Vertigo - causes, symptoms, diagnosis and treatment
Vertigo is a common disorder of the vestibular system, defined as an illusory sensation of movement or rotation of the surrounding environment or of oneās own body.
Vertigo is a common disorder of the vestibular system, defined as an illusory sensation of movement or rotation of the surrounding environment or of oneās own body. It is often described as a sensation of dizziness, loss of balance or instability. People who experience vertigo can feel that they themselves or the objects around them are moving, spinning or swaying, even if these movements are not actually happening. This sensation can be accompanied by nausea, vomiting, excessive sweating and anxiety, and it can have a significant impact on a personās quality of life.
Although it is often associated with problems of the inner ear or of the central nervous system, vertigo can be a manifestation of a wide range of medical conditions, including blood pressure disorders, heart conditions, neurological disorders and even emotional or psychological factors. It is a complex and varied condition, and individual experiences can range from mild, passing episodes to severe and chronic symptoms that can affect a personās ability to carry out everyday activities. The duration and severity of the dizziness associated with different types of vertigo can vary with the underlying cause and with the individual characteristics of the patient. In general, the dizziness can last from a few seconds or minutes to hours or even days.
The diagnosis and the treatment depend on the underlying cause and can involve a combination of physical examinations, laboratory tests, medical imaging and consultations with specialists, such as ENT doctors, neurologists, neurofeedback specialists or neurosurgeons. Therapy can include medicines for reducing the symptoms, physical therapy for improving balance and coordination, as well as surgery in certain severe cases or in cases that do not respond to other treatments. It is important that people who experience this sensation seek medical care in order to obtain the correct diagnosis and treatment.
Despite its impact on health and on quality of life, vertigo can be underdiagnosed and undertreated, which calls for a deeper investigation and understanding of this phenomenon. In this article we will explore this condition in detail, highlighting the factors that contribute to its onset, the symptoms and clinical manifestations of each type of vertigo, the impact on individuals and the diagnosis and treatment strategies available today.
Types of vertigo
There are several types of vertigo:
Peripheral vertigo
It is caused by problems inside the inner ear or in the nerves that transmit balance and orientation information to the brain. The inner ear is essential for maintaining balance and for detecting the movement and the position of the body in space. This type of vertigo appears when there is a dysfunction in one of the peripheral vestibular structures, such as the semicircular canals, the utricle or the endolymphatic sac.
Central vertigo
It is caused by problems in the brain or in the nerves that control balance and spatial orientation. These problems can affect the control centres for balance and orientation, as well as the nerve connections between the inner ear and the brain.
Benign paroxysmal positional vertigo (BPPV):
Benign paroxysmal positional vertigo (BPPV) is an inner ear condition that causes short and severe episodes of vertigo. It is triggered by head movements and appears suddenly, but characteristically it resolves within a few seconds or minutes.
Psychogenic vertigo:
Also known as functional vertigo or non-vestibular vertigo, this is a condition in which the person experiences the false sensation of movement or imbalance in the absence of a peripheral or central vestibular disorder. It is often caused by psychological or emotional factors, such as stress, anxiety, depression or previous psychological trauma.
Orthostatic vertigo:
Orthostatic vertigo is a sensation of dizziness or instability that appears when a person stands up suddenly from a lying or sitting position, such as when getting out of bed or standing up after a long period of sitting. It is associated with changes in blood pressure and in blood flow to the brain when the position of the body changes rapidly.
Causes and risk factors for vertigo
The most frequent causes and risk factors differ with the type of vertigo the patient experiences.
Causes of peripheral vertigo
- Motion sickness: Sudden or repeated movements, such as travelling by car, by sea or by plane, can disturb the fluid in the semicircular canals of the inner ear.
- Acoustic neuroma: This is a benign tumour that grows on the auditory nerve and can affect vestibular function.
- Vestibular neuritis: An inflammation of the vestibular nerves, which can be caused by viral infections, such as herpes zoster or other viral infections.
The causes of central vertigo
- Strokes: Certain types of stroke, such as ischaemic or haemorrhagic stroke in the brain regions responsible for balance and coordination.
- Brain tumours: Tumours that affect the brain and the nerves that control balance can cause central vertigo as a result of the compression or the irritation of these structures.
- Traumatic brain injuries: Severe head trauma can affect the brain and the vestibular nerves.
