Vertigo Explained

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ON THE MORNING sixty-something development professional C.M. was heading from Philadelphia to Boston for a child’s high school graduation, she woke with a sensation of spinning inside her head. She recognized it from prior experiences: vertigo.  If she kept her head propped on pillows and remained still, it wasn’t too bad, but cars and airplanes, standing up and sitting down, would be unbearable.

The spinning that defines vertigo—that the head or the surrounding environment is spinning—is “the perception of motion when no movement is present, or the abnormal perception of motion in response to movement.”

Vertigo is unpleasant and disorienting—and dangerous if you try to drive or climb a ladder.  It’s not the same as dizziness—which usually lasts just seconds, while vertigo can persist—or fear of heights, although dizziness can accompany both vertigo and acrophobia.

The most common kind of vertigo is BPV, benign positional vertigo (or BPPV with the added P for paroxysmal, meaning sudden recurrence or intensification of symptoms, such as spasm).  Most cases of BPV resolve in a day or two, 80% end within a week; and 95% of patients recover fully.

BPV is usually idiopathic, meaning there’s no known cause, although it occurs more often in those over age 65 and twice as often in women as men. It may be linked to osteoporosis and family history. Lying on the back for a long time, such as in a dentist chair, can be a trigger.

BVP arises from a disturbance in crystals in the ear that monitor the body’s movement. Displacement of the crystals—composed of calcium carbonate and called otolith crystals or otoconia, also debris and “ear rocks”— from the inner ear into the semicircular canals can alter sensitivity to positional changes.

Vertigo can also start with a bacterial infection; an infection that inflames the inner ear (labyrinthitis) or the vestibular nerve (vestibular neuronitis); or Meniere’s disease, causing a buildup of fluid in the inner ear.

Or it can begin in the brain, with migraines or a tumor, or following head injury.  Persistent vertigo can be caused by—as well as independently be the cause of—mental health issues, such as depression and anxiety.

The “head impulse test” for vertigo involves trying to hold the gaze on an object (like the doctor’s nose) while moving the head quickly from side to side.  When the gaze shifts when moving the head to one side, that can help indicate which ear is affected. Rarely does vertigo affect both.

Indicative of vertigo and thus an aid in diagnosis are unusual eye movements called nystagmus that occur with rapid movement: from sitting to lying down, or with the additional rapid movement of the head to one side and then down (over the side of the bed or other support) below the level of the body.

Vertigo can disappear without treatment when the cause, such as viral infection, clears. Or when the body adapts by relying more on the other senses for balance—either naturally or with the help of vestibular rehabilitation.

To break up the displaced crystals, the series of movements is similar to that used to diagnose BPV. Called the Epley maneuver or canalith repositioning, in which each position is held for 30 seconds after symptoms cease but should be recommended and demonstrated at least initially by a physician.

Depending on the cause of vertigo, antihistamines or medications for seasickness or nausea can help with the discomfort.  Because even mild dehydration can trigger BPV, drinking water can help prevent attacks. On the other hand, decreasing fluids via diuretics can help reduce the inflammation that accompanies vestibular vertigo and Meniere’s disease.

Ginger as an all-around nausea-suppressant is on the home remedy list, along with ginkgo biloba, also almonds (perhaps because of their high Vitamin A, B and E content). BPPV can recur, most commonly in people who sleep on the affected side.  The best antidote can be adding a pillow under the head and/or using pillows or other props to prevent turning onto that side.

Chronic sufferers should move their bodies, and their heads in particular, slowly when changing position, especially when standing or reaching overhead.  In other words, the familiar advice: Move more mindfully.

—Mary Carpenter

Every Tuesday, well-being editor Mary Carpenter reports on health news you can use.