Vertigo and Dizziness
Vertigo, typically characterized by a sensation of spinning, is usually caused by problems involving the inner ear (peripheral vertigo) or central nervous system (central vertigo). Seeking medical attention quickly for sudden unexplained vertigo is essential, as stroke may be an underlying cause in some cases.
Dizziness usually falls into one of four categories: vertigo, fainting sensation, imbalance sensation, and lightheadedness.
Evidence indicates some types of vertigo and dizziness are associated with abnormal glucose metabolism, osteoporosis, and sleep apnea.
Natural interventions, such as vitamin D, Ginkgo biloba, gastrodin, and coenzyme Q10 (CoQ10) have shown promise for the management of vertigo.
Causes and Risk Factors
- The most common cause of vertigo is benign paroxysmal positional vertigo, which may account for up to 33% of cases. Another common cause of vertigo is Ménière’s disease.
- Migraine sufferers are at a higher risk of developing vertigo, as are older people, females, and those with a family history.
- Many medications can cause dizziness, including some antibiotics, statins, and antidepressants.
- Physicians must systematically exclude diagnostic possibilities in patients with dizziness. Ruling out urgent causes of vertigo and dizziness, such as stroke, is vital.
- Nystagmus or other eye movement abnormalities may help a clinician rule out certain causes of dizziness.
- A specialized maneuver called the Dix-Hallpike test may help diagnose positional vertigo.
- Semont and Epley maneuvers, designed to move debris out of the semicircular canals in the inner ear, are effective in the majority of cases of positional vertigo.
- Diuretic medications are commonly used to treat Ménière’s disease, but some evidence suggests medication may not be effective.
- Medications such as antihistamines, antiemetics, anticholinergics, and benzodiazepines may be used during repositioning maneuvers or to temporarily relieve symptoms of severe positional vertigo, but these drugs do not treat the underlying cause of positional vertigo.
Novel and Emerging Strategies
- In case reports, jugular vein abnormalities were corrected, resulting in a complete resolution of vertigo symptoms.
- Flunarizine, a drug not approved for use in the United States, is an effective adjunct treatment for migraine-associated vertigo.
- Emerging findings suggest serum protein S100-beta, a novel diagnostic biomarker, may someday be used to differentiate vertigo caused by vascular stroke.
- The half somersault maneuver to move crystals out of the semicircular canals is a novel technique developed for at-home use without assistance. Compared with the Epley maneuver, those who used the half somersault experienced less dizziness and other complications and were more likely to remain in remission.
Diet and Lifestyle Considerations
- Follow a consistent low-sodium diet for Ménière’s disease.
- Avoid migraine trigger foods (including red wine, cheese, and chocolate).
- Stress reduction, manual therapy, and acupuncture may be helpful.
- Vitamin D: Studies have shown vitamin D supplementation can improve positional vertigo, especially in those with low vitamin D status.
- Ginkgo biloba: In a 12-week trial in subjects with vertigo, ginkgo extract daily was more effective and better tolerated than betahistine, a medication sometimes used to treat vertigo.
- Gastrodin: A rigorous analysis of controlled clinical trials that used injections of gastrodin, an extract from the gastrodia plant, to treat vertigo concluded that this treatment was more effective than medication.
- Coenzyme Q10 (CoQ10): Patients with congestive heart failure were treated with CoQ10 and 73% reported improvement in their vertigo.
- Glutathione and related nutrients: A study in treatment-resistant patients with Ménière’s disease that included glutathione found that 21 of the 22 patients with vertigo reported complete recovery or substantial improvement 12 months after treatment. Based on these results, nutrient supplements that can increase glutathione levels, such as L-cysteine, vitamin C, whey protein, selenium, and N-acetylcysteine, may have a role in the treatment of vertigo and Ménière’s disease.