Vertigo & Imbalance

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Vertigo is the term used to describe a false sensation of movement or spinning. It is often referred to as ‘dizziness’, which is a less specific term that can refer to anything from feeling light-headed or unsteady to a spinning sensation.

Some people describe the dizzy feeling they get from looking down from a height as vertigo. Fear of heights and the dizzy feeling that accompanies it is actually called acrophobia. Vertigo is caused by problems with the inner ear or the brain.

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Vertigo symptoms

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People with vertigo often feel as if they are spinning, rocking or moving, or as if the world is spinning around them. Sometimes it can feel like you are falling.

Attacks of vertigo can last from a couple of minutes to hours, and it is often accompanied by other symptoms, including:

• nausea;

• vomiting;

• looking pale; and

• sweating.

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Certain positions or movements (e.g. turning over in bed or moving your head back to look up) can bring on vertigo or make it worse.

Vertigo can be a very overwhelming and intensely unpleasant experience – like the feeling you get after being spun around very fast on fairground ride. In rare cases, the nausea and vomiting can be severe enough to cause dehydration.

Vertigo can also cause you to lose your balance and can put you at risk of falling over.

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Causes of vertigo

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Any condition that causes problems with the balance mechanism in your inner ear (the vestibular labyrinth) can cause vertigo. Sometimes vertigo is caused by problems with certain areas of the brain.

 

The more common conditions that cause vertigo include the following.

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Benign paroxysmal positional vertigo (BPPV) causes brief episodes of vertigo associated with certain sudden head movements. People with BPPV often experience nausea, but rarely vomiting. Symptoms are often triggered by lying down, rolling over in bed or tilting the head backwards. BPPV usually affects people older than 50 years. There may be no obvious cause, but in some cases it may develop after a minor head injury, ear surgery, or following a period of prolonged bed rest.

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Vestibular neuritis (also called vestibular neuronitis) – inflammation of one of the nerves to the inner ear – causes sudden, intense vertigo. Vestibular neuritis is usually caused by an infection with a virus. Symptoms of vestibular neuritis tend to be worse when moving the head, but also occur at rest.

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Labyrinthitis is inflammation of the inner ear resulting from infection – usually a viral infection such as influenza. In addition to vertigo, symptoms can include hearing loss, ringing in the ear, fever and ear pain.

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Meniere’s disease is an inner ear condition that causes episodes of vertigo, ringing in the ear (tinnitus), hearing impairment and a feeling of fullness in the ear.

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Migraine headaches can cause vertigo – up to a quarter of people who have migraines experience vertigo.

Vertigo is also reported as a side effect of many medicines.

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Less common causes include:

• stroke or mini-stroke (TIA — transient ischaemic attack);

• a benign (non-cancerous) tumour of the nerve connecting the inner ear to the brain (called an acoustic neuroma);

• multiple sclerosis (MS); and

• a tumour in the part of the brain called the cerebellum.

Rarely, vertigo can be caused by a middle ear infection.

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Tests and diagnosis

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Your doctor may determine the cause of your vertigo by asking specific questions about your symptoms and examining you.

To help make the diagnosis, your doctor will want to know:

• whether the symptoms come on at rest or are only brought on by movement;

• how long you have been experiencing vertigo;

• whether your vertigo comes and goes; and

• whether or not there are other symptoms as well.

The examination may include checking your hearing and balance, as well as testing whether certain head positions cause vertigo.

Your doctor will also look for any abnormal rhythmic eye movements (known as nystagmus), which are usually seen in people with vertigo.

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Tests

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Your doctor may recommend certain tests, including:

• Hearing and balance tests; and, possibly

• Audiogram

• VNG (Videonystagmography)

• MRI

• OEA 

• VEMP

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Treatment for vertigo

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The treatment of vertigo depends on what’s causing it. There are medicines that can be used in the short term to help control both the dizzy sensations and nausea and vomiting if they occur.

For conditions where there are recurrent attacks of vertigo (such as migraine), there are medicines available in Australia to help reduce the frequency and severity of attacks.

Vestibular neuritis often gets better without treatment within a few days. It can be treated with corticosteroid medicines, which can help improve symptoms in some people. Some people have ongoing symptoms for several weeks.

Labyrinthitis usually gets better on its own without treatment.

If you suffer from benign paroxysmal positional vertigo (BPPV), your doctor or specialist may treat you by performing a simple procedure that involves moving your head into a variety of different positions. BPPV is caused by tiny particles in the fluid-filled canals of your inner ear becoming trapped in the wrong place. Particle repositioning procedures (the Semont and Epley manoeuvres) work by dislodging these particles so that they move into a part of the ear where they don’t cause any problems. Special positioning exercises can also be performed at home to help with ongoing symptoms.

There are specific treatments available for Meniere’s disease, including dietary changes, medicines and surgery. However, symptoms can be difficult to treat and in some people last for years. Attending a support group can be helpful for people with Meniere’s disease. Talking to other people who also have the condition can help with feelings of isolation and frustration. You might also be able to share tips on coping with having the condition.

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Vestibular rehabilitation therapy

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Several conditions causing vertigo can be treated with vestibular rehabilitation therapy. This treatment involves training your brain to ignore the distorted messages that are coming from the affected inner ear, and to rely on signals from your good ear and other senses.

Vestibular rehabilitation therapy involves performing special exercises where you continue to move despite feeling dizzy. A physiotherapist or hearing specialist can train you in these exercises.

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Self-care

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The following self-care tips may help you manage problems with vertigo.

• Lying down in a dark, quiet room may help ease an attack of vertigo.

• Sit down as soon as you feel dizzy to reduce your risk of falling.

• Try to avoid things that can trigger your vertigo, such as certain head positions, getting out of bed too quickly, drinking alcohol, or lack of sleep.

It may be unsafe to drive when you have vertigo. Sudden head movements like checking for blind spots can make vertigo worse and driving dangerous. Talk to your doctor about driving and vertigo.