the symptoms?
A person with vertigo will have a sense that their head, or their surrounding environment, is moving or spinning.
Vertigo can feel like:
- Spinning (either you or the room around you)
- Tilting or swaying
- Feeling off balance
These feelings come and go, and may last seconds, hours, or days. You may feel worse when you move your head, change positions (stand up, roll over), cough, or sneeze. Along with vertigo, depending on the condition, there can be some associated symptoms such as:
- Headache or be sensitive to light and noise
- See double, have trouble speaking or swallowing, or feel weak
- Feel short of breath or sweaty, have a racing heartbeat
- Tinnitus/fullness in ears
What causes vertigo?
The most common causes of vertigo are due to issues with the inner ear where our vestibular system (balance system) exists. Any disease of the inner ear, inflammation or infection can trigger vertigo symptoms.
This is the most common cause of vertigo. It stands for:
- Benign: It is not life threatening, even though the symptoms can be very intense and upsetting.
- Paroxysmal: It comes in sudden, short spells.
- Positional: Certain head positions or movements can trigger a spell.
- Vertigo: You feel like you are spinning, or the world around you is spinning.
Occurs when small crystals break free and float inside the tubes of your inner ear, which are called semicircular canals that trigger signals to the brain that cause a sensation of disequilibrium/spinning. These crystals move with positional change of the head so sudden movement of the head such as lying flat/turning in bed or tilting head can trigger the symptoms.
BPPV typically results in short episodes of vertigo that come on suddenly and last a few seconds to a few minutes. There’s no hearing loss and some nausea (though it’s not severe). Symptoms often resolve when turn head in opposite direction of triggering direction.
Vestibular neuritis or labrynthitis (inflammation/swelling of the inner ear that causes swelling around balance nerve)
This is often brought on by inner ear infection and can cause severe bout of vertigo that can last 1-2 days and can include hearing loss, difficulty standing, hearing.
This is caused by the buildup of fluid and pressure in the inner ear causing sudden intense vertigo, ringing in ears and sensation of plugged ears. It seems to run in families, too. Spells can last minutes to hours.
Who is effected by vertigo?
Having these risk factors doesn’t mean you will develop vertigo—they just put you at an increased risk for the condition:
- Being over age 50
- Being a woman
- Suffering a head injury
- Taking certain drugs, especially antidepressants or antipsychotics
- Having any medical condition that affects balance or your ears
- Experiencing a previous episode of vertigo
- Having a family member who has vertigo
- Having an inner ear infection
- Experiencing high levels of stress
- Drinking alcohol
How to diagnose
First step is to see your doctor to review your symptoms including:
- Duration of symptoms
- What triggers episodes and associated symptoms such as hearing loss/headache.
Your doctor will start by learning about your symptoms and doing an exam. During the exam, he or she will check:
- Your hearing
- How you walk and keep your balance
- How your eyes work when you watch a moving object, and when your head is turned from side to side
Depending on what your doctor finds during the exam, he or she might order more tests to better understand your hearing or balance problems. In some cases, the doctor will order an MRI or CT of your brain.
If your symptoms are concerning or difficult to diagnosis the cause, a referral to an ENT specialist or neurologist is warranted for review and for other specialized testing.
Can it ever go away?
It depends upon the cause of the vertigo. In many cases, vertigo goes away without any treatment. Vestibular neuritis (labrynthitis) can last several days and resolve and inflammation resolves. BPPV generally resolves with treatment but can recur but be managed. Vestibular migraines can recur, as can Meniere’s. If you have persistent symptoms of vertigo, your doctor should consider referral for specialist for consideration of medication to treat the underlying cause.
Treatment depends on cause. Treatment can vary from medications, exercises, physiotherapy and, in rare cases, surgery.
High risk of falling with vertigo so at home, make your home as safe as possible: Sit down as soon as you feel dizzy.
- If you know a movement normally makes you feel symptoms, do it slowly.
- Use good lighting when getting up at night.
- If vertigo impacts your ability to walk or sense of balance, use a cane to help prevent falls and serious injuries
- Get rid of loose electrical cords, clutter, and slippery rugs. Also, make sure that you wear sturdy, non-slip shoes, and that your walkways are clear and well lit.
When to see a doctor
There are rare but serious causes of vertigo. See a doctor ASAP if you have vertigo with:
- A new or severe headache
- A fever higher than 100.4ºF (38ºC
- See double or have trouble seeing clearly
- Have trouble speaking or hearing
- Have weakness in an arm or leg or your face droops to one side
- Pass out
- Have chest pain
- Cannot stop vomiting
- Are older than 60
- Had a stroke in the past; are at risk for having a stroke, for example because you have diabetes or you smoke