How to deal with vertigo?

‘Vertigo or dizziness is not something you have to live with’

If you have ever suffered from vertigo, you will be familiar with that dreadful sensation of feeling off-balance and dizzy, as if you are spinning, or the world around you is spinning.

Vertigo is a symptom, not a disorder in itself or a diagnosis, explains vestibular physiotherapist Sheila Barrett. However, many people with vertigo go undiagnosed for years, incorrectly believing their only choice is to live in this debilitating state.

The east Cork-based physiotherapist became aware of this fact when training in vestibular rehabilitation at Emory University, Atlanta, US, where vestibular rehab is part of general physiotherapy training. She now works in conjunction with the Vestibular Disorders Association of America, the Migraine Association of Ireland, and through GP group training to raise awareness of vestibular disorders among Irish GPs and the public.

Sheila Barrett at her clinic in east Cork.

Vestibular rehabilitation evidence-based medicine is now considered the most successful management approach for people with dizziness and balance associated with disorders of vestibular system, Barrett says.

“It’s never normal to be dizzy regardless of your age. The most important thing to realise is that vertigo or dizziness is not something you have to live with. However, only when an accurate diagnosis is implemented can the correct management programme for you be put in place,” says Barrett.

Causes

There are many causes of dizziness and vertigo, most of which are not associated with any serious condition. They include low blood sugar, low blood pressure, dehydration, inner ear disorders, medication side effects, heart problems and anxiety or stress.

The vestibular system includes the parts of the inner ear and brain that help control balance and eye movements. If this system is damaged by disease, ageing, or injury, vestibular disorders can result.

Barrett explains: “ 35 per cent of adults aged 40 years and older experience vestibular symptoms at some point in their lives. Dizziness is one of the most common reasons people go to A&E. Vestibular disorders affect balance and often produce disabling symptoms that include vertigo, dizziness, balance problems and difficulty concentrating.

“These life-altering symptoms can deeply inhibit a person’s ability to perform basic day-to-day tasks, and are compounded by their invisibility to others, making it difficult to understand that a person with vestibular dysfunction is probably struggling to remain orientated and functional.”

One of the most common vestibular disorders is Benign Paroxysmal Positional Vertigo (BPPV) which is caused by tiny crystals of calcium (otoconia) becoming displaced and floating around the ear canal. One of the most common symptoms of BPPV is vertigo, which is often accompanied by dizziness, imbalance and nausea. Symptoms can be brought on by a change in position such as turning over in bed, looking up, leaning forwards or bending down to pick something up.

Another common vestibular disorder is vestibular migraine which, unlike other forms of migraine, does not cause pain in many people. The predominant symptoms are vertigo, dizziness, loss of balance, disorientation, motion and light sensitivity, and visual distortion.

People with vestibular migraine often undergo a multitude of medical consultations and extensive lab, imaging and other diagnostic evaluations without any diagnosis, says Barrett.

“In addition, vestibular suppressant medications are often given, increasing postural instability and further compounding the situation. Without a diagnosis, but with persisting symptoms, patients become disillusioned and hopeless. Some patients are given a diagnosis of ‘vertigo’ which is in fact a symptom – not a disorder. That’s why many people with these symptoms can go undiagnosed for several years incorrectly thinking that their only choice is to live with it. Like any condition, accurate diagnosis is the essential starting point and so once these patients are diagnosed with vestibular migraine, they can then be successfully managed.”

Triggers

Many of Barrett’s vestibular migraine patients report a family history of migraine, but on some occasions there is only a family history of “vertigo” stemming from misdiagnosed vestibular migraine. The known migraine triggers such as certain foods and environmental, emotional and hormonal changes can also trigger vestibular migraine.

An accurate diagnosis for vestibular disorders is vital, says Barrett. A detailed medical history and physical exam followed by functional vestibular testing using infra-red goggles can identify the root cause of the problem. Once an accurate diagnosis is identified, appropriate treatment can begin which may include vestibular rehabilitation therapy (VRT), medication, surgery or elimination of a provoking drug.

