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Vertigo

(Dizziness)

• Definition • Causes • Risk Factors • Symptoms • Diagnosis • Treatment • Prevention

Definition

Vertigo is a feeling of spinning or whirling when you are not moving. It can also be an exaggerated feeling of motion when your body is still. Vertigo is a symptom that can be caused by many different conditions. Vertigo is different from passing dizziness or lightheadedness.

Causes

Inner ear nerves and structures sense the position of your head and body in space. Vertigo is often caused by problems with these nerves and structures. Less commonly, it is due to problems in the brain.

Vertigo can be classified as:

Vertigo of Peripheral Origin

Vertigo of peripheral origin is caused by problems of the inner ear. It is the most common type of vertigo. Causes may include:

Benign Paroxysmal Positional Vertigo (BPPV)
Meniere's disease
Perilymphatic fistula—an abnormal canal or connection in the inner ear
Ototoxic medications—some medications can disrupt the inner ear's ability to balance
Infection
Acoustic neuroma—benign tumor of the inner ear
Reduced blood flow
Injury
Otosclerosis—a bony growth near the middle ear

Vertigo of Central Origin

Vertigo of central origin is not as common as vertigo of peripheral origin, but it is more serious. This type of vertigo is affects the brainstem or the cerebellum, the region of the brain that controls balance. Causes may include:

Brain lesion or tumors
Stroke
Migraine headaches
Nervous system disorders such as Parkinson's disease, or multiple sclerosis
Epilepsy
Excessive exposure to alcohol, heavy industrial metals, or poisons
Injury

Risk Factors

Vertigo is a symptom that may be caused by many conditions. Having any of the conditions will make your more prone to having vertigo.

Symptoms

Common vertigo symptoms include:

Sensation of rotation
Illusion of movement
Sensation of feeling pulled in one direction
Feeling off-balance

Vertigo is different then lightheadedness. With lightheadedness, there is no sensation of movement. People often feel lightheaded before they faint.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. To find the cause of your vertigo, your doctor may recommend tests. Tests may include:

Dix-Hallpike maneuver—particular movement of the head to relieve or stimulate symptoms
Auditory tests
Blood pressure test, both lying down and standing up
Electronystagmogram (ENG)—to check for nystagmus, an abnormal, rhythmic, jerking eye movement
MRI
Rotatory chair test in certain situations
Brainstem auditory evoked potential studies (BAEPS or BAERs)—to check for nerve conduction in the brain auditory nerve and brain stem

Treatment

Vertigo is a symptom of another medical condition. Treatment will focus managing the underlying medical condition. Efforts may also be used to decrease the symptoms of vertigo.These may include one or more of the following:

Medications

Antihistimines
Benzodiazepines
Anticholinergics
Anti-nausea medicines

Lifestyle Changes

Living with vertigo can be challenging, but not impossible. Try these tips:

If you are in a crowded, open space or out in public:

Use a cane to help with balance and mobility
Sit at one end of the sports field or theater to avoid moving your head back and forth
Bring a stool or chair so you can sit down when you need to
Schedule what your day around peak times when places are crowded

Other tips:

Don't read or work on a computer if you are moving
Don't fly if you have sinus or ear problems due to an infection
Avoid loud background music and harsh lighting
Try to eat smaller meals throughout the day
Drink plenty of fluids
Avoid tobacco, alcohol, and caffeine

Lifestyle Changes

You and your doctor will plan lifestyle changes. These may that may help include:

If you are out in public:

Use a cane to help with balance and mobility
Sit at one end of the sports field or theater to avoid moving your head back and forth
Bring a stool or chair so you can sit down when you need to

Other tips:

Don't read or work on a computer if you are moving
Avoid loud background music and harsh lighting

Prevention

There is no known way to prevent vertigo.

RESOURCES:

American Academy of Otolaryngology—Head and Neck Surgery
http://www.entnet.org

Vestibular Disorders Association
http://www.vestibular.org

CANADIAN RESOURCES:

Balance and Dizziness Disorders Society
http://www.balanceanddizziness.org

Canadian Academy of Audiology
http://www.canadianaudiology.ca

REFERENCES:

Chan Y. Differential diagnosis of dizziness. Curr Opin Otolaryngol Head Neck Surg. 2009;17(3):200-203.

Dizziness and vertigo. Merck Manual for Health Care Professionals. http://www.merckma.... Updated January 2009. Accessed April 25, 2013.

Dizziness-differential diagnosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated December 16, 2011. Accessed April 25, 2013.

Karatas M. Central vertigo and dizziness: epidemiology, differential diagnosis, and common causes. Neurologist. 2008;14(6):355-364.

Mukherjee A, Chatterjee SK, Chakravarty A. Vertigo and dizziness-a clinical approach. J Assoc Physicians India. 2003;51:1095-1101.

Swartz R, Longwell P. Treatment of vertigo. Am Fam Physician. 2005;71(6):1115-1122.

Strategies for everyday living. Vestibular Disorders Association website. Available at: http://vestibular..... Accessed April 25, 2013.

7/2/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Oh HJ, Kim JS, Han BI, Lim JG. Predicting a successful treatment in posterior canal benign paroxysmal positional vertigo. Neurology. 2007;68:1219-1222.

Last reviewed April 2013 by Rimas Lukas, MD; Brian Randall, MD
Last Updated: 4/25/2013

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