What is Vertigo?

According to research, five people in every thousand in the UK consult their GP every year due to vertigo. This makes it a very common ailment and symptom. It is believed that between 15% and 20% of adults experience dizziness at some point each year and 5% of these cases are attributed to vertigo. Women are two to three times more likely to experience this symptom too. So, what is vertigo and what causes it? Let’s find out.

What is vertigo?

Firstly, vertigo isn’t a medical condition in itself. Rather, it is a symptom. Similar to dizziness, vertigo is the sensation that you’re moving or spinning when you’re not. You could also feel that the room or environment is spinning or moving around you.

There are different degrees of vertigo. It might be only slightly noticeable and only last a matter of seconds, or it can be so severe that it makes daily life difficult. This can last several days or even weeks.

When you have vertigo, you also might lose your balance, be sick or feel sick and be dizzy.

What vertigo isn’t

Many people falsely believe that vertigo is a fear of heights or an unsteady feeling you get when you’re somewhere up high. This is false. A fear of heights is acrophobia. You can read more about it here.

What is vertigo caused by?

The most common cause of vertigo is a disruption in the inner ear and how balance works. It can, however, be caused by a problem in a part of the brain.

Depending on the cause of the vertigo, it might be known as central vertigo or peripheral vertigo.

Peripheral vertigo

This is the most common type of vertigo and is typically caused by the inner ear’s balance mechanisms not working well.

The most common reasons why peripheral vertigo happens is due to:

• BPPV – Benign paroxysmal positional vertigo – This is when certain head positions or movements trigger vertigo symptoms.
• Labyrinthitis.
• Head injury.
• Vestibular neuronitis – vestibular nerve inflammation. This nerve runs between the inner ear and the brain and sends messages to help control your balance.
• Ménière’s disease.
• Medication.

Let’s look at these causes in more detail below.

BPPV – Benign paroxysmal positional vertigo

BPPV is one of the most frequent causes of the symptoms of vertigo. This happens with certain head movements. It could happen from turning over in bed, crossing a road, bending over, or standing up.

BPPV means recurrent, short and intense vertigo attacks that last anywhere between a few seconds to a couple of minutes. Often, the person will have nausea but won’t actually vomit. It’s also common to have nystagmus – involuntary eye movements – briefly.

After an attack, it’s common to experience light-headedness or lose your balance. This can linger for a few hours after.

It is thought that this condition occurs due to small amounts of calcium carbonate crystals breaking from the channel lining in the inner ear. These fragments aren’t an issue unless they manage to get into the fluid-filled ear canals.

When the head isn’t moving, these fragments will be at the canal bottom. However, when the head moves in a certain way, they get swept along the canal, which confuses the brain signals, causing vertigo.

Typically, it is older people (those over 50) that experience this condition. It can happen on its own or it might happen after a person has had prolonged bed rest, a head injury, ear surgery, or an ear infection.

Head injury

After a head injury, people can often develop vertigo. If you’ve had a head injury and you get vertigo or dizziness, you should seek medical attention.

Labyrinthitis

The labyrinth is a structure located deep inside your ear. If you have an ear infection that causes this structure to become inflamed, you have labyrinthitis. As its name suggests, the structure is a maze of channels. These are filled with fluid and help to control your balance and hearing.

With labyrinthitis, your brain will receive different information from this side compared to what it’s experiencing on the other side and what it sees through the eyes. It is these conflicting signals that cause dizziness and vertigo.

Typically, labyrinthitis is caused by a virus-like flu or the common cold, but it can also be caused by a bacterial infection.

When vertigo is a result of labyrinthitis, you might also experience hearing loss, nausea and vomiting, ear pain, tinnitus and a high temperature.

Vestibular neuronitis

Also called vestibular neuritis, this is an inner ear problem causing inflammation to the nerve that connects the brain and the labyrinth. Sometimes the labyrinth is also inflamed. Like labyrinthitis, a viral infection is usually to blame.

This condition comes on quite suddenly and it is typically in conjunction with nausea, unsteadiness and vomiting. Unlike other causes, you usually don’t have any problems with hearing.

Vestibular neuronitis can last anywhere from a few hours to a few days. It can, however, take up to six weeks to be completely resolved.

Ménière’s disease

This is a rare condition affecting the inner ear. Ménière’s disease causes vertigo in addition to tinnitus, hearing loss and a feeling of pressure in the ear (aural fullness).

People with this condition often experience attacks that can last from a few hours to a few days. They will also often feel sick and vomit.

The cause of this condition isn’t known but many people try to control it with medication and diet. Rarely, surgery is used to treat it.

Medication

Some medications can have a side effect of vertigo. All medicine should come with a patient information leaflet so check to see if the possible side effects mention vertigo.

You shouldn’t stop taking your medication but you could consult a doctor to see if there is an alternative.

Central vertigo

Central vertigo is caused by a problem somewhere in your brain. This is most commonly the cerebellum (the bottom of your brain) or the brainstem (the lowest part that connects to your spinal cord).

Central vertigo is caused by the following:

• Migraines – A very severe headache that is most common in younger people. It is experienced as an intense throbbing on the side or front of your head.
• MS (multiple sclerosis) – A medical condition affecting the central nervous system, i.e., the spinal cord and brain.
• Acoustic neuroma – A benign and rare brain tumour growing on the acoustic nerve. This nerve helps control balance and hearing.
• A brain tumour located in the cerebellum (the bottom part of the brain).
• A stroke or TIA (transient ischaemic attack) – Where blood supply is cut off to the brain.
• Medication.

