Vertigo

Vertigo is not a condition as such, but a symptom of other conditions that affect areas involved in regulating balance and space awareness in the inner ear (peripheral vertigo) or in specific parts of the brain (central vertigo).^[1] People affected often describe it as a spinning sensation of various intensities, which can start suddenly and last a few seconds, days, or longer. The term vertigo is often misused to describe the fear of heights, but the fear of heights, which is known as “acrophobia”, is actually unrelated to vertigo.

The main symptom of vertigo is a spinning sensation, in which people feel as if they or things around them were rotating despite being still. This is sometimes followed by nausea and vomiting.^[1]

Depending on the type of vertigo and its root cause, other signs and symptoms can occur:

• Ringing in the ears (tinnitus)
• Gradual partial or total hearing loss, in one or both ears
• Trouble focusing the eyes
• Instability, which can make it hard to stand or walk and can cause falls

Some signs and symptoms are specific to vertigo triggered by neurological problems in the brain (central vertigo) and include:

• Double vision (“diplopia”)
• Difficulty swallowing (“dysphagia”)
• Problems with keeping the eyes on track, or involuntary eye movements (“nystagmus”)
• Facial paralysis
• Slurred speech
• Limb weakness

Vertigo is a symptom of a wide range of medical conditions and problems involving the inner ear or brain, so there isn’t one single test, but rather a series of examinations and maneuvers to determine the triggering factors and whether it’s peripheral or central. Eyes, ears, and balance tests are usually performed first to identify other symptoms other than dizziness. To establish if it’s peripheral or central, a specialist can also perform head movements (e.g., Epley maneuver, Semont maneuver, Foster maneuver, Dix-Hallpike maneuver, and HINTS exam), some of which can also treat the symptoms. When the symptoms’ origins are unclear, an electroencephalogram (EEG), a head computed tomography (CT) scan, a magnetic resonance imaging (MRI) scan, electronystagmography (ENG), or a blood test may be requested.

If any central neurological problems are detected, they need to be treated immediately, but medical treatments vary depending on what is causing vertigo symptoms.

For the most common type of vertigo, benign paroxysmal positional vertigo (BPPV), a specialist will usually perform the Epley maneuver, a head movement used to reset the balance organs in the inner ear. Medications such as meclizine may help alleviate symptoms.

Antibiotics and vestibular rehabilitation training (VRT) are effective to treat vertigo caused by labyrinthitis (inflammation of the labyrinth, a part of the inner ear, due to an inner ear infection).

Medications such as prochlorperazine and antihistamines are often prescribed to manage symptoms of nausea and vomiting. Steroids and benzodiazepines may also help relieve symptoms for some people.

If vertigo is triggered by vestibular migraine, the doctor might also prescribe medications, such as triptans, to abort the root cause of vertigo at the onset of migraine symptoms.

Both riboflavin (vitamin B2) and coenzyme Q10 have shown positive results in reducing the frequency and intensity of migraine attacks, including vestibular migraine (VM), a type of migraine whose symptoms include vestibular symptoms such as vertigo.^[2]

Ginger can also be used for relieving nausea ^[3], although there are only a few studies looking into its potential for treating queasiness specifically caused by vertigo-related conditions.

Finally, various studies looked into the potential of supplementation with vitamin D and calcium to prevent BPPV from recurring, but the results are often inconsistent and conflicting; more research is needed.^[4]

Vertigo can be a symptom of several underlying conditions, which are not all affected in the same way by diet, so no generalization about diet and vertigo should be made. A very limited amount of research has been done into associations between diet and vertigo associated with certain causes.

When vertigo is caused by Ménière’s disease, dietary interventions, such as a low-salt, low-caffeine, low-alcohol diet, a gluten-free diet, or the introduction of specially processed cereals (SPC), are often considered. However, there is currently no agreement on their usefulness amongst clinicians, and further assessments will be needed to validate the use of these approaches.^[5][6]

For benign paroxysmal positional vertigo (BPPV), one study from 2015 showed a potential link between BPPV in the elderly and inadequate carbohydrate, fiber, and polyunsaturated fatty acids intake.^[7]

Other treatments will vary depending on the vertigo-related condition diagnosed.

At-home physical exercises to restore the sense of balance and strengthen muscles to prevent falls may be prescribed. Additionally, to prevent symptoms from worsening and to reduce their impact on daily life, the following actions are recommended at the first sign of a vertigo attack: stay still, avoid sudden position changes, rest as much as possible, and avoid bright lights and reading, as they may exacerbate the false sense of spinning and whirling.

Causes of peripheral vertigo include:^{[1][8][9][10][11]}

• Inner-ear problems, such as neuronitis or labyrinthitis, and Ménière’s disease
• Vestibular nerve problems, such as pressure on, or inflammation or infection of, the vestibular nerve
• Medications which have vertigo as a side effect, including some antibiotics, diuretics, salicylates and cisplatin
• Head injury affecting peripheral vestibular structures
• Benign paroxysmal positional vertigo (BPPV), the most common cause of peripheral vertigo

Causes of central vertigo include:

• Certain conditions, such as blood vessel disease or multiple sclerosis (MS)
• An inadequate blood supply to the brain, such as a stroke or a transient ischemic attack (TIA)
• Medications such as aspirin and anti-epileptic drugs (e.g., phenytoin, phenobarbital, and carbamazepine)
• Drinking alcohol
• Head injury affecting central vestibular structures
• Posterior fossa brain tumors^[12]
• Vestibular migraine