Carl Rosenkilde, - Westchester Health
Dizziness and Vertigo
  • If you sometimes don't know which way is up, you’re not alone.
  • More than seven million times a year, Americans seek medical attention for dizziness.
  • Thirty percent of people will experience at least one bout of vertigo by age 65.
  • Whether acute or chronic, these conditions are both common and debilitating.
Dizziness is one of the most common reasons adults visit their doctors, up there with chest pain and fatigue.
Dizziness is a feeling that may be hard to describe, but often includes a feeling that you are spinning or tilting, or that you are about to fall or pass out. 
Dizziness can also cause you to feel lightheaded or giddy, or have difficulty walking straight. 
Dizziness Causes: some of the many possible causes of dizziness include: medication side effects (most common), history of stroke, carotid artery atherosclerosis, vestibular disease including hearing loss, tinnitus, visual problems, including amblyopia, cataracts, glaucoma, progressive macular degneration, diabetes, CHF, spinal disease, orthopedic issues and neuropathy to name a few.
Many people who feel dizzy have vertigo, a specific type of dizziness. Vertigo causes a sense of spinning dizziness, swaying, or tilting. You may feel that you are moving or that the room is moving around you.
Vertigo can be caused by a number of different problems involving the inner ear or brain. Most such problems are benigh, not serious, although very uncomfortable, while others can be life threatening.
The most common symptoms of vertigo include a feeling of:
  • Spinning (you or the room around you)
  • Tilting or swaying
  • Feeling off balance
These feelings come and go, and may last seconds, hours, or days. You may feel worse when you move your head, change positions (stand up, roll over), cough, or sneeze. Along with vertigo, you may:
  • Vomit or feel nauseous
  • Have a headache or be sensitive to light and noise
  • See double, have trouble speaking or swallowing, or feel weak
  • Feel short of breath or sweaty, have a racing heart beat
If you seek treatment for vertigo, you should mention how long these symptoms last, what triggers the symptoms, and any other associated problems. These clues can help point to the cause of vertigo.
The Most Common Causes of Vertigo are Due to Inner Ear Conditions
Collections of calcium, inflammation, and certain infections can cause problems in the vestibular system. The vestibular system includes parts of the inner ear and nervous system, which controls balance.  Three most common types of inner ear problems:
  • Benign paroxyxsmal positional vertigo
  • Meniere's disease
  • Vestibular neuritis
Benign paroxysmal positional vertigo (BPPV)
BPPV, sometimes called benign positional vertigo, positional vertigo, or simply vertigo, is a type of vertigo that develops due to collections of calcium in the inner ear. These collections are called canaliths. Moving the canaliths (called canalith repositioning) is a common treatment for BPPV.
Vertigo is typically brief in people with BPPV, lasting seconds to minutes. Vertigo can be triggered by moving the head in certain ways.
Meniere's disease
Meniere's disease is condition that causes repeated spells of vertigo, hearing loss, and ringing in the ears. Spells can last several minutes or hours. It is probably caused by a build up of fluid in the inner ear.
Vestibular neuritis
Labyrinthitis is probably caused by a virus that leads to swelling around a nerve. People with vestibular neuritis develop sudden, severe vertigo, nausea, vomiting, and difficulty walking or standing up; these problems can last several days. Some people also develop difficulty hearing in one ear.
Head injury
Head injuries can affect the vestibular system in a variety of ways, and lead to vertigo.
Certain medications can damage the ear and lead to vertigo.
In a condition called migrainous vertigo, vertigo can be caused by a migraine. This type of vertigo usually happens along with a headache, although sometimes there is no headache.
Brain problems
Brain problems such as TIA, (transient ischemic attack), bleeding in the brain, acoustic neuroma, or multiple sclerosis can also cause vertigo. There are usually other symptoms, besides vertigo, that happen with these brain problems.
