Vertigo

Vertigo is a symptom associated with the sensation of movement. It includes spinning, tilting and swaying. Vertigo is often described as a feeling that your surroundings are spinning around you.

It is estimated that each year, 1 in 10 people will experience vertigo or dizziness (Robinson 2016).

The primary cause of vertigo is an inner ear problem or condition, the most common of these being benign paroxysmal positional vertigo (BPPV).

Other causes of vertigo include vestibular neuronitis (inflammation of the vestibular nerve), Ménière's disease, head injuries, stroke, circulation problems and infections (Healthdirect 2017; Dommaraju et al. 2016).

The feeling of vertigo might be barely noticeable, or it might be so severe that a person finds it very difficult to keep their balance and carry out everyday tasks. ‘Attacks’ of vertigo can happen very suddenly or last a long time (NHS 2019).

Generally, vertigo is generally not considered serious except when it increases the risk of falls (Healthdirect 2017; Mayo Clinic 2018) or other at-risk settings, e.g. driving.

Most of the already listed causes of vertigo are benign, however, serious conditions such as multiple sclerosis, tumours and psychogenic causes must be considered, particularly in the case of older patients and/or patients with a high risk of vascular disease (Dommaraju et al. 2016).

Vertigo or Acrophobia?

The term ‘vertigo’ is often used incorrectly to describe a fear of heights (NHS 2019), this is a falsity perpetuated in popular media, most notably in Alfred Hitchcock’s classic 1958 film Vertigo. Hitchcock was able, however, to give audiences a fairly accurate sense of the unsettling feeling of vertigo through the use of the ‘dolly zoom’ camera (Johnson 2018).

‘Acrophobia’ is the medical term for a fear of heights and the dizzy feeling related to looking down from a very high place (NHS 2019).

What’s the Difference Between Dizziness and Vertigo?

Dizziness covers a broad range of experiences. It covers feelings of lightheadedness, feeling as though you might faint, and feeling unsteady on your feet. Dizziness can be related to many factors including cardiovascular or breathing pattern problems (Robinson 2016; Better Health Channel 2019).

Vertigo creates the illusion of movement. Normally, the brain identifies that you are moving by integrating signals from your eyes, inner ear and receptors that sense body movement in the neck and limbs (Robinson 2016). In a true case of vertigo, you feel as though the world moves around you even while you are standing still.

Vertigo is a common, distressing presentation in general practice and constitutes approximately 54% of cases of dizziness (Dommaraju et al. 2016).

Benign Paroxysmal Positional Vertigo

BPPV presents when minuscule calcium particles cluster together in the section of the inner ear that controls balance, affecting the messages sent from your inner ear to your brain (Healthdirect 2017). Crystals in our ears designed to move when we do, can be caused to move independent to signals emitted from the eyes and limbs, creating the false illusion of movement (Robinson 2016). Certain head movements will trigger BPPV such as looking up and rolling over while lying down (NHS 2019).

In vertigo, the inner-ear signals are responsible for jerky uncoordinated eye movements ‘nystagmus’. This conflicts with the brain’s other signals of movement. These repeated attacks tend to last less than 30 seconds (Robinson 2016).

Symptoms

Common symptoms of vertigo include:

• A ringing sound in the ears;
• Loss of balance;
• Nausea;
• Headaches and migraines; and
• Sweating.

(Healthdirect 2017; NHS 2019)

Risk Factors

Benign paroxysmal positional vertigo can occur at any age but is most common in people over the age of 50. BPPV is more common in women than in men.

A head injury or any disorder relating to the ear may make someone more at risk of BPPV (Mayo Clinic 2018).

People with migraines have roughly a 1 in 10 chance of experiencing a bout of vertigo that will come and go and can last for a few seconds to a few days. The treatment for this does not differ from that of treating migraines (Robinson 2016).

Treatment

Treatment must cater to the specific cause of vertigo. A physical examination to determine the cause will include neurological, cardiovascular, eye and ear examinations (Dommaraju et al. 2016).

• Vestibular rehabilitation: A type of physical therapy that may help to prevent recurrences.
• Exercise: Exercise prescribed by physiotherapists relating to eye moment; and balance stabilisation exercises.
• Canalith repositioning measures: A treatment that involves moving calcium deposits out of the ear canal to be absorbed by the body.
• Medicine: Motion sickness medication may relieve the symptoms of vertigo such as nausea. Antibiotics will treat a bacterial infection.
• Surgery: Surgery is only required in a few cases.

(Healthdirect 2017; Dommaraju et al. 2016)

Patients should be directed to a specialist if they have continuous vertigo, hearing loss, headaches or if the diagnosis is uncertain (Dommaraju et al. 2016).

Lifestyle changes are recommended to patients with vertigo, such as limiting alcohol and coffee consumption and restricting salt intake (Dommaraju et al. 2016).

The opening scene of Hitchcock's famous film, Vertigo

References

• Better Health Channel 2019, Dizziness and Vertigo, Better Health Channel, Melbourne, viewed 1 November 2019, https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/dizziness-and-vertigo
• Dommaraju, S & Perera, E 2016, ‘An Approach to Vertigo in General Practice’, Australian Family Physician, viewed 1 November 2019, https://www.racgp.org.au/afp/2016/april/an-approach-to-vertigo-in-general-practice/
• Healthdirect 2017, Vertigo, Healthdirect, Canberra, viewed 1 November 2019, https://www.healthdirect.gov.au/vertigo
• Jonhson, TL 2018, ‘13 Facts About Vertigo’, Mental Floss, viewed 4 November 2019, https://www.mentalfloss.com/article/548532/facts-about-vertigo
• Mayo Clinic 2018, Benign Paroxysmal Positional Vertigo (BPPV), Mayo Clinic, viewed 4 November 2019, https://www.mayoclinic.org/diseases-conditions/vertigo/symptoms-causes/syc-20370055
• NHS 2019, Vertigo, NHS Inform, viewed 1 November 2019, https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/vertigo
• Robinson, A 2016, ‘Everything You Ever Wanted to Know About Vertigo (but Were Too Dizzy to Ask)’, The Guardian, viewed 1 November 2019, https://www.theguardian.com/lifeandstyle/2016/may/29/vertigo-migraines-dizziness-ear-infection-health-guide

(Answers: c, b, b)