Vertigo is sometimes used to refer to a fear of heights, but, in medical terms, this is not correct. A fear of heights is known as acrophobia.
Dizziness, or vertigo, can happen at any age, but it is common in people aged 65 years and over. Over 60 medical and psychiatric conditions can cause it, as well as some medications.
Vertigo can be temporary or long term. Persistent vertigo has been linked to mental health issues. A psychiatric problem may cause the dizziness, or the vertigo may affect the person's ability to function in daily life, potentially leading to depression.
Ear problems can lead to vertigo.
A person with vertigo will have a sense that they, or their environment, are moving or spinning, even though there is no movement.
Vertigo is a symptom, but it can also cause other symptoms
- balance problems and lightheadedness
- nausea and vomiting
- a sense of motion sickness
- a feeling of fullness in the ear
Vertigo is not just a feeling of faintness, but a rotational dizziness.
Causes and types
There are different types of vertigo, depending on what causes them.
Peripheral vertigo happens when there is a disturbance in the balance organs of the inner ear.
Central vertigo happens when there is a disturbance in parts of the brain known as sensory nerve pathways.
Peripheral vertigo is linked to the inner ear.
Peripheral vertigo is linked to problems with the inner ear.
The labyrinth of the inner ear has tiny organs that enable messages to be sent to the brain in response to gravity.
These messages tell the brain when there is movement from the vertical position. This is what enables people to keep their balance when they stand up.
Disturbance to this system produces vertigo.
This can happen because of an inflammation, often due to a viral infection.
Various conditions are associated with peripheral vertigo.
Labyrinthitis: This is an inflammation of the inner ear labyrinth and vestibular nerve, the nerve that is responsible for encoding the body's motion and position. It is usually caused by a viral infection.
Vestibular neuronitis: This is thought to be due to inflammation of the vestibular nerve, usually due to a viral infection.
Ménière's disease: A buildup of fluid in the inner ear can lead to attacks of vertigo. It tends to affect people between the ages of 40 and 60 years.
According to The National Institute on Deafness and Other Communication Disorders (NIDCD), 615,000 people in the United States (U.S.) are currently receiving treatment for this condition. It may stem from blood vessel constriction, a viral infection, or an autoimmune reaction, but this is not confirmed.
Benign paroxysmal positional vertigo (BPPV): This is thought to stem from a disturbance in the otolith particles. These are the crystals of calcium carbonate within inner ear fluid that pull on sensory hair cells during movement and so stimulate the vestibular nerve to send positional information to the brain.
In people with BPPV, normal movement of the endolymph fluid continues after head movement has stopped.
However, it can also follow:
- a head injury
- reduced blood flow in part of the brain, known as vertebrobasilar ischemia
- ear surgery
- prolonged bed rest
Drug toxicity and syphilis can also lead to inner ear disturbances.
Other, rarer causes of peripheral vertigo are:
- perilymphatic fistula, a tear in one or both of the membranes separating the middle and inner ear
- herpes zoster oticus, a viral infection of the ear, also known as Ramsay Hunt syndrome
- otosclerosis, a genetic ear bone problem that causes hearing loss
Central vertigo is linked to problems with the central nervous system.
It involves a disturbance in one of the following areas:
- the brainstem and cerebellum, which are the parts of the brain that deal with interaction between the senses of vision and balance
- sensory messages to and from the part of the brain known as the thalamus
Migraine headache is the most common cause of central vertigo. An estimated 40 percent of patients with migraine have some vertigo, which can involve disrupted balance, dizziness, or both, at some time.
Uncommon causes are:
- transient ischemic attack
- cerebellar brain tumor
- acoustic neuroma, a benign growth on the acoustic nerve in the brain
- multiple sclerosis
Tests and diagnosis
A doctor will carry out a physical examination, and they will ask the patient how the dizziness makes them feel. This will enable the doctor to find out what kind of dizziness they have.
The doctor will ask about ask about the patient's medical history, including any history of migraine or a recent head injury or ear infection.
The person may undergo a CT or MRI scan.
The doctor may also provoke an eye movement known as nystagmus, as this can occur with vertigo.
