What causes vertigo to act up?

Sometimes it’s a bump on the head that dislodges the crystals.

“BPPV is positionally triggered,” says Kim Bell, a San Diego-based doctor of physical therapy who specializes in vestibular rehabilitation. That means when you move your head in certain ways — dropping it forward to pick something up off the floor or attempting a Downward-Facing Dog yoga pose, for instance — you can cause these crystals to move and bring about an attack of vertigo.

It’s often triggered when you’re lying down: You go to bed feeling perfectly fine, then roll over toward your bad ear to get out of bed in the morning, and wham!

The shifting of the crystals sends a faulty signal from your inner ear to your brain about how you’re moving, which leads to that “world is spinning” sensation.

Those dizzy spells typically last for less than a minute but can return anytime you pitch your head and trigger another brief, brisk spin. Some attacks can be merely annoying, says Brian McKinnon, an ENT-otolaryngologist in Philadelphia: “Others can be debilitating and dangerous, making you feel off-balance and putting you at risk for falls.”

Treatment

BPPV usually goes away on its own within weeks of the first episode, though it can last for months or even years. If you want immediate relief from those bouts of spinning, you might consider something called the Epley maneuver. The treatment — typically performed by a vestibular rehabilitation therapist (a specially trained physical therapist), occupational therapist, audiologist or ENT — involves moving the head in a series of precise positions, allowing the crystals to migrate out of the semicircular canals back to the original vestibular organ they came from — the utricle. “It’s kind of like playing one of those small, handheld pinball games,” says Bell, “tipping it right and left, trying to get the silver ball through the maze.”

Typically, BPPV can be eliminated in about 85 to 90 percent of patients with just one or two treatment sessions, though it can recur periodically. “A few of those little crystals get loose and the whole thing starts all over again,” says Rauch. If this happens, your doctor or therapist can teach you how to perform the Epley maneuver on your own at home.

Even after BPPV has been treated, some people have residual symptoms of imbalance or unsteadiness. These can be resolved by working with a vestibular rehabilitation therapist — basically, using specific exercises to help patients regain their stability. It might include walking on different types of surfaces, stepping over thresholds, or maintaining one’s balance in a stationary position.

Unsettling symptoms aside, BPPV isn’t life-threatening. “If your symptoms are centered exclusively around the ear, and you want to wait it out, there’s probably no big danger in doing that,” says Rauch. However, he notes, there are times when dizziness can point to more serious disorders, such as heart disease, stroke, diabetes, brain tumors or multiple sclerosis. If you have symptoms in any other part of your body — say, your vision has changed, or you have numbness, weakness, confusion or slurred speech — it’s worth taking a trip to the ER and getting it checked out by a doctor.

Vertigo: A common problem that left one man teetering for months and months

March 27, 2009. I was fine the night before. The little cold I’d had was gone, and I’d had the first good night’s sleep all week. But when I woke up Friday morning at 6:15 and got out of bed, the world was whirling counterclockwise. I knocked against the bookcase, stumbled through the bathroom doorway and landed on my knees in front of the sink. It was as though I’d been tripped by a ghost lurking beside the bed.

Even when I was on all fours, the spinning didn’t stop. Lightheaded, reaching for solid support, I made it back to bed and, showing keen analytical insight, told my wife, Beverly, “Something’s wrong.”

The only way I could put on my shirt was to kneel on the floor first. I teetered when I rose. Trying to keep my head still, moving only my eyes, I could feel my back and shoulders tightening, forming a shell. Everything was in motion, out of proportion, unstable. I barely made it downstairs for breakfast, clutching the banister, concentrating on each step and, when I finally made it to the kitchen, feeling too aswirl to eat anyway. I didn’t realize it at the time, but those stairs would become my greatest risk during this attack of relentless, intractable vertigo.