- Neurological diseases: Conditions such as multiple sclerosis, hereditary ataxias and other neurological conditions can affect the functioning of the central nervous system.
Causes and risk factors for BPPV
- BPPV is caused by the presence of small particles of calcium carbonate, known as canaliths, which accumulate in the semicircular canals of the inner ear.
- These canaliths are usually found in the saccule and the utricle of the inner ear, which are responsible for detecting head movement and for maintaining balance.
- BPPV is triggered by specific head movements, such as getting out of bed, turning the head during sleep, tilting the head backwards or forwards, as well as rapid head movements, such as quick turns.
- During these movements, the calcium carbonate particles can move inside the semicircular canals, causing an abnormal stimulation of the vestibular receptors and generating the sensation of vertigo.
The causes of psychogenic vertigo
- Psychological and emotional factors: It can be triggered by intense stress, anxiety, depression or previous psychological trauma.
- Previous trauma: Traumatic events or previous trauma, such as accidents, abuse or personal losses, can contribute to its onset.
- Lifestyle: Unhealthy habits, such as a lack of sleep, an inadequate diet or the excessive use of alcohol or other substances, can affect emotional balance and can contribute to the onset of various neurological disorders.
The causes of orthostatic vertigo
- Changes in blood pressure: It can be caused by a sudden drop in blood pressure when a person moves from a lying or sitting position to standing. This drop in blood pressure can be caused by several factors, such as dehydration, medicines, heart problems or neurological problems.
- Blood circulation disorders: Certain blood circulation disorders, such as heart rhythm disorders or heart failure, can contribute to the onset of orthostatic vertigo.
- Medication: Some medicines, such as those for treating high blood pressure or heart problems, can cause a drop in blood pressure when a person stands up.
The symptoms of vertigo
The symptoms and manifestations of vertigo differ with the causes that underlie it, as we will see below:
Peripheral vertigo
- The sensation of spinning or swaying: The person can feel that the surrounding environment is spinning or that their own body is swaying, even if there is no actual movement.
- Nausea and vomiting: These symptoms are common and can be quite distressing.
- Nystagmus: Involuntary, rhythmic eye movements, which can be observed when the person is having an episode of vertigo.
- Loss of balance and instability when walking: The person can have difficulty maintaining balance and may need support when walking or standing.
Central vertigo
- The sensation of spinning or swaying: The person can feel that the surrounding environment is spinning or that their own body is swaying, even if there is no actual movement.
- Difficulty coordinating movements: The person can have difficulty coordinating movements and can show instability when walking or when carrying out other activities.
- Vision and hearing disturbances: It can be associated with vision disturbances, such as double vision or oscillating images, as well as with hearing disturbances, such as hearing loss or tinnitus (sounds in the ears).
- Other neurological symptoms: Depending on the underlying cause, central vertigo can be accompanied by other neurological symptoms, such as headache, weakness, changes in sensation or speech disturbances.
BPPV
- Benign paroxysmal positional vertigo is characterised by sudden episodes of vertigo, which can last from a few seconds to a few minutes.
- It can be accompanied by the sensation that the surrounding environment is spinning or swaying.
- People who suffer from BPPV can also show nystagmus, which is an involuntary and rhythmic movement of the eyes that can be observed when the vertigo is triggered.
Psychogenic vertigo
- The sensation of movement or imbalance: The person can experience the false sensation of movement or imbalance, although there is no actual change in the position of the body or in the surrounding environment.
- Associated symptoms: It can be accompanied by other psychological or somatic symptoms, such as anxiety, depression, palpitations, shallow breathing, excessive sweating or muscle tension.
Orthostatic vertigo
- Dizziness or instability: The person can feel a sensation of dizziness, spinning or imbalance when standing up.
- Weakness: It can be accompanied by a sensation of generalised weakness or by a sensation of tiredness.
- The feeling of fainting: In more severe cases it can cause a feeling of fainting or presyncope, in which the person feels close to fainting but does not completely lose consciousness.
Diagnosis
The diagnosis of vertigo is made after a thorough physical examination, medical imaging tests and, where appropriate, specific tests, depending on the cause that underlies this disorder.
Peripheral vertigo
- The physical examination: The doctor can carry out a detailed physical examination, including a neurological examination and an examination of the inner ear using specific manoeuvres.
