Medicine, Exercise Can Alleviate Symptoms
Vertigo is a term used to label the symptom of the sensation of spinning or loss of balance. The perception may be that the surroundings are moving or that the actual person is moving. Vertigo is a distressing feeling often associated with nausea and vomiting. There are a number of conditions that can cause vertigo. Most of the time it is not serious, but there are some exceptions.
When someone tells me they are dizzy, the first thing I try to clarify is the type of dizziness they are experiencing. People often use the term “dizzy” to describe a feeling of light headedness. So I first try to determine whether their dizziness is lightheadedness or a sensation of spinning or movement (vertigo). The causes — and therefore the evaluation and treatment — are quite different.
We all have a balance mechanism in the inner ear that is known as the vestibular labyrinth. It contains the semicircular canals. These are like tiny hoops oriented in three planes that have fluid in them and are lined by nerve fibers that send signals to the brain. The labyrinth also contains tiny sensors with crystals in them that respond to movement. The fluid and crystals move when there is a change in position and this helps the brain control balance and sense position.
Most of us have probably experienced vertigo at one time or another. The sensation we get when we spin ourselves in a circle, then stop and try to stand still is transient vertigo. The movement of the inner ear fluid and crystals causes the symptom. Sudden changes in position that cause transient symptoms of spinning or unsteadiness that resolves by staying still is referred to as Benign Positional Vertigo.
Many people find they get sick to their stomach from motion of a boat, car or airplane. This is due to the fluid moving in the balance mechanism unnaturally. This is referred to as motion sickness. Motion sickness is common. Getting to a flat, still place generally eases the symptoms. Meclizine is a medication available over the counter that treats motion sickness and is most effective if used before being exposed to the motion. Also, trying to focus on a level surface (like the horizon), avoiding reading or doing close work, and sitting in the front seat with the head up can help avoid symptoms.
The most common type of vertigo I see in the emergency department is known as acute Labyrinthitis. People will have sudden onset of a spinning sensation, worsened by movement, with nausea and vomiting that often occurs on arising out of bed. This is felt to be due to inflammation of the labyrinth probably due to a virus. This is not associated with ear pain or significant headache. Medication, like meclizine, can treat symptoms, but the problem generally resolves within days on its own.
Vertigo associated with hearing loss can be due to a condition called Meniere’s Disease and the dizziness tends to be persistent and recurring. Rarely, a tumor involving the inner ear, known as an acoustic neuroma, can cause persistent dizziness often with hearing loss. Also, a rare but serious cause of vertigo would be due to a stroke or bleeding in the base of the brain. This is generally associated with headache and other neurologic symptoms.
Meclizine can be used to treat the symptoms of vertigo. In addition, people can learn maneuvers to put the head in a series of positions to try to position the fluid and crystals so the vertigo can be controlled.
Vertigo is a common symptom that is mostly a nuisance. But if it is associated with hearing loss or persistent it should be evaluated. Sudden vertigo with headache or other neurologic symptoms is an emergency that could indicate a stroke and should be evaluated right away. Stay healthy my friends.
Michael Shattuck, MD, is an emergency department physician at ThedaCare Medical Center-Berlin.