Vertigo — the feeling that you or your surroundings are spinning — is a symptom, not a disease. You don’t get a diagnosis of vertigo; instead, you present with vertigo, a hallmark of balance dysfunction. Or with dizziness, a more generalized term referring to a range of off-kilter sensations including wooziness, faintness, unsteadiness, spatial disorientation, a feeling akin to swooning. It happens to almost everyone: too much to drink or standing too close to the edge of a roof or working out too hard or getting up too fast.

But according to the National Institutes of Health, “more than four in 10 Americans will experience an episode of dizziness sometime during their lives that’s significant enough to send them to a doctor.” That would be approximately 125 million of us.

Anatomy of vertigo

If it came with a soundtrack, vertigo’s would sometimes be a train’s wheels grinding and screeching on the tracks as the car turns and almost tips over. Other times it would be a treetop filled with the ruckus of rioting crows in a sudden windstorm.

I remember feeling helpless and untethered, needing to reach out for something stable to steady me but finding that there was too much give in everything I sought. Vertigo is a carnival world and I was the Human Bumper Car. I moved without authority because the simple act of shifting my head’s plane threw me into chaos. But so did remaining motionless. I was never comfortable or relaxed, never at ease, at home in my world.

But I was not alone. In part, that was because I had Beverly’s support and my daughter’s steady concern. I was also not alone because, as a study published in the Archives of Internal Medicine in 2009 noted, 69 million Americans age 40 and older, or 35.4 percent of the population during the four-year study period, had some form of vestibular dysfunction — a term that includes vertigo.

When I was struck by vertigo, I had no idea it was such a common occurrence.

I was also not unfamiliar with balance problems. In 1988, I contracted a virus that targeted my brain and left me neurologically disabled. Besides damage to my memory systems, abstract reasoning, word-finding and other cognitive powers, my brain’s ability to process information — including information necessary to maintain balance reliably — had been compromised. I’d had to walk with a cane for 15 years.

Disembodied

Human balance is a multi-system operation. “It begins with a series of signals within the tiny balance organs of the inner ear,” according to hearing and balance expert Daniel Sklare. “These organs work with your brain’s visual system to give you a sense of your body’s position.” Other parts of the body — skin, joints, muscles — also relay balance information to the brain. All it takes to trigger a balance disorder is a malfunction in one of these delicate components. Researchers have identified more than a dozen different balance disorders, NIH reported in 2012.

On that March morning in 2009, my primary-care physician thought my problem was the most common of those disorders, benign paroxysmal positional vertigo, or BPPV. He explained that “ear rocks” — small deposits of calcium carbonate, probably dislodged by the viral infection I’d caught the week before at the coast — had collected in the inner-ear canals of my right ear. Such debris, or otoconia, jitters at the least movement and sends all sorts of confusing signals through the balance system. Until it dissolved, I could expect the symptoms to persist. It could last two days or two weeks or two months, he said.

It lasted five months. To be precise, by the time I’d seen the neurotologist — who spun me in an Omniax system chair, a diagnostic device that looks like a futuristic carnival ride or an apparatus for training astronauts to endure zero gravity — and the neurologist specializing in balance disorders — who sent me for an MRI of the brain and then left for a month’s vacation — and the acupuncturist, who was also a doctor of Chinese medicine, my vertigo had been going on for 138 days.

And it wasn’t BPPV, reasonable though that initial diagnosis seemed. Beverly and I had gone home and researched it. We watched several YouTube demonstrations of the Particle Repositioning Procedure, or Epley maneuver, intended to relocate the otoconia. I’d lie supine on our bed with my head turned to the right and dangling dizzily off the edge into Beverly’s hands. After 30 seconds, she shifted my head to the left, waited another 30 seconds and helped me rotate onto my left side, face down, where I looked at her kneecap. When 30 more seconds passed, I slowly sat up and gathered myself for a minute, trying not to puke. Three times a day.

