The causes of vertigo can be classified into peripheral and central.
The causes of vertigo can be classified into peripheral and central.

The causes of vertigo can be classified into peripheral and central.

Peripheral causes (due to problems in the inner ear):

The inner ear maintains balance by sending impulses to the brain about the head, neck, and body movements. Benign paroxysmal positional vertigo (BPPV) is the most common cause of all peripheral vertigo (32%). Other causes include Meniere’s disease or labyrinthitis.

  • BPPV: BPPV usually has no specific trigger; it could because of a trauma or sudden neck/head movements. In BPPV, canaliths (tiny calcium particles) get accumulated in canals of the inner ear. 
  • Meniere's disease: In this condition, fluid accumulates in the inner ear and increases pressure in the ear. This disease can be genetic, caused by allergies, or autoimmune (when the body’s immune system mistakenly attacks its own cells). Patients typically present with vertigo, tinnitus (ringing sound in the ear), and hearing loss/aural fullness (feeling of fullness in the ear).
  • Labyrinthitis: It is inflammation of the nerves inside the inner ear. It can occur following viral or bacterial infections, including common cold.
  • Trauma: Trauma to the ear or skull fractures can damage the structures of the inner ear. 
  • Motion sickness: Vertigo can be triggered while travelling, causing motion sickness. It is also commonly associated with nausea and vomiting.
  • Medications: Certain medications can cause inner ear damage.

Central causes:

Vertigo may be caused due to problems of the central nervous system (CNS). 

  • Lesions (tumors) in various parts of the brain (cerebellopontine angle tumors or vestibular schwannoma)
  • Inflammation/infection of the brain
  • Stroke 
  • Seizures 
  • Cervical spine disorders such as cervical spondylosis 
  • Multiple sclerosis 
  • Parkinsonism 
  • Alcohol intoxication 
  • Vertigo associated with migraine (migrainous vertigo)
  • Trauma to the head and neck

What is vertigo?

Vertigo is a symptom that is characterized by a false sensation of spinning of the head or of surrounding objects when they are not. Patients feel giddy or dizzy and lose balance. This may be associated with nauseavomiting, sweating, or difficulties in walking.

What do you do when you have vertigo?

The following is advised when there is a sudden episode of vertigo:

  • Sitting or lying down immediately and resting in a cool place till the vertigo disappears. This prevents the risk of losing balance and serious injury. One may use a cane, walker, or handrail for support. Those with frequent episodes of giddiness may fix handrails at home, and the elderly can keep a walking stick or walker handy.
  • Avoiding sudden movements of the head and neck and sudden changes in positions
  • Avoiding driving or doing any dangerous activities such as operating heavy machinery till the vertigo completely resolves
  • Avoiding consuming caffeine, alcohol, or smoking because they can worsen giddiness
  • Drinking fluids and remaining hydrated, which can help improve giddiness
  • Removing tripping hazards such as rugs on the floor, low tables, etc. from the house to lower the risk of fall in those who have frequent episodes of vertigo
  • Taking over-the-counter antivertigo medications such as Antivert (meclizine) or antihistamines; painkillers may be taken if there is associated headache.

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How is vertigo treated?

Treatment for vertigo depends on the cause. In some cases, vertigo may resolve without any treatment and never recur due to the ability of the brain to adapt. In other cases, treatment options include:

  • Vestibular rehabilitation: This is a type of physical therapy, wherein the patient is taught certain exercises to help strengthen their inner ear system.
  • Canalith repositioning maneuvers: These are specific maneuvers performed by a healthcare professional, where movements are done to dislodge calcium deposits out of the inner ear canal.
  • Medication: In some cases, medication may be prescribed to suppress the inner ear or improve blood flow in the inner ear. Medications to relieve associated symptoms such as nausea, vomiting, headache, or motion sickness may be administered. Antibiotics would be prescribed in cases of infection or inflammation. Steroids may be needed to suppress inflammations and reduce swelling. In Meniere's disease, diuretics (pills that reduce fluid in the ear) may be prescribed to reduce pressure due to fluid accumulation.
  • Surgery: In severe cases, when the vertigo does not resolve with medication and other conservative measures, surgery may be required.

How to prevent vertigo?

There are various ways to prevent vertigo such as:

  • Doing activities that improve balance, such as vestibular rehabilitation exercises, yoga, or Tai chi
  • Staying hydrated by drinking at least eight glasses of water a day
  • Sleeping for at least seven hours and avoiding stressful situations
  • Eating a healthy diet that consists of vegetables, fruits, and lean proteins 
  • Reducing salt content in food
  • Taking medications as prescribed

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Medically Reviewed on 9/1/2020
References
https://emedicine.medscape.com/article/2149881-overview

https://www.medscape.com/answers/884261-46048/what-is-the-pathophysiology-of-vertigo

https://www.webmd.com/brain/vertigo-symptoms-causes-treatment