- Vestibular tests: Vestibular tests, such as caloric tests and nystagmus tests, can be carried out in order to assess vestibular function and to identify the possible causes of the vertigo.
- Medical imaging: Imaging, such as computed tomography (CT) or magnetic resonance imaging (MRI), can be used to detect structural abnormalities in the inner ear or in the vestibular nerves.
Central vertigo
- The physical examination: The doctor can carry out a detailed physical examination, including a neurological examination, in order to assess the symptoms and the signs associated with central vertigo.
- Medical imaging: Imaging, such as BrainMap (qEEG), computed tomography (CT) or magnetic resonance imaging (MRI), can be used to detect structural or functional abnormalities in the brain or in the vestibular nerves.
Benign paroxysmal positional vertigo
The diagnosis of BPPV usually involves a detailed history of the symptoms and of the triggers of the vertigo.
- Specific manoeuvres, such as the Dix-Hallpike manoeuvre or the Epley manoeuvre, can be used to provoke and assess the vertigo and the nystagmus associated with BPPV.
- Sometimes additional tests, such as caloric tests or nystagmus tests, can be carried out in order to rule out other causes of it.
Psychogenic vertigo
- Ruling out other causes: The diagnosis usually involves ruling out other possible causes of vertigo, such as peripheral or central vestibular disorders, through a detailed physical examination and through additional tests, such as vestibular tests or medical imaging.
- Psychological assessment: An additional psychological assessment may be needed in order to identify the psychological or emotional factors that can contribute to its onset.
Orthostatic vertigo
- Medical history and physical examination: The doctor will assess the symptoms and will carry out a detailed physical examination in order to identify the possible cause of the orthostatic vertigo.
- Measuring blood pressure: Measuring blood pressure in different positions, such as lying down and standing, can help diagnose orthostatic vertigo and assess its severity.
- Blood tests and additional tests: Blood tests and other tests, such as an electrocardiogram (ECG) or Holter monitoring of blood pressure, may be needed in order to rule out other causes of orthostatic vertigo.
Treatment options for vertigo
Depending on the type of vertigo and on the factors that determine this condition, there are a number of treatment options, which we will detail below.
Peripheral vertigo
Treatment can include medicines for reducing the symptoms, such as antiemetics for controlling nausea and vomiting, as well as physical therapy for improving balance and coordination.
Central vertigo
Treatment depends on the underlying cause and can involve medicines for reducing the symptoms, physical therapy for improving balance and coordination, as well as other specific interventions for managing the underlying condition. Brain training is a non-invasive treatment method that has proved effective for treating central vertigo caused by abnormalities in the bioelectrical activity of the brain.
BPPV
- The treatment of BPPV can include canalith repositioning manoeuvres, such as the Epley manoeuvre or the Semont manoeuvre, which help reposition the calcium carbonate particles inside the semicircular canals.
- Medicines can be prescribed in order to control the symptoms, such as the nausea and vomiting associated with the episodes of vertigo.
- In rare or severe cases, surgery can be considered in order to remove the calcium carbonate particles from inside the inner ear.
Psychogenic vertigo
- Brain training: Brain training therapy is a non-invasive method for treating psychogenic vertigo, which addresses the bioelectrical activity of the brain and optimises it with the help of visual and auditory stimuli, NIR light therapy and by practising heart-brain coherence. Neurofeedback Plus therapy treats its psycho-emotional causes, while also improving sleep quality, appetite, attention and energy levels, as well as the decoding of visual and auditory signals.
- Cognitive behavioural therapy (CBT): CBT can be useful in treating psychogenic vertigo, helping the person identify and change the negative thoughts and behaviours associated with the vertigo and learn techniques for managing stress and anxiety.
- Counselling and supportive therapy: Counselling and supportive therapy can offer a safe space for exploring and addressing the underlying psychological or emotional problems.
- Medication: In some cases, medication can be prescribed in order to treat the associated psychological symptoms, such as anxiety or depression.
Orthostatic vertigo
- Managing the underlying causes: Treatment often involves managing the underlying causes, such as treating low blood pressure, adjusting medication or managing heart or neurological problems.
- Lifestyle changes: Adopting a healthy lifestyle, such as adequate hydration, avoiding prolonged standing and avoiding sudden changes in body position, can help prevent the episodes.
