Vertigo: Types, symptoms and causes

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Vertigo is a sensation that makes the environment around you to look like it is spinning in circles. It can make you feel dizzy and off-balance. Vertigo isn’t a disease. Rather, it’s a symptom of varying conditions.

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There are two main types of vertigo. These are:
•Peripheral vertigo – This happens when there’s a problem with the inner ear.
•Central vertigo: This occurs when there’s an issue with the brain. Causes can include infection, brain tumors, traumatic brain injury or stroke.
The differences between vertigo and dizziness are that while both dizziness and vertigo are considered balance problems, the two symptoms are different. Dizziness is an overall feeling of being unbalanced. With vertigo, you have a sensation that you’re moving or that your surroundings are spinning.
Vertigo attacks can happen at any age, but they’re more common in people over 65. Women are somewhat more likely to experience vertigo than men. Some people experience vertigo as a side effect of pregnancy.
Vertigo is a common issue. Nearly 40 percent of Americans are said to experience vertigo at least once during their lifetime.
Vertigo attacks, on average, last several seconds to several minutes. In severe cases, however, people can experience vertigo for hours, days, weeks or even months.
Many people compare vertigo to motion sickness. It can make you feel like you’re spinning, rocking or tilting. Feelings of unbalance may worsen when you stand, walk, change positions or move your head.
Vertigo can be scary but the condition itself isn’t considered serious. However, vertigo can be linked to other potentially serious health conditions. That’s why you should inform your healthcare provider if you experience recurrent or prolonged vertigo attacks.

Symptoms and Causes
While vertigo isn’t hereditary, it can be a symptom of a range of conditions — some of which run in families. Therefore, frequent vertigo attacks could involve genetic factors.

A number of syndromes or conditions can result in vertigo. These include:
•Benign paroxysmal positional vertigo (BPPV): The most common cause of vertigo, BPPV is typically triggered by changed in your head’s position. People with BPPV often experience vertigo when lying down, sitting up or turning over in bed.
•Meniere’s disease: This condition causes fluids to build up inside the ear, leading to vertigo attacks. Meniere’s disease may also be accompanied by tinnitus (ringing in the ears), fluctuating hearing loss or a feeling a fullness in the ears.
•Labyrinthitis: If the inner ear labyrinth becomes inflamed or infected, it’s called labyrinthitis. The ear labyrinth houses the vestibulocochlear nerve, which transmits information to the brain regarding sound, position and head motion. People with labyrinthitis often experience headaches, ear pain, vision changes, tinnitus or hearing loss.
•Vestibular neuritis: This inflammation of the vestibular nerve can cause vertigo. Vestibular neuritis is similar to labyrinthitis, but it doesn’t alter your hearing. People with this condition may experience vertigo and nausea or blurred vision.
•Cholesteatoma: Repeated ear infections can cause noncancerous skin growth to develop in the middle ear. This condition is referred to as cholesteatoma, and it can lead to dizziness, vertigo and hearing loss.
There are other factors that can lead to vertigo attacks. Here are some common vertigo causes:
•Migraine headaches.
•Certain medications.
•Stroke.
•Arrhythmia.
•Diabetes.
•Head injuries.
•Prolonged bed rest.
•Shingles in or near the ear.
•Ear surgery.
•Perilymphatic fistula (when inner ear fluid leaks into the middle ear).
•Hyperventilation.
•Low blood pressure (orthostatic hypotension) – a condition in which your blood pressure decreases when you stand up.
• Ataxia, or muscle weakness.
•Syphilis.
•Otosclerosis (a bone growth problem affecting the middle ear).
•Brain disease.
•Multiple sclerosis (MS).
• Acoustic neuroma.
Many people who have migraines also experience vertigo during episodes. Vertigo may occur before the onset of a headache, during a headache or — most commonly — during a headache-free period. It should be noted, though, that some people have vertigo as their main migraine symptom instead of a headache.
It is good to note that stress itself doesn’t cause vertigo, but it can contribute to inner ear dysfunction. This can lead to vertigo attacks in some people. Approximately 5% of American adults experience vertigo when they’re anxious or stressed.
As mentioned above, vertigo is a symptom of many different conditions. However, vertigo can also occur in combination with other symptoms, including:
•Nausea and vomiting.
•Balance problems.
•Tinnitus.
•Headaches.
• Motion sickness.
•A feeling of fullness in the ear.
• Nystagmus, in which the eyes move side to side uncontrollably.