Vestibular rehabilitation therapy includes a manoeuvre that eliminates BPPV by moving the displaced calcium particles out of the affected inner ear canal. It’s a hugely successful treatment, according to Barrett, with 95 per cent of people symptom-free following one manoeuvre and the other 5 per cent after a repeated manoeuvre. A programme of vestibular rehab exercises which train people to focus and move their head at the same time is also prescribed to be performed at home.

Head movements

Many people with vestibular disorders avoid moving their head because it causes them to feel dizzy and nauseous, but this avoidance of head movements further compounds the condition, explains Barrett. She has to train people to move their heads despite the short-term dizziness so they can get better and back to their normal lives.

A physiotherapist for 30 years, Barrett has always loved her work but she is hugely passionate about vestibular rehab which now forms the bulk of her workload as people come from all over the country for treatment.

“It makes such a difference to people’s lives, it helps them get their lives back and is incredibly rewarding work to be involved in.”

She is keen to share her training and expertise in diagnosing and treating vestibular disorders with more Irish GPs so people are not forced to suffer unnecessarily while undiagnosed.

“When a patient is diagnosed with ‘vertigo’ by their GP, they are usually put on vestibular suppressants. People on medical cards with no access to an ENT consultant often stay on this medication for years which further suppresses the vestibular system and hinders function. This can greatly limit a person’s lifestyle, lead to low mood and force them to time take off or give up work when all that is needed is to identify the cause of their vertigo and treat it appropriately.”

Pádraig Carroll: vestibular migraine

Teacher Pádraig Carroll had been suffering from dizziness for a few years on and off, but put his symptoms down to blood pressure issues. However, his condition deteriorated last year after he was hit with two infections and he was left with severe dizziness, balance problems, nausea and fatigue.

The Kilkenny man was diagnosed with vertigo by his GP and referred to a consultant geriatrician who sent him for an MRI, which was clear. He was prescribed medication, but saw no major improvement in his symptoms.

“By late October, I was totally debilitated. I felt like I had a permanent hangover, constant nausea and a muzziness in my head. I didn’t have sharp pain, more of a general discomfort and I was constantly fatigued. There was no question of me being able to work, it really put me under.”

Carroll had never heard the word vestibular until he met Sheila Barrett at East Cork Physiotherapy, Balance and Acupuncture Clinic and she diagnosed him with vestibular migraine.

As well as a rehab exercise programme, Carroll came off his medication (after consultation with his doctor) and went on a standard migraine diet which involved cutting out caffeine, chocolate, citrus fruits, alcohol and other foods.

“I noticed an immediate improvement when I started doing the exercises and diet. I’m still not 100 per cent better, but I was able to get back to work in January and am improving a bit every week. I have to avoid triggers like stress, infections and certain foods, but I am back walking every day again which is a great form of stress relief.”

Margaret Downey: BPPV

When Margaret Downey (77) started experiencing problems with her balance that caused her to “trip over nothing” on a number of occasions, she told nobody as she felt it was just a normal part of ageing.

“My balance wasn’t right, I was leaning to the left when I walked and I was extremely tired all the time. When I start something, I always finish it to the bitter end but I was leaving things unfinished and that was bothering me because it’s not my style. I fell a few times but made no fuss about it. I just thought everybody falls as they get older, but I know now it’s not normal.”

Living near the sea in Castletownbere, Downey had swam in the sea all her life but started to have difficulties swimming due to her lack of co-ordination and had to stop.

It wasn’t until early January of this year that the great grandmother finally sought help when things got even worse.

“One morning, as I got out of bed everything tumbled backwards. It was a terrible sensation, like being in an airplane somersaulting backwards. It was very frightening as I didn’t know what was happening. I gradually got up and was okay as the day went on, but I started to get a floating sensation when I turned on my right side in bed. I was also having problems with my sight, it was as if there was broken glass at the side of the lens of my glasses when there was nothing wrong with them.”