When To Seek Help
You should seek help immediately if you have dizziness or vertigo along with any of the following:
  • New or severe headache
  • Temperature greater than 100.4ºF (38ºC)
  • Seeing double or having trouble seeing clearly
  • Trouble speaking or hearing
  • Weakness in an arm or leg
  • Passing out
  • Numbness or tingling
  • Chest pain
  • Vomiting that will not stop
  • Gait imbalance that persists when vertigo or dizziness are alleviated
In addition, you should seek help immediately if you have vertigo that lasts for several minutes or more if you:
  • Are an older adult
  • Have had a stroke in the past
  • Have risk factors for stroke (high blood pressure, diabetes, smoking)
If you have dizziness or vertigo that comes and goes but you do not have any of the above problems, make an appointment with your doctor. He or she will perform an exam, and may order further testing, depending on your exam and your history.
In most people, vertigo is bothersome but it is not caused by a serious problem. Treatment for vertigo aims to treat the underlying cause (if the cause is known), relieve the bothersome symptoms, and help with recovery.
Treatment for symptoms
If you have spells of vertigo that are severe or last for hours or days, your doctor or nurse may recommend a medication to relieve severe vertigo symptoms, like vomiting. Treatment is not usually recommended if your vertigo lasts only second or minutes.
Possible treatments include:
  • An antihistamine, such as the prescription medicine meclizine (Antivert), or non-prescription medicines like dimenhydrinate (Dramamine), or diphenhydramine (Benadryl.) Unfortunately, these medications are often of limited benefit, since some patients will complain of sedation or worsening of lightheadedness.
  • Prescription anti-nausea medications, such as promethazine (Phenergan), metoclopramide (Reglan), or ondansetron (Zofran).
  • Prescription sedatives, such as diazepam (Valium), lorazepam (Ativan), or clonazepam (Klonopin)
Most of these medicines can make you sleepy, and you should not take them before you work or drive. You should only take prescription medicines to treat severe vertigo symptoms (like vomiting), and you should stop the medicine when your symptoms improve.
Taking the medicine for longer may mean that it will not work as well if you need it for future episodes of vertigo.
Canalith repositioning: Epley Maneuver 
Canalith repositioning is a treatment someitmes is used for people with benign paroyxsmal positional vertigo (BPPV). The success rate is around 80%.
A treatment called the Epley manuer be done by your neurologist or by a physical therapist by moving your head into certain positions. You may be given instructions on how to perform similar movements at home, if needed. These movements encourage the calcium collection to move into a part of the ear where it will be reabsorbed.
You may begin to feel better immediately after this treatment or within a few days.
Balance Rehabilitation
Most patients with vertigo prefer to keep their head still. However, staying still and not moving the head can make it harder to cope with vertigo.
Rehabilitation can help people with vertigo that is caused by injury to the vestibular system. The vestibular system includes parts of the inner ear and nervous system, which controls balance.
The rehabilitation works by helping your brain adjust its response to changes in the vestibular system. The therapy can also help train your eyes and other senses to "learn" how to compensate. This therapy is most helpful when it is started as soon as possible after you develop vertigo.
During rehabilitation, you will work with a therapist who will teach to you perform exercises at home. For example, you might start by focusing on an object with a blank background and move your head slowly to the right and left and up and down. You would perform this exercise for several minutes two to three times per day.
If you have trouble standing or walking because of vertigo, you are at risk for falling. In older adults, falls can lead to serious complications, such as a broken hip. Talk to your physician about your concerns.
To reduce the risk of falls, get rid of hazards in your home, such as loose electrical cords and slippery rugs, and avoid walking in unfamiliar areas that are not lighted. (see
Exercises for Vertigo
It is not always necessary to visit a physical therapist. The movements that need to be done can be performed right in ones living or bed room.
Movement #1: Stand straight up and place your feet together. Your arms need to be at your side. This position needs to be held for 30 seconds. Now, sit down and rest until the dizziness subsides. Once you begin to feel better, stand up again and repeat the exercise.
Movement #2: Stand up again, place your feet together and hang your arms at your side. Swivel your head from side-to-side. Take a break then do it again. Do a set with your eyes open and then with your eyes closed.
[edited from]
"Anxiety is the dizziness of freedom."
~ Søren Kierkegaard
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