- Medication: In some cases, medicines that raise blood pressure can be prescribed in order to help control the symptoms.
- Brain training: Brain training therapy can be used as a treatment method in orthostatic vertigo, improving blood circulation in the brain and promoting the optimisation of blood pressure. Brain training also treats the neurological causes that can lead to this diagnosis.
Vitamins and physical exercises that can help relieve vertigo:
In general, vitamins and physical exercise can be beneficial for managing and relieving the symptoms of vertigo, but their effectiveness can vary with the specific cause of the disorder and with the individual needs of the patient.
Here is some information about how vitamins and physical exercise can be used in the treatment of vertigo:
Vitamins:
- Vitamin D: A vitamin D deficiency can be associated with certain balance disorders and can contribute to the onset of vertigo. Vitamin D supplementation can be useful especially for people with a deficiency confirmed by blood tests.
- Vitamin B12: A vitamin B12 deficiency can affect the central and peripheral nervous system, including vestibular function. Vitamin B12 supplementation can be beneficial for people with low levels of vitamin B12.
- Vitamin C: Antioxidants, such as vitamin C, can help reduce inflammation and improve blood circulation, which can be useful for people with vertigo caused by circulatory or inflammatory problems.
Physical exercises:
- Vestibular rehabilitation exercises: Vestibular rehabilitation exercises, also known as vestibular rehabilitation therapy (VRT), can be beneficial for people with peripheral vertigo, such as benign paroxysmal positional vertigo (BPPV) or vestibular neuritis. These exercises involve specific movements of the head and of the eyes in order to recalibrate the vestibular system and to reduce the symptoms.
- Balance exercises: Balance exercises, such as standing on one leg, walking along a straight line or climbing stairs, can help improve vestibular function and increase the general stability of the body.
- Cardiovascular exercises: Aerobic physical activities, such as walking, running, cycling or swimming, can improve blood circulation and the oxygenation of the brain, which can contribute to reducing the symptoms of vertigo.
It is important to always talk to your doctor before starting any regimen of supplements or physical exercise, in order to determine the most suitable approach for the cause and the severity of your vertigo.
Prevention methods
- Maintaining a balanced and healthy diet: Eating a diet rich in nutrients, such as vitamins and minerals, can help maintain general health, including the health of the vestibular system.
- Avoiding alcohol and substances that can affect balance: The excessive use of alcohol or of other substances can affect balance and coordination.
- Managing stress and anxiety: Stress and anxiety can worsen the symptoms of vertigo. Stress management techniques, such as meditation, deep breathing and relaxation exercises, can be useful in reducing stress and anxiety.
- Avoiding sudden head movements: For people with benign paroxysmal positional vertigo (BPPV) or with other vestibular disorders, avoiding sudden head movements can help reduce the frequency and the severity of the episodes of vertigo.
- Maintaining adequate hydration: Dehydration can affect balance and can increase the risk of vertigo. Make sure you drink enough water during the day in order to maintain adequate hydration.
- Avoiding eye strain and visual fatigue: Activities that involve prolonged eye focus, such as reading or using electronic devices, can worsen the symptoms experienced. Take regular breaks and rest your eyes in order to avoid straining them.
- Maintaining regular physical activity: Regular physical exercise, such as walking, swimming or yoga, can improve blood circulation and the oxygenation of the brain, which can help reduce the risk of neurological disorders.
- Managing environmental factors: Avoid the situations or the environmental factors that can trigger or worsen the symptoms of this condition, such as bright light, loud noise or strong smells.
- Brain training therapy: this therapy, which can be used for treating vertigo, can also be followed as a form of prevention, in order to treat in good time the functional neurological causes and the psycho-emotional causes that can trigger it.
References
- Sasu, R. (2022). Infra-low frequency neurofeedback in persistent postural-perceptual dizziness-Case report. Frontiers in Human Neuroscience, [online] 16. doi:https://doi.org/10.3389/fnhum.2022.959579 .
- Decker, L., Basta, D., Burkart, M. and Ernst, A. (2021). Balance Training With Vibrotactile Neurofeedback and Ginkgo Biloba Extract in Age-Related Vertigo. Frontiers in Neurology, [online] 12. doi:https://doi.org/10.3389/fneur.2021.691917.āā
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