Vertigo
Vertigo is a feeling that you or your surroundings are moving when there is no actual movement. You may feel unsteady, it may be hard to walk or stand, and you may lose your balance. Some people feel as though they are spinning around or falling.
What vertigo is
Vertigo is a symptom rather than a condition itself.
Different people experience different intensities of vertigo. It may or may not persist when you are still or lying down. You may also feel sick (nauseous) and throw up (vomit).
Vertigo is often a symptom of an inner ear disorder. But it could be a sign of a more serious medical condition such as stroke, circulation problems or infection.
Symptoms of vertigo
Vertigo often begins suddenly and may vary in intensity. It may be constant, or it may come and go.
If you have vertigo, you may also have these symptoms:
- feeling sick (nausea) and throwing up (vomiting)
- tinnitus or ringing in your ears
- a loss in your hearing
- ear pain.
Causes of vertigo
For some people, the cause of their vertigo is unknown. If you have vertigo, it is normal to feel out of control and frightened. But in most cases, the causes of vertigo are not a serious health threat.
These are the most common causes of vertigo.
Benign paroxysmal positional vertigo (BPPV)
- This is one of the most common causes of vertigo. It's usually triggered by sudden changes in the position of your head such as when you tip your head up or down, when you lie down or when you turn over or sit up in bed. It can increase your risk of falls.
- This type of vertigo happens when small calcium crystals in your inner ear come loose from their normal location and move into another part of your inner ear.
- The vertigo tends to last for around a minute. But some people can feel a mild unsteadiness between episodes of vertigo.
Labyrinthitis and vestibular neuritis
- Vestibular neuritis is when the vestibular nerve in your inner ear gets inflamed. This nerve carries messages about head movement to the rest of your body to help you balance.
- Labyrinthitis is when the auditory (hearing) and vestibular nerves in the hearing part of your inner ear become inflamed.
- Both can cause dizziness, vertigo and feeling sick (nausea).
- Labyrinthitis can also cause hearing loss and ringing in the ears (tinnitus).
- Both are usually caused by a viral infection but may be caused by a bacterial infection.
- The vertigo lasts from hours to days but usually improves within one to 3 weeks.
- Some people experience long-term balance problems.
Ménière's disease
- Ménière's disease is a disorder of the inner ear where you experience episodes of vertigo with hearing loss and a feeling of pressure or fullness in one ear.
- Episodes usually last from one to 24 hours and can occur every few days, weeks, months or less than once a year.
- Hearing loss usually varies then becomes permanent as the disease progresses.
Migraine
- Some people feel dizzy and have a sensation of motion or spinning during or just before a migraine headache.
- In some cases, vestibular migraines can cause vertigo even without other migraine or headache symptoms.
Other causes
- Stroke or Transient Ischaemic Attack (TIA).
- anxiety.
- Ongoing infection of the middle ear (chronic otitis media).
- Head injury.
- Some medications such as some antibiotics, phenytoin, carbamazepine and water tablets (diuretics).
- Alcohol.
Diagnosing vertigo
Your healthcare provider may ask you:
- to describe your symptoms such as whether you felt lightheaded or if your surroundings were spinning
- if you also experience other symptoms such as hearing loss, ringing in your ears, nausea (feeling sick), vomiting (throwing up), fullness in your ear, headaches or changes in your vision
- how often your symptoms occur and how long they last
- if your symptoms are affecting your daily activities such as being unable to walk during an episode of vertigo
- whether anything starts your symptoms (called triggers) or makes them worse, such as moving your head in a particular direction
- what makes your symptoms better.
They will also examine your ears, examine your eyes and check your balance. Because vertigo could be a symptom of another medical condition, they may also do several different tests.
Treating vertigo
This type of vertigo is usually caused by small calcium crystals in your inner ear. It happens when you suddenly change the position of your head — when you tip your head up or down, lie down or turn over or sit up in bed.
It can increase your risk of falls. The vertigo tends to last for a minute or less and goes away if you keep your head still.
BPPV often clears up without treatment after several weeks or months.
To help ease the symptoms, try simple things like:
- getting out of bed slowly
- avoiding activities where you have to look up, such as painting and decorating, or looking for something on a high shelf
- trying special exercises.
Exercises for benign paroxysmal positional vertigo
These exercises may help you with benign paroxysmal positional vertigo (BPPV). A healthcare provider, such as your doctor or a physiotherapist, will decide if they are suitable for you.
