Vertigo – An Overview

Vertigo is a symptom someone may experience and it is not a disease. Approximately 40% of people experience vertigo at least once in their lifetime. The primary symptom which a person reports is the feeling that their surroundings are moving, and/or spinning, even though they may be absolutely still. Often there is also accompanying sweating, nausea, and vomiting. Typically vertigo and its related symptoms are worsened when there is movement of the head.

While vertigo is more likely to affect an older person, however, any age group can be affected. The duration and severity of vertigo varies from person to person and from episode to episode. In some the symptom may last seconds, while in others it may extend for months. In most cases it lasts a few days to a week or two. Vertigo is often recurrent.

Vertigo is often a frightening experience for someone experiencing it for the first time. However, in the vast majority of instances its course is uneventful and without any complications. Vertigo in a very small percentage of cases can result in falls, accidents and serious injuries, including fractures.

The following may be reported by someone experiencing 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 sound in the ear

● Reduced hearing

● Double vision

● Headaches

● Fever

Possible complications of vertigo

● Falls and injuries

● Accidents (e.g. when driving, operating machinery, climbing stairs, etc.)

● Fear of heights because of loss of confidence in one’s balance

● Anxiety

● Depression

● Irritability
● Permanent hearing loss

Risk factors for developing vertigo

● 50 years old

● History of head and neck injuries

● 75% of those affected are female

● Menopause

● Pregnancy

● Diabetes

● History of migraine

● Elevated cholesterol

● Vitamin D deficiency

● Vitamin B12 deficiency

● Boat ride

● Overindulgence in alcohol

● Moderate to severe dehydration
● Stroke

● Osteoporosis

● Acoustic neuroma

● Parkinson’s Disease

● Anxiety disorders

● Upper respiratory allergies.

Types of vertigo

Vertigo can be peripheral or central. Peripheral vertigo is a result of a problem arising in the inner ear. On the other hand, with central vertigo, the problem is located in the brain, in the brainstem or the cerebellum.

Causes of peripheral vertigo:

● Benign paroxysmal positional vertigo (BPPV) – This is by far the most common cause of vertigo. Persons experiencing this type of vertigo often report the symptom while lying, sitting or changing position of their head.
● Medications – e.g. aspirin, certain types of antibiotics, diuretics, chemotherapy

● Head injury

● Inflammation of the inner ear’s structures -e.g. Nerve, vestibular apparatus, etc.
● A benign tumour of the inner ear – i.e. acoustic neuroma

● Meniere’s disease

● Extended bed rest

Causes of central vertigo:

● Migraine

● Multiple sclerosis (MS)

● Stroke

● Abnormal heart rhythms

● Disease affecting blood vessels

● Brain tumours

● Syphilis

● 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 of what is causing the patient’s vertigo. Blood tests and other investigations are not routinely done for persons who have been diagnosed with Benign paroxysmal positional vertigo (BPPV). 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:

● 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 cannalith in the semicircular canal. The Epley manoeuvre is often helpful. In rare circumstances, surgery may be required.

● Middle ear infection – Treating the infection alleviates the vertigo.

● Meniere’s disease – This can be managed with the appropriate medications along with restricting salt, caffeine, chocolate, alcohol, and cigarettes.

● Self care – At the time of the attack sleep on two or more pillows; take your time to get out of bed; avoid sudden head movements; avoid bending over at the waist; there are YouTube videos demonstrating how an Epley manoeuvre is performed.

● 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  inflamed inner ear structures are suspected.

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Sergeant Jack Drive, Arnos Vale. For appointments: clinic@familycaresvg.com, 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, are not liable for risks or issues associated with using or acting upon the information provided above.