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Health Protocols

Vertigo and Dizziness

Background

Vertigo results from disturbances of the vestibular structures of the inner ear, which help control balance and orientation, or regions of the brain involved in balance control (Strupp 2013; NIH 2015; Wetmore 2013).

Positional vertigo, the most common type of vertigo, is caused by dislocation of particles from part of the inner ear called the otolith. Normally, these crystals help sense head movements. In positional vertigo, they move into another part of the inner ear called the semicircular canals, which contain sensors that help determine the head’s orientation relative to gravity. When the crystals from the otolith enter the semicircular canals and stimulate these sensors, a sensation of vertigo can arise (Mayo Clinic 2015).

There are two main types of vertigo: peripheral and central.

  • Peripheral vertigo arises from problems in the vestibular apparatus of the inner ear or the vestibular nerve. Vertigo as a side effect of medications is usually peripheral vertigo (NIH 2015).
  • Central vertigo arises from problems in the cerebellum or brainstem where postural information is processed.

Another type of vertigo, sometimes referred to as psychic or psychogenic vertigo, can be associated with anxiety, panic attacks, phobias, or other psychiatric disorders (Lin 2013; Chimirri 2013).

Table 1: Common Disorders That can Cause Vertigo (Wetmore 2013)

Disorder

Manifestations

Positional vertigo

Episodes of vertigo often lasting one minute or less and triggered by a specific movement of the head; Nystagmus (involuntary, rapid, sweeping movement of the eyes) is often present. Positional vertigo can have an intermittent course (Mayo Clinic 2015)

Vestibular migraine

Migraine-associated vertigo; wide variety of symptomatic presentations that can last from minutes to days. Typically associated with migraines, but headache and migraine symptoms are absent in up to 30% of cases (Strupp 2013; Espinosa-Sanchez 2015)

Ménière’s disease

Sudden onset vertigo lasting from one to 24 hours, often preceded by tinnitus (ringing in the ear), ear pressure or fullness on one side, and hearing loss. Visual disturbances, nausea, and vomiting are often present (Demetroulakos 2010)

Vestibular neuritis (also called Vestibular neuronitis)

Sudden onset of severe vertigo that can last for as long as a week. May be accompanied by nausea and vomiting. No neurologic or hearing symptoms, though dizziness may persist for days or weeks (Wetmore 2013; VDA 2016b)

Central nervous system diseases

 Condition-specific symptoms associated with underlying disease such as stroke, neurodegenerative disorders, or transient ischemic attacks (Frohman 2003; AHRQ 2014; Holmes 2011; Fernandez 2015)

“Vertigo” vs. “Dizziness” – What Is The Difference?

The terms “vertigo” and “dizziness” are frequently used interchangeably, though inaccurately, to refer to the same symptom. However, the terms are technically different (Post 2010).

“Vertigo” is a type of dizziness. Vertigo typically includes symptoms of dizziness, but not all cases of dizziness include the sensation of motion while not moving (vertigo). “Dizziness” is a non-specific symptom that non-medical professionals may use to describe a wide variety of conditions (Wipperman 2014).

Dizziness typically falls into one of four categories. These are vertigo, pre-syncope, disequilibrium, and lightheadedness (Susanto 2014; Post 2010). Vertigo related to inner-ear or vestibular problems (eg, positional vertigo) is a common cause of dizziness (Post 2010).

Table 2: Four Categories of Conditions That Cause Dizziness (adapted from (Susanto 2014; Post 2010; Samuels 2010))

Category

Pathophysiology

Cause(s)/Origin(s)

Vertigo

    (spinning sensation)

Problems with vestibular (inner ear) structures or balance-control regions of the brain

Vestibular neuritis; labyrinthitis; Ménière’s disease; Positional vertigo

Pre-syncope

    (fainting sensation)

Reduced blood flow to the brain

Blood volume depletion; neurocardiogenic syncope (sudden drop in heart rate or blood pressure, leading to fainting)

Disequilibrium

    (imbalance sensation)

Gait disorder

Spinal cord disease (myelopathy); peripheral neuropathy; Parkinson’s disease

Lightheadedness

    (sensation of disconnection from the environment)

Psychological disorder

Anxiety; depression

Physicians use certain tests to help identify the type of dizziness a patient is experiencing. For example, assessment of nystagmus (rapid, involuntary eye movement) with the Dix-Hallpike maneuver (see Diagnosis) can help rule out vertigo, and monitoring orthostatic blood pressure can help rule out pre-syncope due to hypotension (Post 2010).