For 69 days. Not that I was counting, but that was 1,656 hours of my life during which I had to walk with a cane, couldn’t safely manage the stairs, couldn’t drive, could barely endure being a passenger in a moving vehicle, fell in the grocery store while reaching for a package of paper towels, sagged to my knees while trying to walk along the street beside Beverly, couldn’t write or sustain focus on reading, grew lightheaded when tree limbs moved in a breeze or swallows changed direction in flight. Through all that time I felt so disembodied, while also feeling trapped inside my body, that I believed I was losing myself hour by hour.

My vertigo had never been benign in any sense of the word; had never been paroxysmal, since it didn’t come and go; had never been a function of position; had involved more than simply vertigo; and had not been resolved by 207 repetitions of the Epley maneuver (nor by drinking ginger tea). As a result, we thought I might not have benign paroxysmal positional vertigo. My doctor agreed.

Unplugged

After weeks of intensive testing — during which I had electrodes stuck deep in my ears, I was barraged by piercing sounds and by air puffed into my ear canals, and I was subjected to jerking/tilting floor platforms and those crazy loop-the-loops on the Omniax chair — I was given the diagnosis of endolymphatic hydrops. This condition, a fluctuation of the volume and concentration of fluid in the inner ear, can occur as a result of infection, allergy, tumor, degeneration of the inner ear, head trauma or unknown causes. In my case, the neourotologist thought the cause was a viral endolabyrinthitis — a virus attacking my inner ear. He felt it might be a reactivation of some earlier virus in my system, most likely the herpes zoster I’d contracted in 2002, when I had chickenpox for the first time at age 55.

Since the neurotologist prescribed a potent antiviral drug, Valtrex, I wanted to consult my primary-care physician again before taking the medication. He was skeptical of the diagnosis. After all, besides vertigo I had none of the classic symptoms of endolymphatic hydrops. My symptoms didn’t fluctuate according to position or activity, I had no hearing loss, no ringing or buzzing or feeling of fullness in the ear.

Technology and medical science confirmed that I was dizzy. They still didn’t know quite why.

On Day 95, I consulted with the neurologist, who talked about strokes in the brain stem and tumors and said, “Let’s have a look, so we can rule things out.” On Day 97, I had an MRI of the brain. On Day 101, my 62nd birthday and the day before the neurologist was heading off for a vacation, he called to say there was no sign of anything worrisome, though there might be a slight area of contact between a blood vessel and nerves of the inner ear. He thought I was in no danger unless I fell, so I shouldn’t fall. We’d meet when he returned. He prescribed a tiny dose of Valium twice a day to dampen nerve response in case there was that contact with a blood vessel.

At 8:09 on the evening of Aug. 12, Day 138, Beverly and I were sitting on the couch in our living room. It had rained all day. I’d had my ninth acupuncture treatment the day before. I was reading, slowly, Willie Morris’s memoir about his friendship with James Jones, when there was a great burst of outward pressure inside my head. It plugged my ears. I dropped the book, opened my mouth wide, put both hands to my ears. In two seconds, the pressure reversed, vanished.

“Did something happen?” Beverly asked.

Delighted that I could still talk, move both arms and shift position on the couch, I said, “I don’t think it was a stroke.”

She looked at me for several seconds and smiled. “Stand up. I wonder if your vertigo is gone.”

I did. It was.

Twelve days later, when I told the neurologist what had happened and that, except for some residual lightheadedness, the symptoms hadn’t returned, he said, “You were in such bad vestibular shape. I’d like to take credit for this, but I don’t think I can.”

The vanishing, he felt, confirmed a theory he’d been considering: intracranial hypertension, a buildup of pressure inside my skull, brought on by a virus. A buildup of viral material in the spinal fluid plugged the holes through which the fluid normally drains. That led to a buildup of fluid and pressure, which caused the symptoms.

“So, it came unplugged on its own?”

“It’s a pretty elegant theory.” He smiled.

