What is it about ?
“Vertigo” comes from the Latin word vertere, which means to turn. Vertigo is the feeling that everything revolves around you. You may also have a sensation of spinning yourself, while you are lying down or sitting still. Vertigo is caused by a disorder of the vestibular organ, the organ whose function is to maintain balance. This small organ is located inside the ear. If it is not functioning well, the brain sends out faulty information about the position of the body in relation to the environment.
Vertigo can have different causes. The most common causes are:
- the benign paroxysmal positional vertigo (BPPV) ;
- Vestibular neuritis (inflammation of the vestibular nerve);
- The Ménière’s disease ;
- Tension in the neck;
- A drop in blood pressure when going from lying or sitting to standing (orthostatic hypotension);
- A panic attack with hyperventilation ;
- The aging process (changes in the brain, eyes, vestibular organs);
- Certain drugs or drug abuse.
Other causes are rarer:
- Multiple sclerosis, and in this case there are often also other neurological symptoms;
- Stroke;
- Heart rhythm disturbance;
- Other heart disease;
- Brain tumour.
About 1 in 10 times, there is no explanation.
In whom and how often does it occur?
Out of 1,000 consultations with the general practitioner, it is 7 times a question of vertigo. Women suffer from it twice as often as men. The frequency clearly increases with age.
How to recognize it?
Benign paroxysmal positional vertigo (BPPV)
Vertigo occurs in fits when the person moves their head. This often happens in the morning or at night. Vertigo may increase when the person leans back from a sitting position or when rolling over in bed. A BPPV attack does not last more than a few minutes.
Vestibular neuritis
Dizziness comes on suddenly. It is often accompanied by pallor, nausea and vomiting. In vestibular neuritis, the organ of balance, on the right or left side, suddenly stops working. We do not know the cause. It could be an infection of the inner ear. With this type of vertigo, the person often cannot do more than lie in bed with their eyes closed. Severe dizziness gradually goes away within 1 to 2 weeks. Slight balance problems persist longer. There is usually no recurrence.
Ménière’s disease
Large-scale, very disabling vertigo attacks that last a few minutes to a few hours (between 20 minutes and 12 hours). They are often accompanied by hearing loss (hearing loss) and ringing in the ears (tinnitus) or a feeling of a blocked ear. Sometimes there is also nausea and vomiting. After that, the person may still experience milder symptoms for a few days.
Vertigo can also be associated with other diseases or processes:
- Hyperventilation with dizziness (panic) most often affects young people.
- Vertigo of cervical origin is due to muscle tension, with the neck muscles and shoulder muscles (deltoids) often strained.
- Dizziness associated with the aging process often results from a combination of various factors, such as impaired sensory perception, blood flow, blood pressure control, and medication.
- Dizziness can be caused by medications (hypotensive drugs, antiparkinson drugs, antidepressants, antiepileptics, sleeping pills and tranquilizers)
- Chronic alcohol consumption causes damage to the cerebellum, which is largely responsible for balance.
- In case of’transient ischemic attack (TIA), vertigo is accompanied by other symptoms, such as double vision, difficulty speaking, paralysis of the limbs …
- Acoustic neuroma is a slowly growing benign tumor that develops from the hearing and balance nerve. The main symptom is progressive hearing loss on one side. Ringing in the ears (tinnitus) may also occur, and the person has a hesitant step, but usually there is no dizziness.
- The first symptoms of multiple sclerosis (MS) are sometimes a feeling of dizziness and a hesitant step. Other neurological examinations allow the diagnosis.
- With hypertension, dizziness is worse in the morning and after meals.
- Heart rhythm disturbances may be accompanied by attacks of dizziness (non-rotating) and fainting (syncope).
How is the diagnosis made?
The doctor will ask you questions about vertigo:
- Is there a link between vertigo and particular situations, such as change in posture, turning your head, physical exertion?
- How long does vertigo last?
- What medications do you take ?
Your answers to these questions will help the doctor to clarify the nature of the vertigo.
Then the doctor will examine you: he will take your blood pressure, listen to your heart, check your eardrums and perform a neurological exam. He will also examine your neck. In some cases, the doctor will do a blood test and / or an EKG (recording of heart activity). In most cases, this will be sufficient to make the diagnosis.
The doctor may perform other examinations or refer you to an ENT specialist (otolaryngologist, nose, throat and ear doctor), a neurologist or a cardiologist.
What can you do ?
If this is your first time experiencing dizziness, try, if possible, to continue what you are doing. It is not necessary to lie down, and it is not even recommended. Your vestibular organ will recover faster if you don’t try to avoid seizures.
For the rest, the advice depends on the cause:
- In case of benign paroxysmal positional vertigo (BPPV), you can do exercises (Brandt-Daroff exercises) which make the vertigo disappear more quickly. Sit on the edge of the bed (center), and lie on your side. Once in bed, turn your head to look at the ceiling. Get up when the dizziness has passed. Lie on the other side and turn your head to look at the ceiling. Repeat this until the vertigo subsides. Do these exercises 3-5 times a day. These exercises cause dizziness, which makes it difficult at first to continue until the end.
- Dizziness from vestibular neuritis and those from Ménière’s disease are often so severe that bed rest is the only possibility at first. As soon as the vertigo subsides, you can try to resume your daily activities.
What can the doctor do?
Treatment depends on the cause of the vertigo:
- Acute dizziness accompanied by vomiting can be treated with medicines for nausea and vomiting.
- In Ménière’s disease, the most important thing is to understand the phenomenon. In addition to the explanations, you may be prescribed betahistine. There is, however, little scientific evidence for the effectiveness of this product.
- In the event of neck problems, physiotherapy and exercises can help.
- If the dizziness is associated with panic attacks, these will be taken care of first.
- In the event of dizziness that recurs regularly, it is important to improve balance control with training. Because a bad balance gives rise to reduced mobility and a limitation of physical activity, which affects the balance even more.
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