Vertigo is the feeling of a rocking or rotation when you are perfectly still. It tends to last for several hours or days. Medically, it is distinct from dizziness because it involves the sensation of movement. Vertigo is often due to a problem in the inner ear. An important part of the inner ear is the collection of semicircular canals. These structures are lined with cells that act like a gyroscope for the body and are responsible for providing feedback of our position.
Causes of Vertigo
There are a variety of causes for vertigo. The cause may be central or peripheral. Central causes occur in the spinal cord or brain, while peripheral causes are due to a problem with the inner ear. The most common cause of vertigo, however, is benign paroxysmal positional vertigo also known as BPPV. BPPV is a common disorder, and it can be very debilitating, confining sufferers to their homes in many cases. With BPPV, small crystals in the inner ear become displaced and can cause an irritation within the semicircular canals. With Meniere’s disease, there is a fluid buildup in the inner ear that can cause vertigo. Headaches, head injuries, strokes, tumors and multiple sclerosis can also cause vertigo. Head injuries definitely increase the risk factor for vertigo. In addition, antidepressants, aspirin, blood pressure medications and anti-seizure meds can also cause vertigo. For some, alcohol can cause vertigo.
Diagnosis and Treatment
To diagnose vertigo, a medical professional will take a full history of your symptoms and events. This includes previous medical issues, recent illnesses and medications. Then, a physical exam is performed. It includes a comprehensive neurological exam to check brain function. This allows for the determination of whether it’s peripheral or central. Signs of abnormal eye movement may pinpoint the problem. The Dix-Hallpike test or the roll test may be done. The Dix-Hallpike test repositions the head and monitors symptoms. With the roll test, the head is rapidly moved from side to side. A CT scan or MRI may be done to exclude structural problems. Sometimes, electronystagmography may be performed.
The most effective treatments if the vertigo is peripheral include partial repositioning movements. It’s known as the canalith repositioning procedure or the Epley maneuver. Specific head movements are performed to move the crystals in the inner ear. Cawthorne head exercises may also be performed. It’s a series of head and eye movements. This leads to decreased sensitivity of the nerves and improves vertigo. However, this needs to be done on a regular basis for optimal results. A trained physical therapist can perform these types of treatments. Keep in mind that medications may provide some relief but are not a cure. Meclizine is the most popular medication prescribed.
Unfortunately, many people suffer from BPPV either due to mis-diagnosis or improper treatment. Dizziness caused by BPPV typically occurs with changes in head positions, it usually lasts between 15-60 seconds, and it can be very severe, resulting in falls. Most people suffering with BPPV can report symptoms occurring when rolling over in bed or upon rising in the morning; but many can't recall a specific cause of their dizziness. Others report mild head trauma from a fall or car wreck, an ear infection, or having cold symptoms days prior to the onset of their symptoms. Also, BPPV does occur more frequently with age as most sufferers are between the ages of 60 and 80 years old; though younger adults do experience BPPV.
Most patients with peripheral vertigo can find substantial relief with treatment. Though BPPV can be very debilitating, the good news is that it is a condition that can be treated very quickly and effectively. At ELEVATE, our physical therapists are experts in treating dizziness caused by BPPV. Approximately 50% of all our patients have symptom resolution within 3 visits, while 95% are symptom free by week four. It's been our observation that the longer the symptoms have been going on, the longer it takes to treat; so don't wait! BPPV can be very debilitating, and it can cause frequent falls resulting in fractures or more serious injuries. If you or someone you know is suffering from the debilitating and, many times, dangerous effects of BPPV, call our office today. We can get you "back into life!"