Experiencing vertigo can be a frightening and unsettling experience. The sudden sensation that the room is spinning or that you’re losing your balance can cause intense anxiety and confusion, especially when it strikes unexpectedly.
Many people describe it as feeling like the ground is shifting beneath them, making it difficult to stay steady or move confidently. This sense of instability can lead to fear of falling or an overwhelming feeling of being out of control, which can interfere with everyday activities and diminish quality of life. Even simple tasks like walking, driving, or turning your head can trigger dizziness and disorientation, leaving individuals feeling vulnerable and unsure of what’s happening to their bodies. Understanding vertigo and its underlying causes can help alleviate some of the fear and uncertainty, but the experience itself can still be deeply distressing for those who live with it.
BPPV:
The most common cause of vertigo is benign paroxysmal positional vertigo (BPPV). BPPV occurs when tiny calcium carbonate crystals, called otoconia, dislodge from their usual location in the inner ear and move into one of the semicircular canals. These canals are responsible for sensing rotational movement, so when the crystals shift, they can disrupt the normal fluid movement and send incorrect signals to the brain about your body’s position. This causes a sudden, spinning sensation, usually triggered by specific head movements such as looking up, turning over in bed, or bending down. BPPV is typically not harmful, but the episodes can be disorienting and unsettling, especially because they tend to happen unexpectedly and last from a few seconds to a few minutes. While the exact cause of BPPV is often unclear, it can sometimes be associated with head trauma, aging, or prolonged bed rest.
Key Features of BPPV:
· Benign: The condition is not life-threatening.
· Paroxysmal: The episodes are sudden and short-lasting.
· Positional: The vertigo is triggered by specific changes in head position, such as looking up, lying down, or turning over in bed.
· Vertigo: The sensation of spinning or dizziness.
Common Symptoms:
· Sudden episodes of vertigo that last seconds to minutes.
· Dizziness, loss of balance, or a sense of unsteadiness.
· Nausea or vomiting (in some cases).
· Nystagmus (uncontrolled eye movements) during an episode.
Diagnosis:
BPPV is often diagnosed through a physical exam and specific positional tests like the Dix-Hallpike maneuver, which can provoke symptoms and identify which ear and semicircular canal are affected.
Treatment:
The most common treatment for BPPV is the Epley maneuver, a series of specific head and body movements performed to guide the dislodged crystals back into the correct part of the inner ear. The procedure can be done by a healthcare professional or, once trained, by the patient at home.
BPPV is generally considered a self-limiting condition, meaning it can improve or resolve on its own. However, some people experience recurrent episodes and may require multiple treatments or lifestyle adjustments.
Lifestyle Adjustments:
First, try to minimize sudden head movements and avoid activities that involve looking up or bending down quickly. When getting out of bed, move slowly and sit at the edge of the bed for a few seconds before standing. Sleeping with an elevated head, either by using multiple pillows or a wedge, can also reduce nighttime symptoms. Avoid sleeping on the affected side, and consider using a cervical collar to limit neck movements during sleep if symptoms are severe.
Red flags:
Red flags associated with vertigo can indicate a more serious underlying condition and should prompt immediate medical attention. Key red flags include sudden onset of severe headache, changes in vision or speech, difficulty swallowing, loss of consciousness, and numbness or weakness in the arms or legs. These symptoms could suggest central causes of vertigo, such as a transient ischemic attack, stroke, or brainstem lesions.
The HINTS exam (Head Impulse, Nystagmus, Test of Skew) is a specialized bedside test used to differentiate between central and peripheral causes of vertigo. The exam is most often performed by practitioners who manage patients presenting with dizziness or vertigo, including neurologists, emergency physicians, otolaryngologists, and neuro-otologists. These medical professionals receive focused training on the HINTS exam during their residency or fellowship programs, as it requires a deep understanding of vestibular and ocular motor physiology. While general practitioners and family physicians may be familiar with the HINTS exam, they typically do not receive extensive training in its application unless they pursue additional education in emergency or neurology-based disciplines.
Differential Diagnoses:
Cervicogenic Vertigo
Cervicogenic vertigo is a condition characterized by dizziness or a sense of imbalance that originates from dysfunction or abnormalities in the cervical spine (neck). It typically arises due to issues such as neck trauma, degenerative changes, or muscle spasms, which can disrupt the proprioceptive input from the neck to the brain and lead to sensations of vertigo. Patients often report dizziness that coincides with neck pain or restricted neck movements, and the vertigo may be exacerbated by specific head or neck positions.
Diagnosing cervicogenic vertigo can be challenging, as there are no definitive tests for it. Diagnosis is often made through a process of exclusion, ruling out other causes of vertigo such as vestibular or neurological disorders. A comprehensive evaluation includes a detailed patient history, a physical examination focusing on neck function and cervical range of motion, and imaging studies like X-rays or MRI if necessary. Provocative maneuvers, where the neck is moved or stressed to see if symptoms are reproduced, can also aid in diagnosis.
Treatment of cervicogenic vertigo typically focuses on addressing the underlying cervical spine dysfunction. This can include manual therapy such as chiropractic adjustments, physical therapy to improve neck mobility and strength, and exercises to restore normal proprioception. Additional approaches like vestibular rehabilitation, medication to manage pain or inflammation, and lifestyle modifications to reduce strain on the neck may also be recommended. In more severe or persistent cases, referral to a specialist for further evaluation and management might be necessary.
Meniere’s Disease
Ménière's disease is a chronic inner ear disorder that affects balance and hearing. It is characterized by episodes of vertigo (spinning sensation), tinnitus (ringing in the ear), a feeling of fullness or pressure in the ear, and fluctuating hearing loss. The exact cause of Ménière's disease is unknown, but it is believed to involve an abnormal buildup of fluid (endolymph) in the inner ear, which disrupts the normal balance and hearing signals.
Diagnosis typically involves a combination of a detailed medical history, a physical examination, and several specialized tests. These tests may include audiometry (hearing tests) to assess hearing loss, vestibular testing to evaluate balance function, and imaging studies like an MRI to rule out other conditions. There is no cure for Ménière's disease, but treatment aims to manage symptoms. Treatment options include lifestyle modifications (e.g., reducing salt intake, caffeine, and alcohol), medications such as diuretics or anti-vertigo drugs, physical therapy for balance, and, in severe cases, surgical interventions like endolymphatic sac decompression. Additionally, cognitive behavioral therapy or counseling may be recommended to help patients cope with the anxiety and depression often associated with this unpredictable condition.
If you would like more information, feel free to call (304-840-2820) or stop by the office. No appointments are necessary, and consultations are free. You can also email me at DocLeviChiropractic@yahoo.com.
Yours in Health,
Dr. Levi G. Merritt, D.C., NBC-HWC, CPT
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