The symptoms haven’t returned. They’ve looked in on me occasionally, teasing — wooziness when I move my head quickly, lightheadedness when I look out the window or see great blue herons land in a swaying cottonwood tree — but that’s all. It’s been four years, eight months and 10 days.

Skloot’s most recent book is “Revertigo: An Off-Kilter Memoir.”

Vertigo

Symptoms

If you have vertigo, you may feel as though you are spinning, falling or tumbling in space, or standing still while your surroundings are moving.

Vertigo often begins suddenly and may vary in intensity. It may be constant or it may come and go.

Vertigo or giddiness is often mistaken for light-headedness or dizziness. Light-headedness is a feeling that you are going to lose consciousness or faint (pass out). This feeling isn’t caused by an inner ear problem but is due to a lack of oxygen flowing to the brain.

If you have vertigo it’s normal to feel out of control and frightened – but in most cases, the causes of vertigo aren’t a serious health threat.

If you have vertigo you may also have these symptoms:

  • nausea and vomiting
  • tinnitus or ringing in your ears
  • decreased hearing
  • ear pain.

Causes of vertigo

Some people with vertigo have a disorder of the nerve that ends in the part of the inner ear called the labyrinth or balance organ. There can also be problems with the balance organ itself such as:

  • build-up of fluid
  • infection
  • tumours.

One common cause is called benign positional vertigo (BPV). This is usually brief, and related either to infection or a loose object or matter moving inside the balance organ. The vertigo is worsened by changes in head position – such as standing from lying, or rolling over in bed.

Your doctor may show you some exercises that are designed to dislodge the loose object or matter. Antihistamine and anti-nausea medications may also help to relieve your symptoms.

Many cases of vertigo will resolve on their own.

Problems outside the inner ear can also cause vertigo. These include:

  • medications
  • injury to the brain
  • migraine, with or without headache.

When to see your doctor

Because there are many causes of vertigo in addition to inner ear problems, it’s important to find out what might be the cause in your case.

Vertigo may go away or reduce when the underlying cause is treated. In some cases surgical procedures may be a part of the treatment.

Call Healthline 0800 611 116 if you are unsure what you should do.

What are the Causes and Risk Factors for Vertigo?

Pin-pointing the cause of vertigo symptoms and what puts you at risk can help you and your doctor come up with an effective treatment plan.

Vertigo is caused by a variety of problems. Getty Images

Vertigo is a symptom of another underlying medical issue. Many different conditions are linked to vertigo.

Generally, vertigo is caused either by problems in the inner ear, known as peripheral vertigo, or problems in the brain or nervous system, known as central vertigo. Certain risk factors and other medical issues can also lead to episodes of vertigo.

Finding what’s causing your dizziness is important because it will determine your treatment options.

The Most Common Reasons People Get Vertigo

About 93 percent of all vertigo cases are caused by one of the following conditions: (1)

  • Benign Paroxysmal Positional Vertigo (BPPV) BPPV is the most common cause of vertigo. (2) It happens when small crystals break free and float inside the tubes of your inner ear, which are called semicircular canals. BPPV typically results in short episodes of vertigo that come on suddenly and last a few seconds to a few minutes. Certain head movements trigger episodes of vertigo in people with BPPV. Most of the time, doctors can’t identify exactly what causes BPPV, but it’s sometimes associated with a minor or severe blow to the head.
  • Labyrinthitis This condition, which is also referred to as “vestibular neuritis,” is characterized by irritation and swelling of the inner ear. It’s typically caused by an inner ear infection or virus. Sudden vertigo symptoms and hearing loss are common in people with labyrinthitis.
  • Meniere’s disease This disease is caused by excess fluid buildup in your inner ear. People with Meniere’s often experience sudden, intense episodes of vertigo that last a long time. They may also have symptoms like ringing in the ears, hearing loss, or “plugged” ears. Doctors aren’t sure exactly what causes Meniere’s disease, but it’s linked to viral infections of the inner ear, allergies, and head injuries. Hereditary factors are also thought to play a role.

