Vertigo is the feeling of a rocking or rotation when you are perfectly still. It tends to last for several hours or days. Medically, it is distinct from dizziness because it involves the sensation of movement. Vertigo is often due a problem in the inner ear. An important part of the inner ear is the collection of semicircular canals. These structures are lined with cells that act like a gyroscope for the body and are responsible for providing feedback of our position.
Causes and Risk Factors for Vertigo
There are a variety of causes for this condition. The cause may be central or peripheral. Central causes occur in the spinal cord or brain, while peripheral is due to a problem with the inner ear. An illness or small crystals in the inner ear that become displaced can cause an irritation within the semicircular canals. This is a central cause and known as benign paroxysmal positional vertigo (BPPV). With Meniere’s disease, there is a fluid buildup in the inner ear that can cause vertigo. Headaches, head injuries, strokes, tumors and multiple sclerosis can also cause vertigo.
Head injuries definitely increase the risk factor for vertigo. In addition, antidepressants, aspirin, blood pressure medications and anti-seizure meds can also cause vertigo. For some, alcohol can cause vertigo.
Diagnosis and Treatment
To diagnose vertigo, a medical professional will take a full history of your symptoms and events. This includes previous medical issues, recent illnesses and medications. Then, a physical exam is performed. It includes a comprehensive neurological exam to check brain function. This allows for the determination of whether it’s peripheral or central. Signs of abnormal eye movement may pinpoint the problem. The Dix-Hallpike test or the roll test may be done. The Dix-Hallpike test repositions the head and monitors symptoms. With the roll test, the head is rapidly moved from side to side. A CT scan or MRI may be done to exclude structural problems. Sometimes, electronystagmography may be performed.
The most effective treatments if the vertigo is peripheral include partial repositioning movements. It’s known as the canalith repositioning procedure or the Epley maneuver. Specific head movements are performed to move the crystals in the inner ear. Cawthorne head exercises may also be performed. It’s a series of head and eye movements. This leads to decreased sensitivity of the nerves and improves vertigo. However, this needs to be done on a regular basis for optimal results. A trained physical therapist can perform these types of treatment. Keep in mind that medications may provide some relief but are not a cure. Meclizine is the most popular medication prescribed.
Most patients with peripheral vertigo can find substantial relief with treatment; it has been suggested that the Epley maneuver in cases of BPPV can benefit as many as 90% of affected patients. Although recurrence of BPPV may be more than 15% in the first year after an episode, it is unlikely that vertigo will persist beyond a few days. When vertigo persists, evaluation for any underlying structural problems of the brain, spinal canal, or inner ear may be necessary.