Lightheaded, woozy, unsteady, dizzy – these are all words used frequently by doctors and patients alike to describe vertigo, a well-known balance disorder that gives you the sense that your surroundings are spinning or moving. According to the NIH, more than four out of 10 Americans will report an episode of dizziness to their doctors. Teasing out the root cause of vertigo can be a difficult task because it can be related to problems with the inner ear, brain, vision, migraines, circulation, or even emotional hardship and anxiety. Fortunately, the majority of causes for balance disorders are not life-threatening. Let’s take a look at some of the reasons your head might be spinning.
Benign Paroxysmal Positional Vertigo (BPPV)
The most common cause of vertigo is BPPV. BPPV produces a short, but intense sensation of spinning typically triggered by specific head movements or laying back. The symptoms last seconds. The onset can be spontaneous or it can follow head trauma. Although anyone can develop BPPV, older individuals are more likely to experience it. BPPV is thought to be secondary to dislodgment of inner ear particles known as otoconia (crystals). Once these particles come loose within the inner ear, certain head movements will cause the crystals to abnormally flow within our inner ear structures, thus triggering a perception of movement or spinning. BPPV is typically self-limited. However, some patients will require evaluation by a physician to have repositioning maneuvers in order to aid in the recovery.
Another common cause of vertigo is vestibular neuronitis, or an inflammation of the balance nerve. The dizziness and vertigo induced by this condition can often last days. Patients are typically quite sick and experience nausea and vomiting. Any movement will exacerbate the sense of motion. As a result, patients often are stuck in bed until they receive medication. The inflammation of the balance nerve is often caused by a viral illness, such as a cold or upper respiratory infection. Treatment involves medications to control the dizziness, nausea and vomiting. Most people recover within a few weeks time, but you can still experience imbalance for months. When there is associated hearing loss, the condition is called labyrinthitis. The hearing loss may be permanent.
Fluctuating hearing loss, ear fullness or pressure, ringing in the ears (tinnitus) and vertigo – all experienced together — is also known as Meniere’s disease. The cause is thought to be elevated inner ear pressures (idiopathic endolymphatic hydrops). The vertigo associated with this disease lasts anywhere from 20 minutes to hours and can leave patients with residual fatigue and a feeling of imbalance for days. Though people of all ages can have Meniere’s disease, it is more common in middle aged adults.
Although we may think of migraines as bad headaches, atypical migraines can present with the primary symptom of vertigo. Certain foods and alcohol, sleep deprivation and stress, hormonal changes and visual stimulants can all trigger attacks. The vertigo associated with migraines can last hours to days. Associated light and sound sensitivity is not uncommon. Treatment focuses on avoiding triggers.
Rare Causes of Vertigo
Acoustic Neuroma or Vestibular Schwannoma
One in 100,000 people will develop these rare benign tumors that typically grow out of the nerve fibers of the balance nerves. Patients also often have hearing loss and tinnitus. The treatment depends on the age of the patient, hearing status, size of the lesion and growth characteristics of the tumor. Surgery, radiation and observation are all treatment options. An MRI is the typical diagnostic study.
Miscellaneous Causes of Vertigo
- Stroke can manifest as vertigo, but typically has other associated neurological deficits.
- A labyrinthine bleed causes severe vertigo and hearing loss that is irreversible.
- Multiple sclerosis
- Primary or metastatic brain lesions can also present with vertigo, but typically have other associated neurological deficits as well.
About Dr. Vivas
Esther Vivas, MD, is a board-certified otolaryngologist and graduated from Albert Einstein College of Medicine in the Bronx, NY. She completed both her internship and residency in Otorhinolaryngology at Albert Einstein College of Medicine. She attended the University of Pittsburgh Medical Center in Pittsburgh, PA for her fellowship in Neurotology and Skull Base Surgery.