What is the prevalence of vertigo?

Both women and men are affected by vertigo but women are twice to three times more likely to develop the condition. Vertigo has some well-known comorbid conditions. These include cardiovascular disease and depression.

The prevalence of vertigo increases with age, but it varies depending on the cause and underlying diagnosis. Large, population-based studies have shown that dizziness (and vertigo included) affects from 15% to more than 20% of adults a year.

Vertigo accounts for around 25% of complaints of dizziness and has a 5% prevalence for 12 months, with a 1.4% annual incidence.

Who is more at risk of vertigo?

Anyone can have vertigo symptoms. However, certain factors can increase your chances of developing them.

These are:

• Being female.
• Being older than 50.
• Having a head injury.
• Taking medication like antipsychotics or antidepressants.
• Having had vertigo previously.
• Having a family member who has had vertigo.
• Getting an infection in the inner ear.
• Experiencing high stress.
• Drinking alcohol.

Even if all of these risk factors apply to you, it doesn’t mean you will get vertigo. These factors simply mean you have a higher chance of experiencing the symptoms.

Signs and symptoms of vertigo

Often, people who have had vertigo say it is like being dizzy. However, vertigo is much more than a dizzy feeling. With vertigo, you often feel as though everything is moving and it is often accompanied by other symptoms.

Here are some of the possible vertigo symptoms:

• Feeling like you’re spinning or floating.
• Dizziness.
• Losing your balance.
• Feeling woozy and light-headed.
• Nausea.
• Vomiting.
• Feeling like the floor or room is tilting.
• Feeling as though you’re ‘spaced out’.

When some people have vertigo symptoms, they also have other symptoms too, depending on what has caused the vertigo.

 This might include:

• Tinnitus (or ringing in the ears).
• Ear pain or pressure.
• Ear drainage.
• Double vision or vision loss.
• Hearing loss.

How does vertigo affect someone’s daily life?

Vertigo symptoms can have a significant impact on a person’s daily life both in terms of daily living and at work. It also impacts whether or not people can remain in their occupation after vertigo.

Vertigo impacts a person’s vocational and daily living activities in terms of their physical, cognitive and mental health needs.

The cognitive impairments associated with vertigo include difficulty in concentrating, thinking, processing and retaining information. The physical aspects affect their strength and balance. A person’s visual perceptions could also be affected.

Due to the debilitating nature of vertigo symptoms, a person’s mental health could be seriously affected. Vertigo can be extremely distressing for sufferers as it impacts all aspects of their life.

How is vertigo treated?

There are ways you can help alleviate your symptoms at home.

These include:

• Lying still in a dark, quiet room (this can help reduce the feeling of spinning).
• Make head movements slowly and carefully.
• Sit down as soon as you start to feel dizzy.
• Turn on lights if you wake up and get out of bed at night.
• Use a walking aid if you’re worried about falling.
• Sleep with a couple of pillows so that your head is raised slightly.
• Get up and out of bed at a slow pace. Sit on the bed for a while before you stand up.
• Try some relaxation techniques, as anxiety could worsen the symptoms.

You should also try not to bend to pick things up – Squatting to lower is much better.

Diagnosing vertigo

If you think you’ve got vertigo, a GP can usually diagnose this.

They might ask questions about the symptoms in order to understand the cause of them. Remember, vertigo itself is not a condition but a symptom of an underlying cause.

You will likely have your eyes and ears examined. You might also be asked to do some physical tasks like going from lying to sitting or sitting to standing.

If the GP can’t find a cause for your vertigo (like an obvious ear infection, for example), then you might be referred to a specialist.

A specialist will try to find the cause of the vertigo in order to treat it. They might conduct hearing tests like otoacoustic emissions tests or audiometric tests. If you have hearing loss, you might also be sent for an MRI (magnetic resonance imaging) scan to look at the inner ear and its surrounding structures.

Other possible tests include rotational chair testing and videonystagmography testing.

The rotational chair test is used to determine whether the vertigo is peripheral or central. The patient sits in a mechanised chair wearing special goggles. The chair rotates slowly while the goggles measure eye movements.

The videonystagmography test is used to determine the inner ear function. It uses sensory and visual tests and tracts eye movements. Essentially, it helps doctors to determine if the vertigo is a result of a problem with the inner ear.

If the doctor believes you have central vertigo caused by a neurological problem, you will likely be referred to a neurologist.

What support is available?

The majority of vertigo cases don’t require treatment and will resolve themselves.

Any treatment offered will depend on what is causing the symptoms. If the vertigo is a result of an ear infection, for example, the patient will usually be given a course of antibiotics.

Sometimes special exercises are given that will help correct a person’s balance.

Finally, sometimes antihistamine medication relieves vertigo symptoms. One medication sometimes prescribed is dimenhydrinate. It helps to prevent nausea and vomiting and reduces dizziness symptoms. Another medicine that treats the spinning and dizziness is meclizine.

Final thoughts on what vertigo is

While there are many causes of dizziness, they’re not always vertigo! However, dizziness is always a part of vertigo. When people talk of dizziness, they’re often feeling light-headed, woozy, unsteady or imbalanced. Vertigo, on the other hand, is more like a feeling of movement when there is none. If in doubt, it’s always best to consult your GP!