Vertigo: Causes, Symptoms, Treatment

What is vertigo?

Vertigo is the sensation of spinning or the feeling that you or your surroundings are spinning, making it challenging for you to maintain balance. It is more than just experiencing dizziness.

A vertigo episode may persist for a few seconds or it last up to hours. If you experience serious vertigo, it can persist for many days or months.

Vertigo can disrupt driving, work, and lifestyle which can potentially cause you to fall, and lead to various injuries, including hip fractures.

What are the causes?

The cause of vertigo is sometimes unknown. However, the most common causes of vertigo are conditions that affect the inner ear, which leads to issues with maintaining balance. These conditions include:

• Benign paroxysmal positional vertigo (BPPV): Caused by tiny calcium particles (canaliths) clumping up in the canals of the inner ear, disrupting normal fluid movement and sending false signals to the brain about head position.
• Vestibular neuritis or labyrinthitis: Inflammation of the vestibular nerve (which connects the inner ear to the brain) or the labyrinth (inner ear structure), often due to viral infections, causing sudden, severe vertigo.
• Ménière's disease: A disorder of the inner ear caused by fluid buildup, leading to episodes of vertigo, hearing loss, tinnitus (ringing in the ears), and a feeling of fullness in the ear.
• Migraines: Some people experience vertigo as a symptom of migraines, known as vestibular migraines, which can be accompanied by headache, visual disturbances, and sensitivity to light and sound.
• Others: Head injury and the usage of certain types of medications.

What are the symptoms?

If you have vertigo, these are the symptoms that you may experience:

• Spinning (or your surroundings are spinning around you).
• Tilting or swaying.
• Off balance.

These symptoms you experience may persist for seconds, minutes, hours, or days. Moving your head, changing positions such as standing up or turning over in bed, coughing, or sneezing may make you feel worse.

You might also experience other symptoms depending on what is causing your vertigo, such as:

• Nausea or vomiting.
• Headache or sensitive to light and noise.
• Double vision, difficulty speaking or swallowing, or weakness.
• Shortness of breath, sweating, or a rapid heartbeat.

When should you seek for immediate medical attention? 

If you suspect you may have vertigo, consult your doctor immediately. It will be helpful if you can describe how long your symptoms persist, triggers, and any other issues you are facing. These clues can help determine what causes your vertigo.

• New or severe headache.
• High temperature (>38ºC).
• Double vision.
• Inability to walk without assistance.
• Chest pain.
• Vomiting that will not stop.
• Have risk factors for stroke (diabetes, high blood pressure or smoking).

How is vertigo diagnosed?

Diagnosing vertigo typically involves a thorough medical history, physical examination, and specific tests to determine the underlying cause.

• Dix-Hallpike test: A specific test for BPPV where the doctor positions you in a way to provoke vertigo symptoms and observes your eye movements for nystagmus (involuntary eye movements).
• Hearing tests: Audiometry or other hearing tests to assess if there is any hearing loss, particularly useful in diagnosing conditions like Meniere’s disease.
• MRI or CT scan: These imaging studies are used to rule out central causes of vertigo such as stroke, tumours, or multiple sclerosis.
• Orthostatic blood pressure testing: A decrease in systolic blood pressure by over 20 mm/Hg when moving from a lying down to a standing position indicates a significant postural drop. This condition is commonly observed in patients who are dehydrated or experiencing autonomic dysfunction. Autonomic dysfunction can develop suddenly and may be triggered by vertigo.

How is vertigo treated?

There are a few treatment options available to treat vertigo, depending on the underlying cause.

• Medication: Antihistamines like meclizine, dimenhydrinate, or diphenhydramine are used to treat vertigo and motion sickness. Prescription antiemetic medications, such as ondansetron, promethazine, or metoclopramide, can also be effective. Additionally, sedatives like diazepam, lorazepam, or clonazepam are commonly used for anxiety but can help relieve vertigo symptoms.
• Vertigo exercises and rehabilitation therapy: Vestibular rehabilitation therapy (VRT) is an exercise-based treatment program designed to encourage vestibular adaptation and substitution. 

Can vertigo be cured permanently?

Most individuals with vertigo improve over time without treatment. Some individuals may experience recurring episodes of vertigo that span many months, or years, as observed in those with Ménière’s disease.

Make an appointment at Pantai Hospitals

Get in touch with us to book an appointment today if you have concerns or questions regarding vertigo. A dedicated and expert team of neurologists at Pantai Hospitals is available for consultation to provide the best care and assistance. We assure you the best possible care tailored to your specific needs.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.