Nystagmus is an uncontrolled eye movement, usually from side to side. It can happen when a person has vertigo, due to the brain thinking there is a rotational movement when there is not.
Similar eye movement happens when you try to fix your eyes on one position while looking at something that is passing quickly by, for example, when looking out from a train window.
To check for nystagmus, the doctor may carry out the following exercise:
- The doctor rapidly moves the patient from a sitting position to lying down on the examination bench.
- The head is turned and held 45 degrees toward the affected side before this quick maneuver, and moved 30 degrees down at the end of it, over the end of the bench, below the horizontal position of the rest of the body.
- If the patient experiences vertigo shortly after, and if the doctor observes specific eye movements, or nystagmus, this can indicate that the patient has vertigo.
Electronystagmography (ENG) can electronically record the nystagmus. The patient wears a headset that places electrodes around the eyes. The device measures eye movements.
Videonystagmography (VNG) is a newer technology can provide a video recording of the nystagmus.
The patient puts on a pair of special glasses that contain video cameras. These record horizontal, vertical and torsional eye movements using infrared light. Computer processing can analyze the data collected.
The head impulse test
The patient is asked to fix their gaze on the tip of the doctor's nose while the head is moved quickly to one side.
If the patient can keep their eyes on the nose during this movement, the test is negative. The cause is not vertigo, so the doctor may then carry out tests to see if the symptoms are due to a cerebrovascular issue, such as blood vessel narrowing or blood clots in the brain.
The test is positive test if the patient cannot avoid following the quick head movement with their eyes, and then moves their eyes back to look at the nose.
By determining if this effect is seen when the head moves to the left or the right, the doctor can find out which ear is affected.
A person who is steady when they have their eyes open is asked to shut their eyes. If they become unsteady, this is a sign of vertigo. The side they fall toward is normally the side where the ear is affected.
The patient marches on the spot for 30 seconds with their eyes closed. If vertigo is present, there may be sideways rotation, toward the affected side.
Some types of vertigo resolve without treatment, but any underlying problem, for example, a bacterial infection, may need medical attention.
Drugs can relieve symptoms of some kinds of vertigo, for example, vestibular suppressants or anti-emetics to reduce motion sickness and nausea.
Patients with acute vestibular disorder linked to a middle ear infection may be prescribed steroids (such as prednisone), antiviral drugs (such as acyclovir) or antibiotics (such as amoxicillin).
The Epley maneuver to cure BPPV
If the vertigo is caused by BPPV, a technique known as the Epley maneuver may help. This is also known as canalith repositioning.
This involves several simple and slow maneuvers to position the head.
The aim is to move particles from one part of the fluid in the inner ear to an open area, or vestibule, of the ear, where they are more easily resorbed and do not cause trouble.
A doctor will maneuver the patient into a series of positions that are held for around 30 seconds after symptoms or nystagmus subsides.
Sometimes, minor surgery is carried out to treat patients with BPPV. The surgeon inserts a bone plug into the inner ear to block the area that is triggering the dizziness. The plug prevents this part of the ear from responding to particle movements or head movements.
Treatment of Ménière's disease
Prescription drugs, such as diazepam or lorazepam can be used to relieve the dizziness experienced with Ménière's disease.
Looking up can make symptoms worse.
Other options include:
- Restricting salt and diuretics to reducing the volume of fluid retained in the body
- Avoiding caffeine, chocolate, alcohol, and tobacco reduce symptoms in some people
- Pressure pulse treatment, where a device fitted to the outer ear delivers air pressure pulses to the middle ear, reducing dizziness
- Surgery to decompress the endolymphatic sac or to cut the vestibular nerve, if nothing else works
Some people have tried acupuncture, acupressure, and herbal supplements such as gingko biloba, but there is no scientific evidence that these are effective.
Patients should discuss any alternative treatments with their doctor before using them.
Precautions for people with vertigo
Anyone who experiences vertigo or other types of dizziness should not drive or use a ladder. It may be a good idea to make adaptations in the home to prevent falls. Getting up slowly may alleviate the problem. People should also take care when looking upward.