Less Common Reasons People May Get Vertigo

Other causes of vertigo may include:

  • Cholesteatoma This condition is characterized by irregular skin growth in the middle ear, behind the eardrum. It can be brought on by repeated, chronic ear infections.
  • Otosclerosis Otosclerosis causes abnormal bone growth in the middle ear that can result in hearing loss.
  • Stroke A blood clot or bleeding in the brain — otherwise known as a stroke — can cause symptoms of vertigo.
  • Perilymphatic Fistula With this condition, an abnormal connection (usually a tear or defect) between the middle ear and the inner ear allows fluid to leak into the middle ear.
  • Acoustic neuroma This is a noncancerous tumor that develops on the main nerve leading from your inner ear to your brain.
  • Multiple sclerosis (MS) Many people with the neurological disease known as MS experience vertigo episodes at some point.
  • Parkinson’s Disease Parkinson’s can affect movement and balance. People with this disease may also experience vertigo.
  • Migraine About 40 percent of people who have migraines also have problems with dizziness or balance at some time. (3) There’s even a condition known as “migraine-associated vertigo.”
  • Diabetes Sometimes, complications from diabetes can cause hardening of the arteries and less blood flow to the brain, which leads to vertigo symptoms.
  • Pregnancy Dizziness and vertigo may crop up during pregnancy due to hormone changes, low blood sugar levels, pressure on blood vessels caused by an expanding uterus, or the baby pressing on a vein that carries blood to the heart.
  • Chiari Malformation This condition, where brain tissue extends into the spinal canal, can cause symptoms of vertigo.
  • Syphilis This sexually-transmitted infection (STI) can lead to hearing loss and dizziness.
  • Anxiety Disorders Anxiety and panic attacks may cause people to feel symptoms of vertigo. Stress can also worsen the condition.
  • Brain Tumor A tumor in an area of the brain called the cerebellum can cause vertigo symptoms.
  • Air Pressure Changes Pressure differences between the middle ear cavities are commonly experienced when flying or diving underwater. This can cause a condition called alternobaric vertigo.
  • Allergies Some people have dizziness or vertigo attacks when they’re exposed to certain allergens, such as dust, molds, pollens, dander, or foods.
  • Medication Dizziness and vertigo are sometimes side effects of medicines. Anti-seizure drugs, antidepressants, sedatives, blood pressure meds, and tranquilizers are common culprits.

Related: MS and Vertigo: When the Earth Moves, but Not in a Good Way

Head and Neck Injuries May Cause Vertigo

About 5 percent of the population suffers from a head injury each year, according to the American Hearing Research Foundation. (4)

These injuries can damage the inner ear and lead to vertigo, which is often referred to as “post-traumatic vertigo.” People with head injuries who experience vertigo might have symptoms like dizziness, headaches, hearing changes, pain, balance problems, and even mental disturbances.

Cervical vertigo happens after a severe neck injury. While experts agree that this condition exists, there’s debate over how often it occurs.

When Doctors Can’t Find the Cause for Vertigo

Sometimes, doctors aren’t able to identify a specific source for vertigo symptoms. For instance, there’s often no known trigger for BPPV.

While not knowing exactly what’s causing your vertigo symptoms can be frustrating, it doesn’t mean that you can’t get proper treatment and care. Your healthcare provider will help you find ways to control your episodes, even if a cause isn’t identified.

Some Factors Put You at Increased Risk for Vertigo

Anyone can develop vertigo symptoms, but certain risk factors might raise your chances. These include:

  • Being over age 50
  • Being a woman
  • Suffering a head injury
  • Taking certain drugs, especially antidepressants or antipsychotics
  • Having any medical condition that affects balance or your ears
  • Experiencing a previous episode of vertigo
  • Having a family member who has vertigo
  • Having an inner ear infection
  • Experiencing high levels of stress
  • Drinking alcohol

Having these risk factors doesn’t mean you will develop vertigo — they just put you at an increased risk for the condition.

