That giddy feeling could be vertigo
Ihave recently had vertigo for the first time – it’s a horrible experience, and I have a newfound and sincere sympathy for those who have suffered from this for much longer, and to a much greater degree.
Although it is a form of dizziness, vertigo is quite distinct from other types that cause a feeling of faintness or light-headedness, typically when standing up or getting out of bed. Vertigo is associated with a sensation that either you, or your surroundings, are spinning around.
People with vertigo may describe feeling that they are falling or the room is tilting, and may find it hard to walk, stand and maintain their balance. Nausea and vomiting are common.
Dizziness is extremely common – we will all have experienced this at one time or another. But true vertigo is more unusual. We think around one in 20 people will get vertigo at some point, and it’s much more likely to come on as we age.
Vertigo isn’t a diagnosis, it’s a symptom, and it occurs when something is wrong in either the inner ear (our balance system) or even the brain itself. It can be mild, lasting a few seconds only, or severe and very impacting. The most extreme cases last hours or even days at a time, and sometimes recur over months or years. Finding out the underlying cause can be essential for successful treatment.
The following are the most common causes of vertigo, and how they can be managed:
Benign Paroxysmal Positional Vertigo
This is the most common cause and occurs when little bits of calcium debris lodge in the inner ear (usually a result of degeneration or ageing), and interfere with our balance mechanisms.
BPPV typically comes on at about 50 years of age, though can affect people earlier, and is more common in women. In most cases, we don’t know what triggers BPPV, but in some instances it occurs after a head injury, a viral infection or as a complication of ear surgery.
People with BPPV will notice their vertigo when they have a sudden change in position of their head (for me, rolling over in bed). The vertigo tends to last for less than a minute, and resolves when the head is kept completely still. Although it can cause nausea, it is unusual to vomit with BPPV.
If there are no symptoms to suggest something more serious is going on (see below), your GP will likely be able to manage and treat BPPV without the need for a specialist to get involved.
They will do a series of movements of your head and neck to assess which side is affected. If this confirms BPPV, the treatment involves some manoeuvres (known as Epleys, or Brandt-Daroff) that should dislodge the troublesome particles and relieve symptoms.
The rate of recurrence after successful management is thought to be less than 10 per cent, and those unlucky people who do find their BPPV is persisting can often learn to do these movements at home and treat themselves when needed.
Meniere’s disease
This is caused by a change in the volume of fluid in the inner ear, damaging the balance system. Typically it causes more severe symptoms than BPPV, and is thankfully less common.
People with Meniere’s will also describe tinnitus or a ringing noise, a feeling of fullness in their ears, and associated hearing loss. Usually it will affect one side initially but, if Meniere’s progresses, both ears are involved. Attacks last for minutes to several hours, and usually occur in clusters, so someone may get six to 10 attacks in a number of weeks, and then have nothing for several months before it recurs.
Diagnosing Meniere’s usually requires blood tests, a hearing test and sometimes an MRI. Treatment is aimed at reducing the frequency and severity of attacks, and can include medication such as anti-nausea tablets and steroids, ‘‘vestibular rehabilitation’’, which uses a series of exercises to try to desensitise the balance system, and lifestyle modification, including reducing salt, alcohol, coffee, chocolate and tobacco use. Sadly there is no cure for Meniere’s but most people
report their symptoms improve considerably with a combination of the lifestyle measures.
Vestibular neuritis
This condition is a neuropathy or inflammation of the vestibular nerve, thought to result from a virus infection. It is most common in 40- 60-year-olds, and causes sudden onset of severe, disabling vertigo.
Unlike BPPV, the vertigo in vestibular neuritis isn’t typically triggered by movement, and doesn’t go away after a few minutes. It can last for up to a week and is commonly associated with nausea and vomiting. Although awful to experience, VN is selflimiting and can usually be managed at home with bed-rest and medication to reduce the nausea.
Labyrinthitis
Again, this is caused by inflammation, most often associated with a viral infection. It occurs in people over 30, but can sometimes happen in childhood as well. Although it causes the same sudden, severe, constant type of vertigo as VN, labyrinthitis also leads to temporary hearing loss in one or both ears, and sometimes tinnitus. Management is the same as for VN, and nearly all cases will resolve completely, with no ongoing symptoms.
Vestibular migraine
About 1 per cent of us will get this type of migraine during our life, and bizarrely it doesn’t always feature a headache. The vertigo typically lasts from five minutes up to 72 hours, and may be associated with sensitivity to light and noise, flickering vision, and nausea. This type of vertigo responds to migraine treatments, and can be managed by your GP. Depending on how severe or frequent your migraines are, a preventer tablet taken every day can be effective.
Aside from these causes, other more serious things can also present with vertigo, especially in their early stages. These include sudden events such as a stroke, or more gradually progressing diseases like multiple sclerosis, or even brain tumours. Although it isn’t always possible to distinguish more serious causes from less worrying ones, the following signs would be of concern, and warrant being checked out:
■ Sudden onset of a new, severe headache associated with vertigo
■ Extreme nausea or vomiting, to the extent you are unable to tolerate fluids
■ Any symptoms to suggest a stroke, for example weakness of face, limbs or body, slurred speech or problems swallowing
■ Sudden onset of deafness without the other features of Meniere’s disease.
If your vertigo isn’t going away, please get your doctor to review things. Vestibular physio or rehabilitation is helpful for many people and is more widely available. It is important to put some general safety measures in place to avoid any issues driving, at home or at work so you don’t run the risk of injuring yourself or others.