Vertigo: Symptoms, Causes, Treatment, and More

  1. Meniere’s disease

    Vertigo can stem from infections, migraines, injuries, and various medical conditions. Identifying and treating the underlying cause is essential for alleviating symptoms and achieving long-term relief.

    Vertigo presents as a false sensation of spinning or movement, creating the illusion that either you or your surroundings are moving when they’re not.

    While it shares some characteristics with motion sickness, vertigo differs significantly from general lightheadedness.

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    Types of vertigo – Causes of vertigo – Symptoms of vertigo – Vertigo Treatment – Vertigo diagnosis – How long does vertigo last? – Vertigo vs. dizziness – Vertigo in pregnancy – Is vertigo hereditary? – Takeaway

    Types of vertigo

    Vertigo manifests in different forms, each with distinct characteristics and causes. Recognizing these variations is crucial for proper diagnosis and treatment. The primary types include:

    1. Peripheral Vertigo:
      This type originates in the inner ear or vestibular nerve, which transmits balance signals to the brain. The most common form is benign paroxysmal positional vertigo (BPPV), caused by displaced calcium crystals in the inner ear. Other causes include vestibular neuritis, labyrinthitis, and Meniere’s disease. Symptoms typically involve sudden spinning sensations, nausea, vomiting, and balance difficulties.
    2. Central Vertigo:
      This form stems from central nervous system issues, particularly in the brainstem or cerebellum. Unlike peripheral vertigo, it’s often persistent and may accompany neurological symptoms. Potential causes include migraines, multiple sclerosis, tumors, or strokes affecting these brain regions. Symptoms may include prolonged dizziness, difficulty walking, double vision, and slurred speech.
    3. Positional Vertigo:
      Triggered by head position changes, this type includes BPPV, where specific movements like turning in bed induce brief vertigo episodes. Diagnosis often involves specialized maneuvers like the Dix-Hallpike test to identify displaced inner ear crystals.
    4. Migraine-Associated Vertigo:
      Also called vestibular migraine, this occurs alongside migraine headaches. The vertigo may precede, accompany, or follow migraine attacks. Treatment focuses on managing migraine symptoms through lifestyle changes, medications, and sometimes vestibular rehabilitation.
    5. Non-Vertiginous Dizziness:
      This encompasses sensations like lightheadedness or unsteadiness without true spinning. Causes range from dehydration and low blood pressure to anxiety or medication side effects.

    Accurate differentiation between these types is vital for effective management. Persistent or severe vertigo warrants professional medical evaluation.

    Causes of vertigo

    Common vertigo triggers include:

    • BPPV: The leading cause, featuring brief but intense spinning episodes triggered by head movements, often following head trauma.
    • Viral infections: Vestibular neuritis or labyrinthitis can cause persistent vertigo from inner ear inflammation.
    • Meniere’s disease: Inner ear fluid buildup leads to prolonged vertigo attacks lasting hours.
    • Migraines: Vertigo episodes may accompany migraines, lasting minutes to hours.
    • Head/neck injuries: Trauma affecting the vestibular system frequently causes vertigo.
    • Medications: Certain drugs may induce vertigo along with dizziness, hearing changes, or tinnitus.

    While BPPV is generally benign, it increases fall risk. Symptoms typically include spinning sensations, imbalance, nausea, and vomiting.

    Stress doesn’t directly cause vertigo but can exacerbate it. Research also links severe stress to increased stroke risk, which could potentially lead to vertigo.

    Symptoms of vertigo

    Vertigo presents with various disruptive symptoms:

    1. Spinning sensation: The hallmark symptom, ranging from mild to severe, often worsening with head movements.
    2. Nausea/vomiting: Common during severe episodes, adding to discomfort.
    3. Balance issues: Increased unsteadiness raises fall risk during attacks.
    4. General dizziness: Persistent lightheadedness may continue after spinning subsides.
    5. Physical reactions: Sweating, paleness, and clamminess often accompany episodes.
    6. Vision changes: Blurred/double vision or involuntary eye movements may occur.
    7. Headaches: Some experience migraines before, during, or after vertigo.
    8. Tinnitus: Ringing ears often accompanies Meniere’s-related vertigo.
    9. Anxiety: Episodes can trigger panic, especially with severe attacks.
    10. Concentration difficulties: Cognitive function may be impaired during and after episodes.

    Prompt medical evaluation is crucial for proper diagnosis and management of these symptoms.

    Vertigo Treatment

    Treatment approaches vary by cause but may include:

    Repositioning maneuvers:

    The Epley maneuver effectively treats BPPV by relocating displaced inner ear crystals through specific head positions held for 30-60 seconds each.

    Medication:

    Antihistamines like meclizine help manage motion sickness and vertigo, though they may cause confusion in older adults.

    Exercises:

    Vestibular rehabilitation therapy (VRT) customizes exercises to improve dizziness, eye movement control, and balance. Severe cases should seek professional guidance.

    Surgery:

    Required for structural causes like tumors or severe head injuries.

    Natural remedies:

    Supplements like ginkgo biloba and melatonin may help, along with home exercises (Brandt-Daroff, Semont, or Foster maneuvers).

    Essential oils:

    Lavender may ease dizziness/nausea, though scientific evidence remains limited.

    Vertigo diagnosis

    Diagnosis involves multiple approaches:

    1. Medical evaluation: Detailed history and physical exam assessing symptoms, triggers, and medical background.
    2. Vestibular testing:
      Includes:
      • Dix-Hallpike maneuver: Diagnoses BPPV by provoking characteristic eye movements
      • Caloric testing: Evaluates inner ear function using temperature changes
      • Videonystagmography (VNG): Records eye movements during balance tests
      • Rotary chair testing: Assesses vestibular responses to controlled rotation
    3. Imaging: MRI scans identify structural issues like tumors or MS lesions.
    4. Blood tests: Check for infections, autoimmune disorders, or metabolic imbalances.
    5. Specialized tests: Electrocochleography (ECoG) for Meniere’s; electronystagmography (ENG) for vestibular function.
    6. Symptom tracking: Questionnaires/logs help identify patterns and triggers.
    7. Specialist consultation: Neurologists or ENT specialists may be needed for complex cases.

    Early, accurate diagnosis enables targeted treatment for better outcomes.

    How long does vertigo last?

    Duration varies significantly by cause:

    1. BPPV: Brief episodes (under 1 minute) but may recur frequently with head movements.
    2. Vestibular neuritis/labyrinthitis: Severe vertigo lasts days to weeks, with residual imbalance potentially persisting months.
    3. Meniere’s disease: Attacks last 20 minutes to several hours, often followed by prolonged fatigue.
    4. Migraine-associated: Episodes may continue hours to days, depending on migraine duration.
    5. Other causes: Central or structural issues may cause chronic vertigo lasting weeks to years without treatment.

    Proper treatment typically reduces episode frequency, severity, and duration.

    Vertigo vs. dizziness

    Key differences:

    Vertigo:

    • Specific spinning/rotational sensation
    • Worsens with head movements
    • Often accompanied by nausea/vomiting
    • Typically inner ear or vestibular-related

    Dizziness:

    • General lightheadedness/unsteadiness
    • No spinning sensation
    • Multiple potential causes (cardiovascular, neurological, etc.)

    Accurate distinction guides appropriate treatment approaches.

    Vertigo in pregnancy

    Affecting 20-30% of pregnancies, vertigo stems from:

    1. Hormonal changes: Alter inner ear fluid balance and blood pressure regulation.
    2. Increased blood volume: Affects circulation, especially when standing up.
    3. Postural shifts: Changing center of gravity impacts balance.
    4. Anemia: Reduced oxygen delivery causes lightheadedness.
    5. Gestational diabetes: Affects blood circulation.
    6. Orthostatic hypotension: Blood pressure drops when standing.
    7. Pre-existing conditions: Like BPPV or Meniere’s may worsen.

    Management strategies:

    • Avoid sudden position changes
    • Maintain hydration/nutrition
    • Rise slowly from sitting/lying
    • Use support when standing/walking
    • Practice gentle balance exercises
    • Manage stress/anxiety

    Persistent symptoms warrant medical consultation.

    Is vertigo hereditary?

    While not directly inherited, some associated conditions have genetic links:

    1. Meniere’s disease