Vertigo is a very specific term which means the sensation of moving or spinning when one is not actually moving. It does not mean feeling off balance or lightheaded (though these can also occur with vertigo). It is frequently accompanied by nausea. Vertigo is not a disease, it is a symptom just like pain, itching, or a stuffy nose, which are all caused by an underlying disease or problem.
Problems and diseases of the inner ear balance organs typically cause true vertigo, usually with nausea. Central nervous system (brain) problems can also cause vertigo, but it is usually less severe. The exception is migraine headaches, which frequently cause significant vertigo and nausea, even in the absence of actual headaches.
Most vertigo will improve with some general treatments and the passage of time. Time is probably the most important thing in getting rid of vertigo. The human brain is very adaptable and will adjust with time until the sensation of spinning goes away.
Physical therapy and simple head turning/nodding exercises can also help at treating vertigo. Physical therapy and exercise build strength and also help the brain to adjust faster to the abnormal signals from the inner ear that cause vertigo.
Finally, there are many medications which can potentially help vertigo. These include meclizine, glycopyrrolate, valium, klonopin, ativan, and others. All of these medications act to suppress the signals from the inner ear which cause vertigo. They are very useful for severe incapacitating vertigo in the short term (several days to a week). However, I recommend they be stopped as soon as possible to allow the brain to adjust and get rid of the vertigo in the long term. Staying on medications like meclizine long-term actually prevents the brain from adjusting and can make the vertigo persist much longer.
Common causes of vertigo:
1. Benign paroxysmal positional vertigo (BPPV): spinning occurs after certain head movements, lasts seconds to several minutes then goes away, frequently associated with nausea. Can be cured with Epley maneuver (canalith repositioning maneuver). See link for more details.
2. Vestibular neuritis: spinning usually lasts several days, severe at first with nausea and slowly improving with time. Medicines like meclizine can be helpful for the first few days, physical therapy and exercises most useful for long-term resolution.
3. Meniere’s disease: severe vertigo spells lasting several hours, associated with fluctuating hearing loss, pressure in the ear, and roaring sound (tinnitus) in the ear. No cure but the disease can be managed successfully in most patients.
4. Post-concussive: typically after a head injury, usually improves with time and/or physical therapy.
5. Viral illness related: usually during a cold or stomach flu. Gets better with time, can use meclizine or other medication if vertigo is severe.
6. Unilateral vestibular weakness: when one inner ear is weaker and sends different signals than the other ear. This can cause dizziness, especially after head turns and quick movements. Usually gets better with time and/or physical therapy.
7. Migraine headaches: vertigo spells can last variable lengths of time. Not necessarily associated with headache, though most patients will have a history of migraines in themselves or their family members. Usually has associated nausea and photophobia (bothered by bright lights).
Can be treated effectively with migraine medications.
8. Chronic disease/advanced age/debilitation
9. Previous stroke
There are many other possible causes of vertigo. We will take a careful history to determine if one of the above problems is causing your vertigo or if it is something else.
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