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Vertigo

NHS Direct Online Health Encyclopaedia

 

Introduction

Vertigo is the sensation of spinning even when you are standing completely still. Your surroundings appear to be moving either vertically or horizontally. Some people feel that they are actually spinning. The effect may be slight and only just noticeable, or it may be so severe that you fall to the ground.

Vertigo is more severe than dizziness, which is often experienced as a feeling of light-headedness when you stand up. Vertigo can make moving around difficult, as the sensation of spinning affects your balance.

Vertigo is often confused with a fear of heights. However, the dizzy feeling when you look down from a high place is not the same as vertigo, which can occur at any time, and may last for many years.

Mild vertigo is very common, and symptoms are not serious. However, recurrent or persistent vertigo could be caused by an underlying condition. You should see your GP to rule out a more serious cause and to get treatment.

Symptoms

Vertigo can develop suddenly and last for just a few minutes, or it may occur on and off for a number of days. For some people with severe vertigo, the symptoms may be constant for several days, and can make normal life difficult.

Symptoms of vertigo vary in severity and may include the following:

  • a feeling your surroundings are moving or spinning,
  • nausea,
  • vomiting,
  • difficulty in standing or walking,
  • the sensation of light-headedness,
  • the sensation of not being able to keep up with what you are looking at, and
  • the sensation that the floor is moving.

Causes

Vertigo is most commonly caused by a problem with the balancing mechanism in the inner ear. This is a coiled tube of fluid that lies behind the eardrum called the labyrinth. Viral infections such as a common cold or flu can spread to the labyrinth (labyrinthitis). Less commonly, labyrinthitis is caused by a bacterial infection of the middle ear (otitis media). Vertigo caused by an ear infection usually starts suddenly, and may be accompanied by painful ear and high temperature.

Short but recurrent attacks of vertigo are often caused by benign positional vertigo. This type of vertigo may also follow a viral infection, or can develop following inflammation or damage to the middle ear. It commonly affects older people, and can be brought on by a sudden movement of the head, such as turning rapidly. Attacks are usually very short-lived, and may last only a few seconds, but they can be confusing and disorientating.

Vertigo can also occur because of:

  • Arthritis in the neck - this disorder is usually confined to older people, and can be brought on when the head is turned or tilted.
  • Migraines - particularly if your headaches are severe or if you have a family history of migraine.
  • Poor circulation - may lead to vertigo if insufficient blood reaches the part of the brain that controls balance.
  • Motion sickness and over-breathing (hyperventilation).
  • Alcohol and certain drugs.

More severe vertigo may indicate a disorder of the balancing mechanisms in the inner ears, such as Ménière's disease. This condition has the associated symptoms of tinnitus (ringing in the ears) and difficulty with hearing. People with Ménière’s disease can have attacks of vertigo that last up to twelve hours, often causing vomiting and leaving them completely exhausted.

Rare causes of vertigo include stroke or multiple sclerosis or a tumour affecting the nerve connecting the middle ear to the brain. However, these conditions are usually accompanied by other symptoms such as difficulty with speech or vision, and should always be checked out by a doctor.

Vertigo can sometimes develop after a head injury. It is important to consult your GP straightaway if this happens.

Diagnosis

Your GP will diagnose vertigo from a description of the symptoms. An examination of your ears, eye movements and nervous system may be necessary to find out the cause.

If your vertigo is severe or ongoing, it may be necessary to conduct more specific tests. Your GP can carry out some tests in the surgery, such as a provocation test. This involves putting your head in certain positions to bring on the dizziness, and is used to diagnose benign positional vertigo. Another simple test is to stand still and close your eyes. If your balance is affected, it may indicate a middle ear problem.

Your GP may conduct a caloric test, in which air at different temperatures is blown into the ear to check that the inner ear is working correctly. If arthritis of the neck is suspected, your neck may be X-rayed. If you also have tinnitus, you may be advised to have a CT or MRI scan of the brain to rule out a brain tumour.

Treatment

Treatment of vertigo depends on the cause and severity of the symptoms.

Vertigo that is a symptom of earache is usually quite mild and will disappear when the earache clears up. However, if you have severe vertigo or vomiting, you may need medication. Antibiotics will often be prescribed for a bacterial infection in the ear.

If labyrinthitis is causing the vertigo, you may be advised to lie quietly in a darkened room to ease the nausea and sensation of spinning. Labyrinthitis often clears up of its own accord, but you may need antibiotics if it caused by a bacterial infection.

Vertigo is often made worse when you travel, so antiemetic drugs may be prescribed for car journeys, aircraft flights or sea cruises. Antiemetic drugs are used to treat nausea by suppressing signals from the part of the brain that triggers vomiting. They are useful if vertigo is brought on by motion sickness, migraine, inner ear disorders and labyrinthitis. If your vertigo is caused by poor circulation, taking small doses of aspirin can help.

Vertigo can also be a symptom of the more serious Ménière’s disease. This may also be treated with antiemetic drugs to relieve nausea, along with antihistamine to reduce the frequency of the attacks of vertigo. During an attack, it may be helpful to lie still and avoid noise. Trying to avoid stress may ease the symptoms, as can a low-salt diet.

Vestibular Rehabilitation is an effective treatment for common vertigo. Vestibular Rehabilitation is an exercise programme that can help you with your symptoms of dizziness and problems with balance.
The programme may include balance activities and eye movement exercises and will be tailored to your own symptoms.
You will be asked to exercise daily at home and after a number of sessions with a therapist who will teach you the exercises.

Occasionally, surgery may be carried out to remove additional fluid in the middle ear. In cases of very severe vertigo, such as in Ménière’s disease, an operation to cut the nerve between part of the inner ear and the brain may be recommended. However, this is a last resort, as the operation can cause hearing loss in the treated ear.

Occasionally, vertigo may be treated with a technique called the Epley manoeuvre. This is a procedure in which your head is moved into four different postures, and each posture is held for about half a minute. However, there is not much evidence to support this technique as a long-term cure.

Prevention

The following self-help techniques may relive or prevent the symptoms of vertigo:

  • Sleep with your head slightly elevated on two or more pillows.
  • In the morning, get up slowly and sit on the edge of the bed for a minute before standing.
  • Avoid bending down to pick up items.
  • Avoid extending your neck, for example, while reaching up to a high shelf.
  • Move your head gently and slowly when at the dentist, hairdresser, or during activities where your head is lying flat (horizontal) or the neck is extended.

Glossary

Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Brain
The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
MRI
MRI stands for magnetic resonance imaging. It is the use of magnets and radio waves to take detailed pictures of inside the body.
Benign
Benign refers to a condition that should not become life-threatening. In relation to tumours, benign means not cancerous.
High temperature
A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37°C (98.6°F).
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Vomit
Vomiting is when you bring up the contents of your stomach through your mouth.
Nausea
Nausea is when you feel like you are going to be sick.
Antibiotic
Antibiotic s are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.
Antiemetic
Antiemetic medicine is used to prevent or control vomiting. For example metoclopramide, cyclizine.
Antihistamine
Antihistamine medicine counteracts the action of histamine (a chemical released during an allergic reaction). For example loratadine, hydroxyzine.
Dose
Dose is a measured quantity of a medicine to be taken at any one time, such as a specified amount of medication

© Queen's Printer and Controller of HMSO, 2005

Crown copyright material is reproduced with the permission of the controller of HMSO and the Queens Printer for Scotland

 

 

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