Physician's Weekly
March 11, 2022
Vertigo – Symptoms, Complications, Risk Factors, Causes, Assessment and Treatment

Q: I keep getting vertigo, where the room keeps spinning. When this happens I have to take medication to stop it. Can you tell me more about this condition and what can I do to control it?

Persons experiencing vertigo feel as though their surroundings are moving, and/or spinning, even though they may be absolutely still. It is not uncommon that there is also accompanying sweating, nausea and vomiting. Vertigo and its related symptoms are worsened when there is movement of the head.

Symptoms associated with vertigo

  • Spinning of surroundings and or self
  • Dizziness
  • Nausea/ Vomiting
  • Imbalance
  • Disorientation
  • Intense fear of falling
  • Elevated blood pressure and heart rate
  • Flicking eye movements
  • Ringing ear sound
  • Reduced hearing
  • Double vision

Complications of vertigo

  • Falls and injuries
  • Accidents (e.g. when driving, operating machinery, etc
  • Fear of heights because of loss of confidence in one’s balance
  • Depression
  • Irritability

Risk factors for vertigo

>50 years old

Head and neck injuries
Female:

  • Menopause
  • Diabetes
  • History of migraine
  • Elevated cholesterol
  • Vitamin D deficiency

Causes of and types of vertigo

Vertigo’s causes can be peripheral or central. Peripheral vertigo is as a result of a problem arising in the inner ear. On the other hand, with central vertigo the problem is located in the brain (e.g. brainstem or cerebellum).

Causes of peripheral vertigo:

  • Benign paroxysmal positional vertigo (BPPV)
  • Medications – e.g. aspirin, certain types of antibiotics, diuretics,chemotherapy
  • Head injury
  • Inflammation of the nerve in the inner ear
  • Inflammation of the inner ear’s structures
  • A benign tumour of the inner ear
  • Meniere’s disease

Causes of central vertigo:

  • Migraine
  • Multiple sclerosis (MS)
  • Stroke
  • Disease affecting blood vessels
  • Brain tumours
  • Medications – e.g. alcohol, antiseizure, aspirin
  • Epilepsy (very rarely)

Assessing a patient with vertigo

A careful history and clinical examination can often point the doctor in the direction as to what is causing the patient’s vertigo.

While blood tests are not routinely done for persons with vertigo, however, the blood sugar levels should be checked. If a central cause of vertigo is suspected a CT scan or MRI of the brain should be ordered.

Treatments

The treatment is closely tied to the underlying cause:

  • Benign paroxysmal positional vertigo (BPPV) – In the majority of instances this type of vertigo resolves spontaneously. In cases where it’s persistent, the sufferer may be subjected to head and neck manoeuvres which are intended to reposition the canalith in the semicircular canal. The Epley manoeuvre which can be carried out by the patient is often helpful. There are YouTube videos demonstrating how this is performed. In rare circumstances surgery may be required.
  • Middle ear infection – Treating the infection alleviates the vertigo.
  •  Meniere’s disease can be treated with the appropriate medications along with restricting salt, caffeine, chocolate, alcohol, and cigarettes.
  • Other – Anti vomiting medicines may be taken for nausea and vomiting. A vestibular suppressant may be given in order to alleviate the spinning of the head. Steroids are prescribed if an inflamed (vestibular) nerve is suspected.

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale, www.familycaresvg.com, [email protected], 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)
Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.