Vertigo

Vertigo is a condition caused by abnormal perception of body movement. It may present as the sensation that the person is moving when stationary or that the environment is spinning. Patients often describe it as seeing the surroundings tilt or spin, or feeling themselves spin in circles, even while remaining still. This can lead to imbalance or exaggerated perception of movement. The symptom is usually due to dysfunction in the vestibular system in the inner ear.

Vertigo is commonly accompanied by nausea, vomiting, pallor, and sweating. The intensity may range from mild to severe and can be acute, chronic, or recurrent. A similar but distinct condition is dizziness, which involves confusion or lightheadedness and may result from issues outside the vestibular system, such as neurological or psychological causes.

Prevention

• Move your head slowly and cautiously during daily activities.

• Use two or more pillows to elevate your head when sleeping.

• Rise slowly from bed, and sit on the edge for a moment before standing.

• Stay hydrated, eat healthy, get enough sleep, and manage stress.

• Avoid caffeine, alcohol, and smoking as they can worsen vertigo.

Self-Management

• Sit or lie down immediately when feeling dizzy. Close your eyes and rest in a quiet, dark room.

• Avoid rapid movements. Use mobility aids like a cane if necessary.

• Relaxation can help, as anxiety and stress may exacerbate vertigo.

When to See a Doctor

If vertigo is sudden, intense, recurrent, or accompanied by:

• Severe and sudden headache

• Difficulty breathing

• Chest pain or tightness

• Weakness in the arms or legs

• Visual disturbances or vision loss

• Confusion or slurred speech

• Irregular or rapid heartbeat

• Seizures

Treatment Options

1. Antivertigo Drugs

• Antihistamines such as betahistine, cinnarizine, cyclizine, dimenhydrinate, diphenhydramine, meclizine, and promethazine are the main treatments. They act on the inner ear and central nervous system and are effective for acute episodes.

• Histamine analogues like betahistine promote vasodilation via histamine receptors and can be used for Meniere’s disease. Side effects may include headache and stomach discomfort.

• For Meniere’s disease, other medications like prochlorperazine may be used. It inhibits dopamine receptors in the brain’s trigger zone, reducing nausea and vomiting. Low-sodium diets are often recommended. Anti-nausea drugs may also be needed for peripheral vertigo with severe nausea.

2. Anxiolytics

• Benzodiazepines (e.g., clonazepam, diazepam, lorazepam) may reduce vertigo severity in Meniere's disease or vestibular neuritis. These should be used in low doses to avoid dependency.

• Common side effects: drowsiness, confusion, and unsteady or clumsy movements.

3. Peripheral Vasodilators & Cerebral Activators

• Flunarizine and nicergoline may be used in certain vertigo cases to improve circulation.

4. Supplements

• Ginkgo biloba extract is sometimes used to treat vascular-related dizziness and vertigo. Caution is advised in patients taking antiplatelet agents (e.g., aspirin <500 mg/day) or anticoagulants (e.g., warfarin, dabigatran, rivaroxaban, apixaban) due to increased bleeding risk.

5. Canalith Repositioning Maneuvers

• Used for Benign Paroxysmal Positional Vertigo (BPPV), these maneuvers help shift displaced crystals in the inner ear to less sensitive areas:
  • Epley maneuver involves head repositioning to move particles.
  • Semont maneuver involves rapidly shifting body position from one side to the other.
  • Brandt-Daroff exercises can be used at home, often for BPPV or vestibular neuritis.

6. Surgical Option

• Canal plugging may be considered when BPPV symptoms persist for more than a year.

7. Vestibular Rehabilitation

• A form of physical therapy used for vertigo due to acute vestibular neuritis. Physical therapists guide patients in exercises that they can later perform at home.

8. Lifestyle Adjustments

• Reducing salt intake can benefit those with Meniere’s disease.