Definition and Overview

Vertigo refers to the sensation as if the surroundings are spinning (objective vertigo) or the person is moving around the environment (subjective vertigo). Although many people believe it’s a type of condition, it is actually more of a symptom that may have something to do with balance issue (peripheral) or problem in the brain (central).

On the other hand, dizziness and vertigo are often used interchangeably, perhaps because they create a similar feeling. Dizziness is also a symptom of an underlying disease or health problem, although it doesn’t have to mean something serious.

However, both are actually different. First, dizziness can be caused by many things including a very low level of blood sugar or low blood pressure, and people can have various ways of describing it. While others associate it with fainting episodes, some may call it light-headedness. There are also people who link dizziness with hyperventilation or a very rapid heart rate.

Dizziness, further, doesn’t have to include a sensation or perception of movement, which is present in vertigo.

Vertigo can happen very suddenly, lasting between a few seconds to a couple of hours. It can also recur frequently or take months between each episode.

It can also be very mild or severe that it can interfere with the person’s mobility such as driving and walking. One of the major concerns of vertigo is the person’s tendency to get involved in an injury or accident that can lead to fractures or more life-threatening situations.

Causes of Condition

The causes of vertigo differ between two types. When it is peripheral vertigo, it means the problem has something to do with balance and the inner ear.

The ear is divided into three sections: outer, middle, and inner ear. In the inner ear is the vestibular system, a part of which is the labyrinth, which is composed of semicircular canals. Inside the canals is the endolymph, a type of fluid. Its motion is responsible for helping the brain determine the orientation of a person in terms of movement.

Vertigo can occur as a result of a condition or a problem that is affecting the inner ear, particularly the vestibule system. The most common cause of peripheral vertigo is BPPV (benign paroxysmal positional vertigo). It normally happens when there’s a sudden change in the head’s position. The occurrence is short, lasting only a few seconds. Inflammation usually due to bacterial infection can also lead to a balance disorder, which can cause vertigo. These include inflammation of the labyrinth (labyrinthitis) or the vestibule (vestibular neuritis). When the vertigo is accompanied by other ear-related symptoms such as tinnitus (ringing sensation in the ears) or even loss of hearing, the cause may be Meniere’s disease. This is different from acoustic neuroma, which is an inner ear tissue damage. Although it also includes tinnitus, in acoustic neuroma, only one side is usually affected.

Peripheral vertigo may also develop due to certain medications and injury to the ear and head.

Meanwhile, central vertigo is caused by a problem that is affecting the brain. One of the most common reasons is a disease in the blood vessel, such as the formation of a blood clot or stenosis (narrowing of the arteries). Alcohol can also lead to central vertigo, along with excessive aspirin intake.

Tumors, whether malignant or benign, can create intracranial pressure that could lead to symptoms including vertigo. Migraine, a rather painful headache that affects at least one side of the head, often happens along with bad vision, nausea, and vertigo.

In other cases, seizures, strokes, and multiple sclerosis (an autoimmune disease that occurs when the immune system destroys myelin that protects the nerves) also occur. As it progresses, the disease also damages the nerves that transmit impulses that help manage balance.

Key Symptoms

The key symptom of vertigo is the spinning sensation or feeling. However, it can also be accompanied by:

  • Partial or complete hearing loss
  • Poor balance
  • Lack of body coordination
  • Inability to walk properly
  • Nausea
  • Appearance of flashes of light (a sign of migraine)
  • Lightheadedness
  • Vomiting
  • Fainting spell
  • Eye movement problems
  • Double vision
  • Weakness
  • Headache
  • Fever (which may occur when the cause is an infection)
  • Excessive sweating

Who to See and Treatments Available

A general doctor or a family care physician can carry out the initial assessment, diagnosis, and treatment of vertigo. If the first line of treatment doesn’t work, the patient will be referred to a specialist, which can be an ENT specialist (otolaryngologist) who treats problems affecting the ear, or a neurologist if the issue is related to the brain. If vertigo is caused by a traumatic injury, a trauma specialist can also help.

Many types of tests including blood and imaging exams can be performed to diagnose vertigo, but one of the most effective is called Dix-Hallpike test, which is used to diagnose both vertigo and involuntary movement of the eyes or nystagmus. It may also help the doctor identify which of the ears is affected in case the vertigo is peripheral.

Although some cases of vertigo can go away without any treatment, many may still need some form of therapy.

When it comes to treatment, doctors can teach the patients certain therapies to relieve the sensation. One of these is the Epley maneuver, which involves turning and lying to the side of the ear where the vertigo is believed to have started. If the maneuver is ineffective or if there are issues with the head and/or neck, an alternative is the Brandt-Daroff exercise, which includes standing and lying in bed at certain intervals.

Medications, on the other hand, can include antihistamines and antibiotics, which can aid in treating bacterial infection. Drugs can also be used to minimize the symptoms commonly associated with vertigo such as nausea.

As vertigo may be aggravated by depression and anxiety, behavioral therapies or stress management can be helpful as well.

In some instances, surgery may be recommended, such as when it’s caused by tumour or injury.

References:

  • Post RE, Dickerson LM. Dizziness: a diagnostic approach. AmFam Physician. 2010 Aug 15;82(4):361-8, 369.

  • Olshaker JS. Dizziness and vertigo. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’' Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 12.

  • Baloh RW, Jen J. Hearing and equilibrium. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 436.

Share This Information: