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Vertigo

(Dizziness)

Definition

Vertigo is a feeling of spinning when a person is standing still. It can be caused by many different health problems.

Causes

The inner ear and nerves sense the position of a person's head and body. Vertigo can happen when there are problems with these nerves and structures. It may also be due to problems in the brain, but this is not as common.
The two main types of vertigo are:

Peripheral Vertigo

Peripheral vertigo is common and caused by problems with the inner ear. Causes may be:

Central Vertigo

Central vertigo is less common but more serious. It happens due to changes in the brainstem or the cerebellum. These parts of the brain control balance. Changes can be caused by:

Risk Factors

The conditions above will raise a person's risk of vertigo.

Symptoms

Problems may be:
  • Sensation of rotation
  • Illusion of movement
  • Feeling of being pulled in one direction
  • Feeling of being off-balance
Vertigo is not the same as feeling lightheaded. A person who is lightheaded does not have a feeling of movement.

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. Tests to look for a cause may include:
  • Blood tests
  • Hearing and vision tests
  • Head maneuvers—the doctor will move a person's head to help to ease symptoms
  • Blood pressure test, both lying down and standing up
  • Electronystagmogram (ENG)—to check for nystagmus , an abnormal eye movement
  • MRI scan
  • Rotatory chair test
  • Brainstem auditory evoked potential studies (BAEPS or BAERs)—to check the function of the brain auditory nerve and brain stem

Treatment

Some lifestyle changes can help manage vertigo, such as using a cane to help with balance. Treating the cause may also stop the vertigo.
Some medicines that cause vertigo may need to be stopped or changed. Medicines that may ease or stop symptoms are:
  • Antihistamines
  • Benzodiazepines
  • Anticholinergics
  • Antiemetics

Prevention

There are no current guidelines to prevent vertigo.

RESOURCES

American Academy of Otolaryngology—Head and Neck Surgery
http://www.entnet.org
Vestibular Disorders Association
http://www.vestibular.org

CANADIAN RESOURCES

BC Balance and Dizziness Disorders Society
http://www.balanceanddizziness.org
Canadian Academy of Audiology
http://www.canadianaudiology.ca

References

Dizziness and vertigo. The Merck Manual Professional Edition. Available at: https://www.merckmanuals.com/professional/ear,-nose,-and-throat-disorders/approach-to-the-patient-with-ear-problems/dizziness-and-vertigo?query=vertigo. Updated March 2019. Accessed April 8, 2020.
Dizziness—differential diagnosis. EBSCO DynaMed website. Available at: https://www.dynamed.com/approach-to/dizziness-in-adults-approach-to-the-patient . Accessed April 8, 2020.
Living with a vestibular disorder. Vestibular Disorders Association website. Available at: https://vestibular.org/living-vestibular-disorder/everyday-challenges. Accessed April 8, 2020.
Muncie HL, Sirmans SM, et al. Dizziness: Approach to Evaluation and Management. Am Fam Physician. 2017 Feb 1;95(3):154-162.

Revision Information

  • Reviewer: EBSCO Medical Review Board Rimas Lukas, MD
  • Review Date: 02/2020
  • Update Date: 04/08/2020
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