Vertigo From Indoor Mold Exposure

Make sure you let your doctor know about all the symptoms you are experiencing and what makes your lightheadedness better and what makes it worse. Also tell your doctor if you’ve been exposed to mold.

Mold in corner of bathroom

Treatment for Vertigo

The recommended treatment will depend on what your doctor determines is causing you to feel dizzy. Sometimes it simply goes away on its own as the cause of the problem resolves or the brain adapts. In other cases, medication may be needed or you may be referred to a physical therapist for a special type of physical therapy called vestibular rehabilitation.

If a mold-related infection is making you feel dizzy, you may need antifungal medication, antibiotics, or other medications for the infection. In addition, you’ll need to arrange for the mold to be removed from your home so that you won’t continue to get sick from exposure.

For Help with Mold Removal

Mold removal will be an important part of your treatment if mold is causing you to feel dizzy. If you are experiencing mold-related health problems, doctors often recommend against attempting to remove mold on your own because doing so will further expose you to the substance that is making you sick. We suggest scheduling a free consultation with a mold removal professional, who will visit your home, inspect the mold growth there, and advise you about the work that needs to be done. Even if you opt to do the work yourself, you can benefit from some valuable advice about the job, including safety tips. To find experienced mold removal professionals offering free consultations in your area, just follow the link.

Return From Vertigo To Our Main Symptoms Page

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Ref:
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Vertigo & Dizziness

http://www.webmd.com/hw/balance_disorders/hw205519.asp?printing=true

Googling ”vertigo” and ”maneuver” will bring up quite a few of these maneuvers, each with a different name. The idea of the maneuvers is to get the loose crystals to travel through the inner ear to a place where they won’t cause any more trouble. Good luck to your husband! anon

Your husband, & you, have my understanding & sympathy. I had the same symptoms for over four years. Here’s what worked for me. As you will see, I needed attention to a variety of issues. // 1. Both acupuncture treatments & Feldenkrais classes helped abate the symptoms. // 2. Four years after the vertigo began, my new ENT doc referred me to physical therapy to determine if my vertigo was caused by displaced ear crystals (Halpike-Dix test).

The test was positive & the treatment (Epley Maneuver) worked. It took several weekly treatments before I completely stabilized; subsequently I was able to deal with vertigo onset by doing exercises the PT taught me. // 3. Even after she had correctly diagnosed & treated the crystal displacement, she could induce vertigo in some positions; plus I had frequent headaches. She observed that I carried my shoulders & head slumped slightly forward & explained that the resulting tension in my neck muscles was causing the headache as well as compressing the channel through which some major nerve passes. She showed me how to balance my head on my neck & taught me simple exercises. Bingo. No more headaches & no more vertigo! // If you need a very discerning physical therapist, I recommend Deena Levy. She’s worked with vertigo & has seen things work & not work for a variety of people. She practices near downtown Berkeley; 510.510.7816 or moveeasy speakeasy.org. // 4. I discovered last year I’m allergic to wheat. When I stopped eating it, my persistent nausea stopped. I still had the vertigo but what a relief. If you want to explore food allergies, you might call naturopathic doc Clare Garcia. For a remarkably low cost, she can get you tested for allergies to a hundred or so foods. She practices on Piedmont Ave in Oakland; 510.410.1087 or www.drclare.com. I got a new lease on life from her treatments for a hormone imbalance & lethargy. // 5. Notice whether your husband is despairing about finding solutions. After two years of vertigo, I was severely depressed & went on an anti-depressant. As I felt better, I had the energy & mental clarity to pursue things that together have made all the difference in my healing. // Best wishes to you both ann

I think your husband should keep a record of every time he gets the headaches and dizziness and write down a description of when it happens, if anything helps or make the symptoms worse, and any other relevant features. Describe the dizziness; is he light headed or is the room spinning? Does he have sensitivity to light or headaches with these symptoms? He should ask his doctor for a referral to a neurologist. Randall Starkey and associates are an excellent neurology practice, Judy I had a recurring problem with vertigo that I think was similar to your husband’s for many years, but haven’t had it for many years. Mine could come on at any time, sometimes for just a few hours, sometimes for days. It was very very unpleasant to say the least.

