Vertigo and Dizziness
Dizziness is a common term used to describe several sensations, such as spinning (vertigo), light-headedness or near fainting (presyncope), and loss of balance or unsteadiness (disequilibrium).
Vertigo is just one form of dizziness and is usually described as the sensation of movement, especially spinning sensations. When dizziness is described this way we refer to it as vertigo. Vertigo can be divided into two broad categories:
- Peripheral vertigo is related to the inner ear.
- Central vertigo is related to the central nervous system regions (that is, the brain) that receive and process inner ear signals.
Benign Paroxysmal Positional Vertigo (BPPV)
Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vertigo. BPPV is a type of peripheral vertigo and is the most common disorder of the vestibular system, which is responsible for balance and sense of spatial orientation. BPPV occurs when small pieces of calcium carbonate called otoconia break free from the gravity-sensing structures of the inner ear and move by the effect of gravity (the crystals are heavy and sink) within the fluid-filled tubes in the inner ear called semicircular canals. As the crystals move within the canal, they set off the sensors causing vertigo.
Near-syncope is another form of dizziness that is due to transient underperfusion of the brain by blood flow. This is basically the same mechanism that leads to fainting (syncope). When it is a little milder, the person may just feel lightheaded, but not actually pass out.
Imbalance or Disequilibrium
Imbalance or disequilibrium refers to a sensation of dizziness in which a person feels unsteady and unsure of balance. There is not a sensation of near fainting, nor is there a spinning sensation, but rather a feeling like the person might fall or lose balance. This sensation is usually present when standing or walking and not when sitting down or lying down. There are many possible causes for this symptom and neurological consultation is appropriate.
How common is vertigo?
Dizziness is a common symptom that affects more than 90 million Americans. It has been reported to be the most common medical complaint in patients age 75 and older.
Benign paroxysmal positional vertigo (BPPV) affects about 64 of every 100,000 Americans.
Who gets vertigo?
BPPV can occur at any age but is most common in people over 60, possibly because otoconia erode as we age.
Other possible causes of peripheral vertigo include:
- Inflammation of the vestibular nerve (vestibular neuritis)
- Meniere’s disease
- Superior canal dehiscence
- Perilymphatic fistulae
- Bilateral peripheral vestibular loss.
Some of these forms of peripheral vertigo can result from head trauma. Sometimes dizziness is caused by taking medication.
Central vertigo may be caused by:
- Certain medications
- Migraine mechanisms
- Multiple sclerosis
- Tumors or any kind of lesion that interferes with the brain’s ability to process balance information coming from the inner ears
How is vertigo diagnosed?
Your doctor may do a series of tests to determine the cause of your dizziness.
If you have dizziness that seems to be trigger by changes in head position, your doctor may perfrom a Dix-Hallpike maneuver. During this test:
- Your head is turned 45 degrees toward one shoulder.
- You are laid back with head hanging slightly off the end of the exam table.
- If you have BPPV on that side, vertigo will occur and the doctor will see characteristic nystagmus (eye movements).
- This confirms the diagnosis, and once confirmed there is a very effective bedside treatment maneuver called canalith repositioning procedure (sometimes referred to as Epley’s maneuver) that can be done to eliminate the vertigo often in one visit.
The Vestibular and Oculomotor Laboratory and Balance Center at Barrow Neurological Institute at Dignity Health St. Joseph’s Hospital and Medical Center offers a range of diagnostic tests to evaluate vertigo, dizziness, ataxia (lack of muscle control during voluntary movements), and hearing disorders.
The main symptom of vertigo is the sudden sensation that you or your surroundings are spinning. It is usually triggered by moving your head, such as rolling over in bed or looking up, and it can last a few seconds to minutes. Additional symptoms that may help explain the cause of peripheral vertigo include:
- Hearing loss or muffled hearing in one ear
- Ringing in only one ear
Central vertigo may have other symptoms such as:
- Difficulty swallowing
- Double vision
- Eye movement problems
- Facial paralysis
- Slurred speech
- Numbness on only one side of the body or face
Contact your doctor if you have symptoms of vertigo. Call 9-1-1 if you suddenly experience severe dizziness accompanied by other symptoms, such as double vision, slurred speech, or loss of coordination.
Some forms of vertigo get better without treatment.
The canalith repositioning procedure, or Epley maneuver, can improve symptoms resulting from benign paroxysmal positional vertigo (BPPV), usually on the same day.
Other forms of peripheral vertigo such as vestibular neuritis may require vestibular rehabilitation physical therapy.
Meniere’s disease is often treated with low sodium diet and diuretics, and sometimes with other approaches which occasionally include surgery.
Vestibular migraine is thought to be a neurotransmitter or ion channel disorder of the brain and can cause recurrent vertigo that can sometimes be disabling. It can sometimes be managed by dietary and lifestyle changes, but many times requires medications to treat the underlying cause.
There are many causes of dizziness, each with its own treatment. Other conditions we treat include:
- Superior canal dehiscence
- Chronic subjective dizziness and phobic postural vertigo
- Bilateral peripheral vestibular loss (Dandy’s syndrome)
- Mal de debarquement
- Perilymphatic fistula
- Isolated utriculosaccular functional loss
- Many others
Our program can manage all forms of dizziness, whether vestibular (inner ear causes, vestibular migraine, central vertigo, etc.), hemodynamic (e.g., low blood pressure or autonomic including POTS), anxiety-related, or whether the dizziness is due to disequilibrium caused by any of a variety of disorders.
- Date of last review: January 24, 2017
- Author: Terry Fife, MD