Vertigo: Causes and Management

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Vertigo: Causes and Management

Abnormal Sensation of Movement, Though Debilitating, is Manageable
© Stephen Allen Christensen

Nov 29, 2008

Vertigo is common and has a variety of causes. Symptoms often respond to desensitzing maneuvers or medication.

The term vertigo is used to describe the illusion of moving or spinning within one’s environment. Symptoms result from false messages reaching processing centers in the brain that are responsible for movement and balance. Vertigo ranges in severity from very mild and transient to severe and incapacitating.

Vertigo is often accompanied by nausea, sweating, and abnormal eye movements (nystagmus). Vertigo has several causes, and treatment varies according to the underlying pathology.

Causes of Vertigo
Benign paroxysmal positional vertigo (BPPV): This most common form of vertigo is usually initiated by moving the head suddenly or in a particular direction. Many experts believe BPPV is the result of degenerative changes in the inner ear that lead to the formation of canaliths (tiny particles in the semicircular canals of the inner ear). (Radtke A, et al. A modified Epley's procedure for self-treatment of benign paroxysmal positional vertigo. Neurology 1999;53:1358-60)
Meniere’s disease: This syndrome, caused by the relative overproduction of fluid in the inner ear, consists of three symptoms: vertigo, tinnitus (ringing in the ears), and hearing loss. Symptoms may be unilateral.
Acute vestibular neuronitis or labyrinthitis: Vertigo arises from inflammation of the inner ear or vestibular nerve. The most common cause is viral or bacterial infection.
Acoustic neuroma: Small tumors along the acoustic nerve can cause vertigo and unilateral hearing loss and tinnitus.
Migraine: Vertigo that is part of the aura that precedes a migraine headache is usually self-limited.
Head trauma: Injuries to the brain are often associated with vertigo. In most cases, the vertigo resolves over weeks to months.
Multiple sclerosis: When certain areas of the brain are damaged by MS, vertigo may result.
Vascular insult: Strokes or other phenomena that reduce blood flow to specific areas of the brain can cause vertigo.
Medications: A wide variety of medications and toxins can cause vertigo (e.g., alcohol, anticonvulsants, antidepressants, antihypertensives, sedatives, antihypertensives, etc).
Cholesteatoma: A cystic collection of keratin and debris, usually involving the middle ear space and the mastoid sinus.
Anxiety or other psychological conditions may cause vertigo.
Treatment for Vertigo
Medications are frequently prescribed for vertigo that lasts several hours to days, but drugs are less useful for episodes that only last seconds or minutes. Medications are also not recommended for vertigo lasting more than a few days; they only delay the brain’s ability to adapt to the aberrant vestibular input.
Vestibular rehabilitation exercises are commonly used in the general treatment of vertigo. These maneuvers help the brain to adapt to the new sensory input.
Canalith repositioning maneuvers are effective for treating BPPV. These exercises transfer canaliths from the semicircular canals to the vestibule of the inner ear, thus decreasing the false messages originating from the semicircular canals.
When bacterial causes of labyrinthitis or acoustic neuronitis can be identified, antibiotics are prescribed. (Many of these cases are caused by viruses that don’t respond to antibiotics).
Acoustic neuromas and cholesteatomas are typically treated surgically.
Meniere’s disease usually responds to medications that decrease the production of fluid in the inner ear. Surgery for Meniere’s is rarely required.
When migraines, anxiety, and psychiatric conditions are appropriately treated, the accompanying vertigo also improves.
Victims of stroke and head trauma—as well as patients with MS—often respond to vestibular rehabilitation exercises and/or watchful observation.
Medications that cause vertigo should be changed or discontinued.
Vertigo can significantly affect one’s ability to safely perform activities of daily living. In most cases its impact is transient and manageable. Persistent vertigo or symptoms that recur should prompt consultation with a health care professional.



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