Diagnosis and Tests
Your healthcare provider will perform a physical examination and ask questions about your symptoms. They may also recommend one or more tests to confirm your diagnosis.

“Vertigo can be scary but the condition itself isn’t considered serious. However, vertigo can be linked to other potentially serious health conditions. That’s why you should inform your healthcare provider if you experience recurrent or prolonged vertigo attacks”

What tests will be done to diagnose vertigo?
Vertigo can be diagnosed with tests performed by your healthcare provider. These may include:
•Fukuda-Unterberger’s test: You’ll be asked to march in place for 30 seconds with your eyes closed. If you rotate or lean to one side, it could mean that you have a problem with your inner ear labyrinth. This could result in vertigo.
• Romberg’s test: For this assessment, you’ll be asked to close your eyes while standing with your feet together and your arms to your side. If you feel unbalanced or unsteady, it could mean that you have an issue with your central nervous system.
•Head impulse test: For this test, your provider will gently move your head to each side while you focus on a stationary target (for example a spot on the wall or your provider’s nose). The clinician will be checking to see how the inner ear balance system is working to help control your eye movements while your head is in motion.
•Vestibular test battery: This includes several different tests to help identify an inner ear problem. Goggles are placed over the eyes to monitor eye movement responses while moving your eyes to follow a target, moving your head and body, and even after warm and cool water are put into the ear canal.
In addition to the tests outlined above, your healthcare provider may request radiographs. These may include:
•CT (computed tomography) scans.
•Magnetic resonance imaging (MRI).

Management and Treatment
Vertigo goes away on its own in many cases. However, there are several treatments that can successfully manage vertigo.
The vertigo treatment that’s right for you depends on several factors, including the root cause. Some of the most notable vertigo treatments include:
• Medication: Treating the underlying cause of your vertigo can help ease symptoms. For example, if vertigo is a byproduct of an infection, your healthcare provider can prescribe antibiotics. Steroids can help reduce inflammation. There are also medications to relieve other vertigo symptoms, such as nausea or motion sickness.
•Vestibular rehabilitation: If vertigo is the result of an inner ear problem, this type of physical therapy may help reduce your symptoms. Vestibular rehabilitation helps strengthen your other senses so they can compensate for vertigo episodes.
• Canalith repositioning procedure (CRP): If you have BPPV, canalith repositioning maneuvers help move calcium deposits into an inner ear chamber where they will be absorbed by your body.
•Surgery: When vertigo is due to a serious underlying issue, such as a brain tumor or neck injury, surgery may be necessary.
There isn’t enough evidence to prove that vertigo can be treated with alternative therapies. However, some people take herbal supplements to ease their symptoms. Popular herbal vertigo remedies include:
•Turmeric.
•Ginkgo biloba.
•Cayenne.
•Ginger root.
•Gongjin-dan.
Be sure to talk to your healthcare provider before adding any herbal supplements to your diet. They can help you safely incorporate them into your regimen.

Prevention
There are a few steps you can take to reduce your risk for vertigo. These include:
• Taking extra time to stand up, turn your head or perform other triggering movements.
• Sleeping with your head elevated on two pillows.
• Sitting down as soon as you feel dizzy.
• Squatting instead of bending over when picking something up.

When should I see my healthcare provider?
If vertigo becomes severe or recurrent, it’s time to call your healthcare provider. There could be an underlying health condition that’s causing your symptoms.

Source@ my.clevelandclinic.org