June 10, 2023
When someone says “I have vertigo,” they are referring to a symptom, not to a particular disease. Vertigo is the name of a sensation, and it can feel like you are spinning around, or in other cases, it feels like your environment is spinning around you. Other symptoms frequently come along with a bout of vertigo, and those can include nausea, vomiting, and loss of balance.
Vertigo can begin suddenly, seemingly out of nowhere and can last from just a few seconds, or may become a prolonged attack with misery for hours or days. These longer vertigo attacks can be very debilitating, as driving, reading and even walking from room to room is difficult or impossible. Vertigo also varies quite a bit in its intensity, from being hardly noticeable to being so severe you can’t stand up.
The majority of cases of vertigo get better without treatment but if you have frequent attacks or a bout of vertigo that won’t go away, see your health care provider for an evaluation. Vertigo is most commonly caused by a problem in the inner ear, but it can also be caused by problems in the brain itself. There are varying causes of vertigo, but these four are the most common:
Labyrinthitis - this is an inflammation of the labyrinth, which is the very innermost structure in your ear. This structure is composed of the cochlea, responsible for transferring sounds to the brain so you can hear, and the vestibular system, which is a system of channels filled with fluid that help you to maintain your balance. This condition is usually caused by a virus and fortunately, with time, goes away on its own. Medications for dizziness and for nausea can help with comfort.
BPPV or benign paroxysmal positional vertigo - a condition where certain movements of the head can precipitate an attack of vertigo. There are a series of simple-to-perform head movements, known as the Epley maneuvers, that can help immensely with this. These head movements can be facilitated by your doctor or audiologist, but before treatment let your provider know if you have a detached retina, blood vessel problems or back or neck difficulties.
Migraines - a form of vascular headache, can cause vertigo in some people
Vestibular neuronitis - this is an inflammation of the vestibular nerve, which sends information about position and motion to the brain and helps to control balance.
There are some things you can do at home to help:
If taken in the early stages of an attack, antihistamines may help. Prescription hydroxyzine is commonly given. If you are prone to attacks of vertigo, ask your doctor about keeping some on hand.
When getting out of bed, move slowly, and sit up on the side of the bed for a minute or two before trying to stand.
Avoid bending over to pick up an object. Squat down instead and keep your head more level.
Sleep with your head slightly elevated on one or more pillows.
If you do go for an evaluation for vertigo, you can expect your eye movements to be tested, and cold and then warm water may be placed in your ear canals to watch for abnormal eye movements. Other tests may involve tests of your balance and possibly blood tests to rule out any imbalance. If your healthcare provider feels there is any chance of a stroke, a CT or MRI of your brain may be necessary
If, after testing, no cause can be found, then medications and possibly a type of therapy known as VRT or vestibular rehabilitation training may be helpful. This therapy consists of exercises for people who have recurring dizziness and problems with balance.
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