Vertigo: Causes and Treatment Plans
Sun, April 18, 2021

Vertigo: Causes and Treatment Plans


Have you ever felt your world twirling while you’re walking down at the street or sitting at work? That might be vertigo. Vertigo is described as a specific type of dizziness and a sudden sensation that you are spinning or that your surroundings are spinning. This can come and go or can last for hours or days.

You may also experience headaches, vomiting, nausea, double vision, or a racing heartbeat. Dr. Marlan Hansen, an associate professor of otolaryngology at the University of Iowa Hospitals and Clinics, informed CBS News, "Dizziness is one of the top reasons why elderly people go to the emergency room, but not all of them have vertigo." However, most of the patients referred to Dr. Hansen are misdiagnosed.   

Cohort Study of the Relationship Between Migraine and Episodic Vertigo (2019)

Christian Lampl and colleagues of open access journal portal BMC analyzed eligible patients with episodic migraine with aura (MwA) and/or without aura (MwoA). The respondents, who were diagnosed by neurologists, were asked in detail if they experienced episodic vertigo (EV) anytime around their migraine attacks. It was divided into three: Onset of headache, <2h before the onset of headache, and 2-48 hours before the onset of headache.

The study population consisted of 356 females and 131 males. The authors found that 30% of patients reported EV anytime during the migraine attack, 16.2% noticed EV with the start of the headache phase (group A), and 10.5% reported EV within two hours before the headache phase (group B) and led to the headache phase in all patients. 3.3% had EV 2–48 hours before the headache phase (group C) and led into the headache phase. 77% of patients experienced MwoA while 22.9% had MwA.

In group A, 82.5% had an aggravation of headache pain during physical activity, 92.6% experienced nausea, 57.1% were sensitive to smell, 77.6% were sensitive to sound, and 82.3% to light. Neck pain was prevalent in 37.7% of patients (12.1% had neck pain bilateral and 25.6% had neck pain unilateral).

In group B, 7.6% experienced headache aggravation during physical activity, 22% had nausea, 6.8% were sensitive to smell, 12.7 to sound, and 16.2% to light. Neck pain was observed in 24.2% of participants (8.4% and 15.8%). In group C, 1.4% experienced nausea, 0.6% were sensitive to smell, 1.6% to sound, and 0.6% to light. Neck pain was present in 7.4% of patients (0.6% and 6.8%).

The authors’ next trial would be prospective as they would use an electronic calendar and conduct a semi-structured interviewed to characterize in detail the array of vestibular symptoms and careful recording of all aspects of vertiginous episodes beyond the migraine attack, including the timing during the attack.

Though the study concluded that the symptom of EV was more of a headache phase, Lampl and colleagues expect future studies that tackle the character and duration of vertigo in migraineurs and their variables outside of migraine attacks to find out if a number of these episodes will meet the criteria for the diagnoses of vestibular migraine.  



Causes of Vertigo

The most common ones include inner ear infections or diseases of the ear like benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and Meniere’s disease. BPPV happens when calcium builds up in the inner ear’s canal, which leads to brief dizziness that lasts from 20 to 60 seconds. Oftentimes, it occurs when the head is moved in certain positions or caused by trauma to the head.

Vestibular neuritis happens due to an inner ear infection, causing inflammation around the nerves. The nerves aid in your sense of balance and vestibular neuritis can lead to vertigo, which can last for a day or more. It may also include hearing loss. Dr. Hansen stated, “A person is dizzy for a day or two and then off balance.” Meniere’s disease happens when there are fluid buildup and pressure in the inner ear. This can cause dizziness, as well as hearing loss and ringing in the ears. Less common causes of vertigo are head or brain injuries or migraines.



Diagnosing Vertigo

Your doctor will try to find the cause of dizziness by performing a physical examination, asking you how your dizziness makes you feel, and learning about your medical history, said Markus MacGill of Medical News Today, a medical news outlet.

Your doctor may also perform simple tests. For example, a Romberg’s test may be conducted by instructing you to stand with your arms by your sides and their feet together. The doctor will instruct you to close your eyes. If you become unsteady once you close your eyes, it could be a symptom of a CNS (central nervous system) problem.

A Fukuda-Unterberger’s test may also be performed by instructing you to march on the spot for 30 seconds with your eyes closed. If you rotate on one side, this may suggest a presence of a lesion in the inner ear labyrinth, which can cause peripheral vertigo. Your doctor may also recommend a head CT or MRI scan to obtain more details, though it depends on the aforementioned and other tests.



Treatment for Vertigo

Vertigo can be a once-in-a-lifetime occurrence that comes and goes quickly, which should not necessarily be a cause for alarm. However, if you experience repeated bouts of dizziness and hearing loss, Dr. Hansen recommends consulting an ear, nose, and throat specialist for appropriate treatment.

Dizziness could be a symptom of a serious brain problem like stroke, bleeding in the brain, or multiple sclerosis. If vertigo is caused by BPPV, it can be treated by physical therapy where you can learn the canalith repositioning procedure, which is a series of exercises. The procedure involves slow maneuvers to help position your head, allowing the particles to shift in the inner ear.

If you have Meniere’s disease, your doctor might prescribe a low sodium diet and a diuretic to reduce fluid pressure in the inner ear. Vertigo can also be treated with prescription medications such as beta blockers, calcium channel blockers, and tricyclic antidepressants.

Vertigo comes and goes, but having severe bouts of dizziness and hearing loss is another story. While not everyone (including the elderly) has vertigo, your doctor can help you pinpoint the exact cause of your dizziness.