Vertigo is a feeling that you are moving, either spinning, floating or moving forward, backward or to one side.
Vertigo is a symptom, like pain is a symptom. Just like for pain, there are many causes of vertigo. To find out what’s causing your vertigo, the surgeon will
- ask you to describe everything about your vertigo, from the first episode to now
- examine your ears, eye movements, balance, coordination, movement and sensation
- test your hearing
- and sometimes arrange blood tests or an MRI looking at the brain, hearing and balance nerves.
If you have vertigo plus any of the FAST symptoms of stroke, call an ambulance to take you to the emergency department immediately.
The five most common causes of vertigo are
Sudden, severe vertigo caused by a viral infection of the inner ear and balance organ. You may be unable to walk without help and vomiting is common. Symptoms last 1-3 days then slowly improve over one-four weeks. Many patients need to go to their GP or emergency department for help. Medication can reduce vertigo and vomiting and corticosteroid can help the nerve recover. Vestibular physiotherapy helps recover balance more quickly and more effectively. Most people recover well. Occasionally, vestibular neuritis can happen more than once over your lifetime.
Frequent brief (seconds to minutes) episodes of vertigo, with head movements, like rolling over in bed, tilting head up or turning to one side. Episodes can happen many times a day over weeks. Some people improve spontaneously, without treatment. Your surgeon or physiotherapist will treat BPPV with an Epley Manoeuvre. This takes 5 minutes and works the first time in 9 out of 10 patients. It can be repeated until the symptoms stop. BPPV can recur several times over your lifetime. If this happens to you, your surgeon can teach you how to treat yourself with an Epley Manoeuvre at home.
This form of migraine causes episodes of vertigo, lasting one or more days. Like other forms of migraine, vestibular migraine can be associated with headache, sensitivity to noise and light, clouded thinking and vomiting. Treatment is in 2 parts
- relieving the symptoms: your GP or surgeon will write a medication plan for you. It’s essential to avoid codeine, oxycodone and any opiate drugs; these are migraine promoters and make symptoms worse over time
- preventing episodes:
- try to identify if there are any triggers to your migraine and adjust your lifestyle as needed. People who get restful sleep, exercise every day, have regular meal times (no fasting or skipping meals) and avoid food and drink that can trigger migraine, then to have less days with migraine symptoms. Evidence based ways of reducing migraine can be found here and note that “soda” means caffeinated soft drinks like Coke and Pepsi
- If episodes are happening more than twice a month, your surgeon or GP may prescribe a preventive medication.
Meniere’s disease is an inner ear problem, causing episodes of vertigo lasting up to 6 hours or so. Vertigo can be severe and many people have a feeling of blocked ear, drop in hearing and loud noise in the ear before the vertigo starts. Meniere’s disease can run in families and the exact cause is not known. Episodes are more likely when you are fatigued, stressed or consuming foods higher in salt, caffeine or alcohol. Treatment is in 2 parts
- relieving the symptoms during an episode with medication to stop vertigo and vomiting and corticosteroid
- preventing episodes:
- diet and lifestyle: see a dietitian for help with a low salt diet. Stop caffeine and alcohol. Try to get enough sleep, exercise regularly and manage stress. Ask your GP for help if needed.
- medication taken by mouth every day
- injection of medication into the middle ear by your surgeon
Persistent Postural Perceptual Vertigo PPPD
PPPD causes a constant feeling of dizziness, lasting weeks to months. It can be triggered by another cause of vertigo and persists after the initial problem resolves. Treatment is with physiotherapy and psychological therapy.