You might have heard people complain about their heads spinning, feeling nauseated and dizzy, and experiencing fullness in their ears. This off-balance sensation and the feeling that the world is spinning around you is called vertigo. It is not a disease but a symptom of an underlying condition. 

 Is vertigo the same as dizziness?

Given the varying sensations, you may go through when it comes to disturbing equilibrium or balance, it can be tough to identify if you are experiencing dizziness or vertigo. However, here are some pointers that might help distinguish between the two. 

Dizziness

• It alters your orientation in relation to your surroundings and makes you feel lightheaded 
• You may feel better once you rest

Vertigo

• It induces the feeling that you are moving or spinning or that your surroundings are moving 
• It results in an off-balance sensation
• It may not improve upon rest. It might also worsen while resting; for instance, when turning towards the right or left in the lying position

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What leads to vertigo?

The inner ear is made up of a few bony canals, which are semicircular in shape. These semicircular canals have special cells, which act as position sensors. These cells get inputs from the eyes, sensors in the skin, and those in the region of the nape of the neck about the orientation and balance of the body. 

The signals are then sent to the brain for analysis. The brain processes the signals and ascertains if the body is in alignment with the surroundings. If the brain perceives any discrepancy in this alignment, it immediately sets into motion, correcting mechanisms. For instance, if you are falling off a table or standing on one leg, your body suddenly balances itself. 

Any condition affecting the components of this balancing mechanism can induce vertigo.

Causes

• Severe squint
• Problems with the sensing mechanisms in the semicircular canals of the inner ear
• Any condition, which affects the sensors in the skin or neck or conditions that affect the processing of signals in the brain, can throw the body in disbalance and cause disorientation, which manifests as vertigo

Types

Depending on the cause, vertigo can be classified into two types:

1. Peripheral vertigo

Peripheral vertigo constitutes nearly 80% of vertigo cases. Any vertigo arising due to problems in the semicircular canals or signals reaching them is called peripheral vertigo. 

Causes

Benign Paroxysmal Positional Vertigo (BPPV) is considered to be the commonest cause of peripheral vertigo. It is the sudden onset of hasty body movements. During this scenario, you abruptly turn in the bed before getting up. The commonest of BPPV occurs due to the displacement of calcium deposits from their normal location in the inner ear. A few other causes of peripheral vertigo include:  

• Injury to ear
• Skull fractures
• Infections like a common cold or vestibular neuritis
• Calcium deposits in the semicircular canals as seen in BPPV
• Cervical spondylosis
• Severe squint
• Age-related degeneration (Meniere’s disease) 

Usually, peripheral vertigo is episodic and severe. The condition can worsen with head movements.

2. Central vertigo

During central vertigo, you feel like the surroundings are moving while you are sitting still. Central vertigo is caused by a problem in the structures in the brain, which process the signals from the inner ear and send correcting signals if required. These structures include the brainstem and the cerebellum, which are located in the back part of the brain, near the nape of the neck. 

Unlike the peripheral type, central vertigo generally develops over a longer period and the associated symptoms tend to be less severe.

Causes

• Stroke
• Hemorrhage or tumors of the vestibular nerve, brainstem, or cerebellum
• Severe head injuries
• Cervical spondylosis
• Infections of the brain

Other factors that may lead to vertigo

• Multiple sclerosis in younger individuals 
• Parkinson’s disease
• Migraines
• Reaction to certain medications
• Alcohol consumption   

Symptoms of vertigo

One or more of these signs may be present in a patient suffering from vertigo:

• Reeling sensation while turning the head suddenly or changing body position
• Nausea or vomiting
• Hearing loss in one or both ears
• Ringing sensation called (tinnitus) in one or both ears
• Trouble focusing one’s vision and blurred vision
• Loss of balance; the imbalance may be mild or moderate
• Frequent falls, especially in the elderly
• Difficulty in walking
• Headaches

Diagnosis

Detailed medical history and physical examination are the primary requirements for diagnosis. You may need to undergo additional tests to confirm the type of vertigo. The doctor might subject you to certain tests in different positions of your head, and a few of these tests may induce vertigo. However, there is nothing to worry about. 

You may also have to undergo audiometry to test your hearing. If central vertigo is suspected, additional studies like MRI or CT scan may be required.

How to manage vertigo

1. The primary method of management is to treat the underlying cause of vertigo. For example, if a migraine is the cause of vertigo, treatment for migraine is initiated.

2. Medications like antihistamines, benzodiazepines, corticosteroids, or antiemetics may be prescribed, depending on the cause. These help in managing the symptoms, and sometimes, treating the underlying cause. It is advisable to take these medicines only under supervision. Many of these medications put your balancing system to sleep. Driving and working near moving machinery should be avoided when you are on these medications. Other precautions, as suggested by the doctor, should be adhered to strictly.

3. The Epley maneuver, a type of exercise with a specific sequence of activities, is reported to be helpful in cases of BPPV. Although you may perform the Epley maneuver at home, consult your doctor for specific instructions and ideal frequency for your condition.

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4. Intermittent episodes of vertigo, triggered by sudden head or neck movements, generally respond to vestibular rehabilitation therapy. It is a type of physical therapy that involves implementing exercises and head movements for stabilizing your gaze and gait.

5. Surgery may be required for treating conditions like tumors or head injuries.

Vertigo is almost always a sign of an underlying disease and should never be taken lightly. Seek medical help as soon as possible to avoid further complications and worsening of the condition.  

References
1. Lui F, Foris LA, Willner K, et al. Central vertigo. [Updated 2021 Jan 31]. Treasure Island (FL): StatPearls Publishing; 2021.
2. Baumgartner B, Taylor RS. Peripheral vertigo. Treasure Island (FL): StatPearls Publishing; 2021.
3. Labuguen RH. Initial Evaluation of Vertigo. Am Fam Physician 2006; 73: 244–51.