My doctor at the time (a GP, not an ENT) told me it was a benign condition in the ear (I can’t remember what), and suggested that I take Meclizine when it bothered me.

Meclizine is sold OTC as Bonine for motion sickness and is very sedating, but I found that just a tiny bit worked great for me.

I don’t know why the problem went away, and it’s been so long that I can’t give you a connection with anything else in my life, but, thankfully, it did stop anon

I didn’t see your original post and I know you have had many responses about your husband. But I wanted to let you know that some people experience dizziness and nausea together as the ”aura” before a seizure. My husband was experiencing those symptoms for 2-3 weeks before he had a seizure. He hadn’t even talked about those symptoms because he thought he was just tired. As soon as he was put on anti-seizure meds, he did not experience those things any longer. I’m not saying your husband has the same condition, but if he has ever had seizures before, even long ago, it might be worth mentioning to a neurologist. Anon

Dr Diego Kaski, neuro-otologist at London’s Charing Cross hospital, says vertigo creates the illusion of movement. Normally, the brain recognises that you are moving by integrating signals from your eyes, inner ear and receptors that sense body movement in the neck and limbs. But in true vertigo, you feel as though you are standing still while the world moves around you.

What causes it?

Vertigo is often attributed to an inner ear infection called vestibular neuritis that starts after a cold and can last for up to a couple of weeks. But Kaski says vertigo is often mislabelled as this when in fact benign paroxysmal positional vertigo (BBPV), and vestibular migraine are the more common and likely culprits.

BPPV is a mechanical problem of the inner ear. We have crystals inside the inner-ear balance organs that move when we do, but if the signals lag behind those emitted from the eyes and limbs, it creates an illusion of movement. In vertigo, the inner-ear signals cause jerky, uncoordinated eye movements, known as nystagmus, which conflict with the brain’s other movement signals. The repeated attacks usually last less than 30 seconds, and are precipitated by head movements including rolling over in bed or looking up.

It could be a migraine

One in 10 people with migraines get bouts of vertigo which come and go, that don’t necessarily coincide with the more typical symptoms of a headache and can last from a few seconds to a few days. These people may be hypersensitive to light, noise and smells. The treatment is the same as managing migraine headaches: try to identify and avoid triggers, short-term painkillers and anti-sickness medication and long-term preventive treatments such as beta blockers.

How do I treat vertigo?

It depends on the cause. Medical advice for vestibular neuritis is to avoid bed rest and get back to normal life as quickly as possible. This kick-starts the brain into compensating for the vertigo so it doesn’t become a long-term problem. BPPV can be cured by head movement exercises (for example, the Epley manoeuvre or Brandt-Daroff exercises) that reset the inner-ear organ of balance. Kaski is exploring novel ways of delivering this treatment using virtual reality glasses and a mobile phone app. You will be guided through the exercises without having to wait months for an appointment with a trained physiotherapist. Drug treatment of BPPV doesn’t work very well, according to Kaski. Prochlorperazine is good for nausea, but Betahistine, often prescribed by GPs, doesn’t help much at the doses that are given.

Kaski is interested in non-invasive brain stimulation. An electrical coil is placed over the head overlying the part of the brain – the parietal lobe – that processes balance. Modifying the electrical activity in this may relieve vertigo.

Can it be caused by stress?

There is certainly a link to stress; animals, including us, rely on signals about movement of predators and prey to survive. Illusions of movement activate the autonomic nervous system, which includes an adrenaline-fuelled fight-or-flight reaction. The extra adrenaline can cause unpleasant symptoms such as palpitations and anxiety. Conversely, anxiety itself can cause unsteadiness; people say it feels as if the world is moving under their feet.