She went to the GP who told her she had vertigo and prescribed medication. The following week, she went to see vestibular physiotherapist Sheila Barrett in east Cork who diagnosed benign paroxysmal positional vertigo (BPPV), a condition where tiny particles called otoconia become dislodged in the inner ear and move around in the wrong place.

The physiotherapist was able to identify which of the three inner ear canals was affected by observing Downey’s eye movements using special infra-red goggles. She used a manoeuvre to move the displaced particles out of the affected panel back to where they should be and gave Downey a series of exercises to do at home to promote full recovery.

“As soon as I sat up after that treatment, I felt well again and the fear was gone. It had been getting worse and I had a fear of everything. Fear is a horrible thing, it takes away your confidence and I’m not that type of person. I couldn’t drive and even at Mass, I would be looking around to see if anybody I knew was near in case I needed help. Things hadn’t been right for a long time but thank God, I am 100 per cent back to myself again. I have my strength back, I’m not tired all the time and I’m sleeping better so my days are better. I would urge anybody with symptoms like mine to get help.”

Lisa Haven, executive director of the Vestibular Disorders Association, reports that “the risk of falling is two to three times greater in people with chronic imbalance or dizziness.” Nearly 9 percent of Americans 65 and older have balance problems, the prevalence of which is likely to increase as the 78 million baby boomers age.

Four Types of Dizziness

The job of the vestibular system is to integrate sensory stimuli and movement for the brain and keep objects in visual focus as the body moves. When the head moves, signals are sent to the inner ear, an organ consisting of three semicircular canals surrounded by fluid. It in turn sends movement information to the vestibular nerve, which carries it to the brainstem and cerebellum, which control balance and posture and coordinate movement. Disruption of any part of the system can result in dizziness.

These are four types of dizziness, all of which are more common with increasing age:

¶Faintness, the feeling of being about to black out when upright. This can result from dehydration, abnormal heart rhythms, overmedication with blood pressure drugs and disorders of the autonomic nervous system.

¶Loss of balance, feeling unsteady and about to fall even though muscle strength is normal. This can be caused by disorders of the inner ear; the cerebellum because of stroke or chronic alcoholism; or the basal ganglia, because of Parkinson’s disease, for example. It can also result from overmedication with drugs like sedatives and anticonvulsants, vision disturbances and neuropathy or spinal cord disease that causes a loss of position sense in the legs.

¶Vertigo, a false sense that the person or the surroundings are moving or spinning. This can result from motion sickness, Ménière’s disease, middle-ear infections, migraines, multiple sclerosis, damage to the vestibular nerve and reduced blood flow to the brain after a stroke or transient ischemic attack. In the most common form, benign paroxysmal positional vertigo, sudden head movements cause a sensation of motion.

Benign Paroxysmal Positional Vertigo (BPPV): Living With

Can benign paroxysmal positional vertigo (BPPV) return? If so, what can I do?

A new episode of BPPV can develop after successful treatment. On average, the rate of recurrence (new episode) is 15-50%.

However, it may be possible to treat recurrent BPPV at home by performing a series of movements when an episode occurs. Patients will receive information on ways to handle recurrences on their own, or they can work with an audiologist or physical therapist to develop a plan.

In general, if you wake up with positional vertigo, try the following steps:

  • Slowly move into the good-ear-down position and wait for a minute.
  • Next, slowly move into a face-down position and slide to the foot of the bed.
  • Keep your head down until you reach the end of the bed and are kneeling or standing on the floor.
  • Slowly bring your head backward into an upright position. (Hold on to the bed at all times.)

Another method is to sit toward the foot of the bed, leaving enough room to lay back with your head resting comfortably at the end of the bed, slightly extended. Be careful not to overextend your neck, as this may aggravate existing neck problems. If your symptoms are severe, you may need assistance to complete the maneuver.

