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Health Protocols

Vertigo and Dizziness

Causes and Risk Factors

There are many factors that can contribute to dizziness, such as inner ear problems, medication side effects, or motion sickness. Some of these conditions can be serious, while others may be relatively minor or transient. The underlying causes and risk factors for vertigo are more finitely characterized.

Risk Factors for Vertigo

General risk factors for developing vertigo include:

  • Older age (Agrawal 2013; Neuhauser 2009)
  • Female gender (AHRQ 2014; Bisdorff 2013; Neuhauser 2009)
  • Family history of balance disorders (Gacek 2013)

Causes of Peripheral Vertigo

The most common cause of vertigo is benign paroxysmal positional vertigo, or positional vertigo (Strupp 2013; Agrawal 2013). Head injury, prolonged bed rest, and infectious inflammation of the vestibular nerve can trigger the onset of positional vertigo, although in the vast majority of cases no clear cause is ever identified (Strupp 2013).

Another common cause of vestibular vertigo is Ménière’s disease, a condition of the inner ear marked by vertigo, ringing in one or both ears (tinnitus), sensation of ear fullness, and hearing loss (Syed 2012). Possible causes of Ménière’s disease include autoimmune processes, allergy, and infection (Weinreich 2014). 

Other causes of peripheral vertigo include (Fernandez 2015; NIH 2015; Ferri 2016; Hain 2015; Cureoglu 2010; NIDCD 2013):

  • Labyrinthitis
  • Damage to the vertebral artery
  • Head and neck injuries
  • Pressure on the vestibular nerve, usually due to a non-cancerous tumor
  • Otosclerosis (hardening of middle ear structures)

Causes of Central Vertigo

Vestibular migraine. The association of migraines with vertigo may be related to a derangement in vestibular signaling and altered processing of postural and positional information (Espinosa-Sanchez 2015). In addition, migraine sufferers appear to be at higher risk of developing positional vertigo (Chu 2015), and migraines can be associated with episodes of Ménière’s disease (Foster 2015; Strupp 2013; Agrawal 2013).

Other causes of central vertigo include (NIH 2015; Fernandez 2015; Wetmore 2013; Fife 2015; Thompson 2009):

  • Cerebrovascular disease, including transient ischemic attack and stroke
  • Multiple sclerosis
  • Parkinson’s disease
  • Seizure disorder
  • Tumor
  • Drug and alcohol intoxication
  • Concussion and mild traumatic brain injury
  • Medication side effects and interactions

Table 3: Medications and Substances That may Cause Vertigo or Dizziness

Medication/Substance

Notes

Antibiotics

Cinoxacin, levoxacin, ciprofloxacin, amoxicillin + clavulanic acid, aminoglycosides, tetracyclines, amikacin, erythromycin, azithromycin, clarithromycin

Ototoxic (toxic to inner-ear structures or nerves involved in equilibration)

Diuretics

Ethacrynic acid, furosemide, hydrochlorothiazide

Related to postural hypotension; some are ototoxic

Antihypertensives

Enalapril, zofenopril, irbesartan, lacidipine, amlodipine, nifedipine, nicardipine

Due to hypotension

Cholesterol-lowering Medications

Simvastatin, atorvastatin

 

Anti-inflammatories and Pain Relievers

Aspirin, acetaminophen, ibuprofen, celecoxib, diclofenac, dexketoprofen, ketorolac, naproxen

 

Dopaminergic/Parkinson’s Disease Medications

Bromocriptine, levodopa

Bromocriptine can worsen hypotension when taken with antihypertensive medications

Anti-psychotics

Chlorpromazine, clozapine, thioridazine

May cause hypotension

Antidepressants

Mirtazapine, paroxetine, sertraline, trazodone, amitriptyline, doxepin

May cause vertigo or dizziness with or without hypotension

Anti-seizure Medications

Lamotrigine, oxcarbazepine, carbamazepine, lacosamide, clonazepam

These are also sometimes used in the treatment of vertigo

Chemotherapeutic Medications

Cisplatin

 

Antifungal and Antimalarial Medications

Amphotericin B, fluconazole, itraconazole, flucytosine, chloroquine

Ototoxic

Alcohol

May damage the vestibular system

Caffeine

 

Heavy metals and Metalloids

Arsenic, lead, mercury

Ototoxic

Tobacco

May cause dizziness, vertigo, and tinnitus

(DeWood 1990; Lin 2013; Chimirri 2013; McCormack 2003; Zanchetti 2006; Chiou 2000; Osterloh 1991; VDA 2016a)

Motion Sickness

Several sensory systems interact closely to control balance and equilibrium. These include the vestibular system or inner ear, the eyes, and receptors in the muscles and joints that sense movement and pressure. When these systems send conflicting messages about the body’s orientation and relative motion to the brain, motion sickness can occur. Motion sickness is a common problem that can cause dizziness, nausea, vomiting, fatigue, and other symptoms (Erskine 2015; American Academy of Otolaryngology 2016).

Many people experience motion sicknesses during passive motion such as while traveling by car, train, or boat. Although anyone with a functional vestibular system is theoretically susceptible to motion sickness, several factors appear to influence risk (Erskine 2015; American Academy of Otolaryngology 2016):

  • Age: children aged 2 to 12 are particularly susceptible
  • Gender: women are more likely to experience motion sickness than men, especially during pregnancy or menstruation, or while using hormone replacement therapy
  • Migraines: migraineurs have increased susceptibility to motion sickness
  • Medication use: several types of medication may increase motion sickness risk. These include antibiotics, estrogens, some cardiovascular medications (eg, digoxin), narcotic pain killers, nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, some asthma medications, and bisphosphonates

Some medications may help relive motion sickness symptoms. These include antihistamines, scopolamine, antidopaminergic drugs, metoclopramide (Reglan), sympathomimetics, and benzodiazepines. Unfortunately, many of these medications can cause side effects such as drowsiness (Erskine 2015; American Academy of Otolaryngology 2016).  

In some cases, motion sickness can be prevented or relieved by specific actions such as lying down, shutting the eyes, avoiding sitting in the rear of the vehicle, not reading while traveling, and looking at the horizon. Staying adequately hydrated, eating small meals, and avoiding alcohol before travel may also help. Distractions such as listening to music or sucking on lozenges may be useful as well. Ginger-flavored lozenges in particular may be helpful because ginger can promote gastric emptying (Lazzini 2016; Marx 2015), which is sometimes delayed in motion sickness (Erskine 2015).