Why do some people get vertigo more than others?

Some people are prone to vertigo because they are more visually dependent than others. This group will think they are moving because the signal from their eyes isn’t being integrated with the information from their body. We all experience this to a certain extent; when you are sitting on a train and it pulls out slowly from the station, it can be hard to know what’s moving.

What else could it be?

Meniere’s disease is a rare condition that affects the inner ear. It causes sudden attacks of vertigo lasting two to three hours, with ringing in the ears (tinnitus) and progressive hearing loss. Harris says further investigations, scan and consultations are important if there are any red-flag symptoms suggesting more serious underlying disease. These rare but potentially dangerous conditions include head injuries, strokes, multiple sclerosis, acoustic neuromas (benign growths on the nerve in the inner ear) and brain tumours.

What is the relationship between stress and vertigo?

In our practice we see many patients with vertigo. They are often referred for a VNG, or balance test. Many of them have a viral infection of the inner ear that results in dizziness that will resolve itself in a few months. Some of them have benign positional vertigo that will go away with a simple procedure to reposition the little stone in their ear that has gone astray. Some patients have chronic difficulties that are more of a mystery.

A substantial part of any VNG is the interview. We talk with patients about the history of their balance problems and their stress level. We ask whether or not they perceive they have difficulty with feeling anxious. While these might seem to be questions out of left field, they are not. Furman and Jacob lay out a series of links between anxiety and vertigo. To adequately assist dizzy patients we use these links to understand the role of anxiety and how it influences sensations of dizziness.

The first link is that of dizziness cause purely by anxiety due to hyperventilation-induced vertigo during panic attacks or near panic attacks. When one feels anxiety, breathing becomes shallow and rapid, reducing the oxygen available in the bloodstream. This causes a sensation of lightheadedness. This lightheadedness is noted by the individual as a source of concern, which causes more rapid and shallow breathing and the cycle spirals down to a full blown attack of dizziness and possibly panic.

The second link is a chance occurrence of anxiety and vertigo in the same patient. Anxiety may not contribute to the presence of vertigo in any significant way.

The third link relates to problematic coping skills with balance symptoms. On the most basic level, if one has a prolonged dizzy attack it is a very bad experience. The next time that sensation presents itself, it is natural to respond with fear that it will be as bad as last time. This response is rational and to be expected. One can be the calmest soul in the world and the presence of vertigo in your life can make you anxious. Support and understanding can help to relieve some of this stress.

The fourth link provides psychological explanations for the relationship between anxiety and vertigo. This refers back to the fixation of some patients on body sensation. If hyperventilation leads to slight dizziness, the tendency to fixate on the sensation will cause it to become more prominent both in the mind and in reality as a result of hyperventilation.

Finally there is the neurological linkage that focuses on the overlap in the circuitry of our brains involved in balance disorders and anxiety disorders. In a study by CD Balaban and JF Thayer published in the Journal of Anxiety Disorders in 2001, a review of scientific literature revealed a relationship based on shared pathways that control vestibular function and somatic and visceral sensory information processing. This means that the parts of your brain that help you interpret incoming balance information from your vestibule, a part of the cochlea, also process information that appears to be involved in avoidance, anxiety and conditioned fear. One can be forgiven for thinking that this is not nature’s most perfect design.

Researchers have indicated that chronic subjective dizziness is consistent with advancing research on anxiety and somatoform illness and offers greater insights into the relationships between neuro-otologic illness (tinnitus, hyperacusis and balance disorder) and anxiety.

When you come to us for a balance assessment, we will be thinking of you as a whole person with balance problems. You are not just a pair of ears. To help your doctor help you, we always keep in mind these important links between the mind and the ear.

If you would like a list of citations, please leave a comment and I will forward it to you. Thanks for reading.

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