The Epley manoeuvre
If you think your vertigo is coming from a particular ear, try doing the Epley manoeuvre for that side. If that does not help, try doing the manoeuvre for the other side. Sometimes it is difficult to know which ear is causing the problem.
How to do the Epley manoeuvre
One Epley manoeuvre, when done correctly, has been shown to resolve positional vertigo in 75% to 80% of people with benign paroxysmal positional vertigo.
It involves 4 separate head movements to move the calcium crystals that cause vertigo to a place where they no longer affect you.
Watch these videos to learn how to do the Epley manoeuvre:
Left Epley manoeuvre — YouTube
Right Epley manoeuvre — YouTube
It may take a few hours for your symptoms to improve after an Epley manoeuvre, and it may be several days before you feel confident moving more normally again. Sometimes you need to repeat the manoeuvre or use other manoeuvres, such as Brandt-Daroff, to make your symptoms go away.
Tell your healthcare provider if your symptoms have not improved after a few weeks. Benign paroxysmal positional vertigo can come back in the future.
Brandt-Daroff exercises
The Epley manoeuvre may be unsuitable if you have neck or back problems. Brandt-Daroff exercises may be better.
These exercises are designed to break up the calcium crystals and unblock your ear canal.
Repeat the exercises 3 or 4 times a day for 2 days in a row. Your symptoms may improve for up to 2 weeks.
How to do Brandt-Daroff exercises
Your healthcare provider will teach you how to do the exercises. The following is a guide.
- Sit on the edge of a bed and turn your head slightly to the left (about 45 degrees).
- While maintaining this head position, lie down quickly on your right side so that the back of your head is resting on the bed.
- Wait 20 to 30 seconds or for any dizziness to go away.
- Sit up straight, and again wait 20 to 30 seconds or for any dizziness to go away.
- Turn your head slightly to the right and repeat the sequence in the opposite direction.
- Continue as above for 10 minutes (5 or more repetitions to each side).
For the exercises to be helpful, you must feel dizzy while doing them. The treatment has been effective when you stop feeling dizzy while doing them.
In most cases, regular exercise should ease the symptoms within a few days.
Watch this video to learn how to do the Brandt-Daroff exercises:
With labyrinthitis and vestibular neuritis, your inner ear gets inflamed. The inflammation is usually caused by a viral infection.
The symptoms often get better over several weeks without treatment, although it is sometimes necessary to treat the underlying infection.
- It is often made worse if you drink alcohol, are tired or have another illness. Avoiding these can help to improve your condition.
- It can be treated with a therapy called vestibular rehabilitation.
- Medication such as prochlorperazine or hyoscine hydrobromide (scopolamine) can sometimes help to relieve nausea and vomiting.
It is important to see your healthcare provider if you have an ear pain, discharge or pus from your ear, hearing loss, or a fever.
This is a disorder of the inner ear where you get the feeling of vertigo, ringing in the ear, and hearing loss. The vertigo lasts from 1 to 24 hours. Although there is no cure for Ménière's disease, there are things you can do to help relieve your symptoms.
You can try the following.
- Changing what you eat, for example, eating low-salt foods, and avoiding caffeine and alcohol.
- Medication such as prochlorperazine, which may ease the dizziness and vomiting.
- Medication such as betahistine. this may reduce the amount of fluid inside your inner ear and stop symptoms from developing. If you take betahistine every day, it probably will not stop all vertigo, but it may make it less severe and happen less often. It does not work in all cases.
- Treatment for tinnitus (ringing in your ears) such as sound therapy and getting information about tinnitus and learning ways to cope with it (information counselling).
- Treatment for hearing loss such as using hearing aids.
- Physiotherapy to deal with balance problems.
Self care for vertigo
To help prevent vertigo when you are getting out of bed, get up slowly and sit on the edge of the bed for a minute before standing up.
Because vertigo can affect your balance and may make you feel unsteady, you're at risk of falling or having an accident. To reduce your risk:
- get out of a bed or chair slowly
- wear low-heeled shoes that fit properly
- use handrails on stairs
- install grab bars in the bathroom, do not use towel racks for balance
- use a shower stool and apply adhesive strips to the shower or tub floor
- use a walking aid if you need one
- avoid driving until your symptoms subside, if you become dizzy or disoriented while driving, you could hurt yourself and others
- at work, let your employer know about your symptoms, especially if your job involves operating machinery or climbing ladders.