Without treatment, the symptoms of BPPV may persist. However, with time (usually within 6 weeks), the otoconia dissolve on their own. Until then, the number and severity of episodes may be reduced simply by paying careful attention to head position. In addition, anti-motion sickness drugs can control nausea.

However, before drugs are taken, it is usually best to try the particle repositioning procedure first. It is a very safe and rapid way to relieve symptoms and reduce the chance for falls. Medications should not be taken for a long period of time.

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What is vertigo?

Do you have vertigo? This is how doctors break down dizziness into three subcategories:

• presyncope – feeling faint or light headed
• disequilibrium – feeling off-balance
• and the more familiar vertigo, defined as the sensation of motion where none actually exists.

Different people experience vertigo in different ways; for some the world might be spiralling around them and others might be spiralling around the world.

Usually, vertigo sufferers can blame their ears, where the balance organs are located, for the unsettling sensations.

Approximately 40 percent of us will suffer from dizziness at some point, and within that group, as many as 42 percent will have benign paroxysmal positional vertigo (BPPV), which is the most common cause of ear-related spinning sensations. (Is your dizziness caused by drinking alcohol? Here’s what to do.)

“The median duration of a single episode of BPPV is two weeks,” says Dr. Matthew Bromwich, an ear, nose and throat (ENT) surgeon and assistant professor of otolaryngology at the University of Ottawa. “Basically, for two weeks, every time you look up, roll over or bend down, you get a spinning sensation lasting for seconds to minutes. It’s very irritating and it can be quite disabling.”

What causes vertigo, specifically BBPV?

What kick-starts this cranial merry-go-round is the balance system in our inner ears. It is made up of gravity sensors (called otolithic organs) and rotation sensors (semicircular canals). (Find out what it means about your health when your ears are ringing.)

Otolithic membranes called saccule sense acceleration through tiny crystals of calcium carbonate, which are stuck to a gelatinous mass containing hair cells. These hair cells bend in different ways, sending signals to your brain that indicate your body’s speed and orientation.

The semicircular canals are fluid-filled tubes with similar hair cells that sense rotation. The problem begins when those calcium crystals dislodge, sending your brain a clash of signals that tell it that you’re rotating even when you’re still.

For the one in 10 people over the age of 60 affected by BPPV, the calcium crystals dislodge because of age and general wear and tear on the ear.

BPPV is also quite common after a car accident or some form of head trauma – either the crystals have been shaken loose by the force of the accident, or the trauma leads to inflammation in the ear, which causes the crystals to dislodge. People with inner-ear infections have similarly inflamed ears and are also more likely to suffer from BPPV.

How to tell if you have BBPV

While Bromwich says BBPV causes no serious repercussions to your health, the spinning sensation can be annoying and debilitating. The good news is that the condition is fairly simple to resolve. So how do know if what you’re feeling is vertigo?

“People can almost make their own diagnosis,” says Bromwich. “There’s a manoeuvre called the Dix-Hallpike, where you lay down with your head hanging over the end of your bed. That’s the most stimulating position for this disease.” (Yoga has a lot of benefits, but here are the top three.)

If you turn your head to the right and experience dizziness, you likely have BPPV in your right ear. If you turn to the left and start spinning around: BPPV in the left ear. Keep in mind that this manoeuvre only works if the cause of your vertigo is BPPV, so it’s best to visit your doctor for an accurate diagnosis. (Don’t miss these thyroid facts everyone should know.)

Treatment for BBPV

Sedatives such as Ativan or Lorazepam are commonly prescribed, because they mask the symptoms of BPPV. They don’t, however, affect the course of the disease.

For people with severe vertigo, brain surgery may be required, although it’s only recommended for those with highly recurrent, entirely disabling episodes.

