What to do when vertigo knocks you off balance

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Once you've experienced it you don't forget it, vertigo that is. Vertigo is a symptom of a balance disorder and it is most typically felt as brief, intense movement in the head or in many cases felt as "the spins" upon movement. It's a symptom that can increase with age.

"Vertigo is a symptom, not a diagnosis," says Dr. Robert Battista, of the Ear Institute of Chicago in Hinsdale and assistant professor of Otolaryngology at Northwestern University Medical School. "Vertigo is the hallucination of movement. So, some people describe the symptom of vertigo as if things around them are moving, or when walking, the floor seems to shift under their feet. It is also described as a feeling of movement inside their head."

Balance disorders that bring on vertigo can be caused by a number of things, according to the National Institutes of Health website: (nidcd.nih.gov). Medical causes include viral or bacterial infections in the ear, a head injury, or blood circulation disorders that affect the inner ear or brain.

"The causes of vertigo due to inner ear conditions include: benign positional vertigo, Meniere's disease and vestibular neuritis (irritation and swelling of the inner ear)," says Battista. "Neurological causes of vertigo include migraine and stroke. Of these conditions, benign positional vertigo and migraine are by far the most common causes of vertigo."

The NIH describes benign paroxysmal positional vertigo or BPPV as a brief, intense episode of vertigo that occurs because of a specific change in the position of the head. Sufferers feel as if they are spinning when they look for an object on a high or low shelf or turn their head to look over their shoulder, such as when backing up a car. Commonly, people also feel this when rolling over in bed. The spinning sense may last for 10 to 20 seconds, and depending on severity can also lead to nausea.

 

Loose crystals

BPPV is caused when otoconia (tiny calcium fragments or crystals) break off in one ear from the inside lining of the vestibule, the larger fluid filled chamber that is part of the inner ear. The problem occurs if a fragment gets into one of the semicircular canals which sense movement of your head. Conflicting messages are sent to the brain about the position of the head. The extra messages from the affected ear conflict with the normal messages from the other ear. The brain becomes confused and reacts to cause the vertigo symptom.

BPPV sometimes may result from a head injury or just from getting older. Many people experience problems with their sense of balance as they get older. Balance problems and dizziness also can result from taking certain medications.

"Vertigo can occur in any age group, but the incidence is higher in older adults," says Battista. "Of the conditions I discussed, men and women are affected equally except for migraine. Migraine is twice as likely in women than men. The cause of migraine is not known, but there is believed to be some hormonal basis, which may explain the difference in incidence between women and men."

 

Diagnosis, treatment, prevention

A visit to your physician is the best way to diagnose dizziness or vertigo. The first thing a doctor will do is determine whether your vertigo is caused by a medical condition or medication. If it is, your doctor will treat the condition or suggest a different medication. Battista says treatments vary from oral medications, physical therapy to surgery.

To diagnose BPPV, during an examination a doctor will check for symptoms of dizziness that are prompted by eye or head movements that decrease quickly, in less than a minute, as well as symptoms that occur with specific eye movements when you lie on your back and turn your head to one side.

In the case of BPPV, your doctor may instruct you on physical therapy called the Epley Maneuver, simple movements that can help train the otoconia to settle back in the vestibule, relieving symptoms. BPPV often goes away on its own after several weeks or months without any treatment. The otoconia are thought to either dissolve or move to a place in the labyrinth where they cause no symptoms.

Since the causes for vertigo are broad, so is prevention.

"There are multiple medical/surgical treatments to prevent vertigo in Meniere's disease," says Battista. "There are also several medications used for prophylaxis to prevent dizziness in migraine," he adds. For benign positional vertigo, surgery is an option but only in cases that do not respond to more conservative treatment. Otherwise, there are no treatments to prevent vertigo, Battista says.

Copyright © 2014, Los Angeles Times
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