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Health Protocols

Vertigo and Dizziness

Introduction

Vertigo is characterized by a perception of motion while not moving, typically a sensation of spinning. Vertigo symptoms can be caused by a variety of different, underlying medical conditions. Vertigo is typically caused by problems involving the inner ear or the central nervous system (Wetmore 2013; AAFM 2005). Importantly, vertigo can be a symptom of a more serious condition, such as stroke. Seeking medical attention quickly for sudden unexplained vertigo is essential (Kerber 2009a).

About 30% of people older than 60 and half of people over 85 experience vertigo or dizziness (Fernandez 2015). Vertigo can interfere with the ability to work and live independently, which can reduce quality of life (Campellone 2013). Vertigo is also a common cause of falls among aging individuals, and falling is the leading cause of accidental death in seniors (Fernandez 2015; Holmes 2011; Agrawal 2013).

Although many people assume that “vertigo” and “dizziness” are synonyms, this is not the case. Vertigo typically includes a sensation of dizziness, but not all patients with dizziness also complain of a sensation of motion while not moving (vertigo). Conditions that can cause dizziness include pre-syncope, disequilibrium, and lightheadedness (Wipperman 2014; Susanto 2014; Post 2010; Samuels 2010).

Many cases of vertigo are attributable to problems related to the inner ear, and the pathobiology of these problems is largely understood, so the management approach is more straightforward (Wipperman 2014; Susanto 2014; Post 2010; Samuels 2010).

The most common type of vertigo, positional vertigo (also called benign paroxysmal positional vertigo), accounts for up to 33% of cases (Agrawal 2013). Positional vertigo is caused by displaced particles in the small canals of the inner ear. These canals are important parts of the body’s equilibration system. Positional vertigo can often be treated with maneuvers that move the particles out of the canals (Johns Hopkins Medicine 2016). However, most of these techniques must be executed by a clinician, which undermines their practical utility. But a novel repositioning technique called the half somersault maneuver can be performed at home and was shown in a randomized controlled trial to be better tolerated than other well-known techniques (Foster 2012; Span 2016).

Intriguing evidence indicates some types of vertigo and dizziness are associated with systemic conditions such as abnormal glucose metabolism (Kraft 1998; Kirtane 1984; D'Avila 2005; Mangabeira Albernaz 1984; Lehrer 1986; Serra 2009; Webster 2015), osteoporosis (Yu 2014), and sleep apnea (Sowerby 2010; Nakayama 2015; Kayabasi 2015; Gallina 2010), suggesting a comprehensive approach going beyond the inner ear and nervous system may be warranted. Moreover, several natural interventions, such as vitamin D, Ginkgo biloba, gastrodin, and coenzyme Q10, have shown promise for the management of vertigo (Buki 2013; Talaat, Kabel 2015). Other causes of vertigo, such as vestibular migraine and Ménière’s disease, may respond to medication (Johns Hopkins Medicine 2016).

In this protocol you will learn about several possible causes of vertigo and dizziness and how clinicians identify the cause in a given case. You will also discover a number of novel treatment strategies and several natural interventions that may help relieve vertigo and dizziness. Dietary and lifestyle considerations that may reduce the severity or frequency of vertigo attacks will be described as well.