How to deal with vertigo

For up to 95 percent of sufferers, the most effective treatment is the Epley manoeuvre, a non-pharmaceutical procedure discovered fewer than 20 years ago. In fact, because the manoeuvre is still relatively new, patients see an average of three doctors and incur average costs of $2,600 in prescriptions and missed work before they receive the proper treatment, according to a U.S. study.

“The Epley manoeuvre is a way of rolling the patient such that you get those crystals from the semicircular canal back to the saccule, where they’re supposed to be,” Bromwich describes.

The entire process takes a matter of minutes and is so straightforward for a doctor to administer that Bromwich designed an iPhone app – called DizzyFix – that walks physicians through the manoeuvre.

“It’s exactly like that game with a maze and a ball in it, only instead of a maze, it’s a floor plan of your inner ear,” he explains. “The iPhone is gravity sensitive, so by placing the phone on the patient’s head, you get immediate feedback as to whether you’re doing the manoeuvre right.”

As recurrence rates for BPPV hover around 60 percent, Bromwich also developed a device that Health Canada has approved for home use (also called DizzyFix) that patients who suffer from the condition can purchase help them to complete the Epley manoeuvre independently.

Does motion sickness have you dizzy. Here is what you can do for it. Try these our natural remedies.

Dizziness Can Be a Drag

Work with your doctor to figure out how to cope with your dizziness on a daily basis and reduce your risk of injury. For example, wear low-heeled shoes or walking shoes outdoors. You might decide to try using a cane or walker. Safe, secure handrails in stairwells and grip handles in bathrooms can help make your home safer. Driving a car may be especially hazardous, so ask your doctor if it’s safe for you to drive.

A specialized rehabilitation therapist can give you a set of head, body and eye exercises to help reduce dizziness and nausea.

Meanwhile, researchers continue to work to develop new, more effective approaches. In one experimental rehabilitation strategy, now in clinical trials, scientists have created a “virtual reality” grocery store. It allows people with balance disorders to walk safely on a treadmill through computer-generated store aisles. While holding onto a grocery cart, they can look up and down, turn their heads and reach for items on virtual shelves. By doing this, they safely learn how to navigate an environment that can be challenging for someone with a balance problem.

“The key for people looking for treatment is to go to the best team of clinical experts that they can gain access to,” says Dr. Sklare. “It’s very important to get that level of assessment.”

4 Reasons for Vertigo and How to Find Help to Cope

Vertigo is a spinning sensation. You may feel as if you are spinning, or the things around you may seem to be spinning. This can happen briefly and go away, or it may happen continuously, lasting for longer periods of time. The source of vertigo is the inner ear, which is responsible for your balance and orientation within your surroundings. So, you may wonder why vertigo happens, and if there is anything to be done for it.

Four Conditions That Bring About Vertigo

  • Benign paroxysmal positional vertigo: This is the most common type of vertigo and is triggered by head or neck movement or standing up too quickly. It is common for this to begin after you have been injured.
  • Meniere’s disease: Known for ringing in the ears, a feeling of fullness in the affected ear, and hearing loss, it usually affects people in the 40 – 50 age range.
  • Vestibular Neuronitis: Usually brought about by a cold or the flu, this condition can also cause hearing loss and ringing in the ears. It is due to an inflammation of the inner ear or vestibular nerve.
  • Labyrinthitis: Due to allergies, respiratory infections, the flu, bacteria, or other viruses, it is an irritation or swelling of the inner ear and can lead to hearing loss.

Victims of Vertigo Find Relief

Vertigo can be difficult and scary to deal with. Many times it can be connected to a misalignment in the bones of the upper cervical spine. If either the C1 or C2 vertebra moves out of alignment just slightly, it can put undue pressure on the brainstem, causing it to send improper signals to the brain about the body’s location. This can lead to symptoms associated with vertigo.

Here at Asbury Family Chiropractic in Dubuque, IA, we use a gentle method that naturally encourages the vertebrae to realign, restoring communication and leading to an improvement in vertigo symptoms.

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