A sudden bout with dizziness can make you feel unsteady and like the world is spinning around you. Balance-related conditions are among the most common health complaints among people over the age of 40, with vertigo being one of the most common symptoms.
“Vertigo is a term to describe the sensation of movement when there is no actual movement,” says Timothy Bushyhead, D.O., a family medicine physician at Ascension St. John.
Vertigo is categorized into two types: central vertigo involves a dysfunction in the central nervous system while peripheral vertigo involves a problem with the inner ear or vestibular nerve.
“If vertigo occurs only when you move, it is most likely linked to the ear,” says Bushyhead. “If vertigo is constant, even when sitting still, it is less likely to be related to the ear.”
Peripheral vertigo accounts for approximately 80% of all vertigo cases, according to the American Medical Association (AMA). Its most common forms are Benign Paroxysmal Positional Vertigo (BPPV), vestibular neuritis and Meniere’s disease. Triggers can include inflammation or infection, a mechanical issue within the semicircular canals or fluid buildup, though the exact cause often remains uncertain.
Diagnosing vertigo typically begins with your primary care physician and may expand to include a cardiology evaluation, physical therapy and advanced diagnostics by an audiologist or ear, nose and throat (ENT) physician.
“Primary care providers often start with a focused physical exam of the heart, ears, nose, throat and review of blood pressure and pulse,” says Bushyhead. “If compelling, they also perform the Dix-Hallpike maneuver. This involves changing the position of the torso and head while monitoring the eyes for signs of abnormal movement and/or reproduction of the vertigo symptoms.”
Anne E. Hogan, Ph.D., CCC-A, is an audiologist at Ascension St. John ENT. She says vertigo patients typically receive a hearing test and a video nystagmography (VNG), and for positional vertigo like BPPV, the treatment is often quick and simple. After triggering the dizziness with a Dix-Hallpike maneuver, the patient then moves slowly through a series of positions, the Epley maneuver, to remove the debris (otoconia) from the semicircular canal.
“It’s similar to moving snow in a snow globe,” says Hogan, adding that patients can often perform this on their own if symptoms return.
When permanent vestibular damage has occurred, Vestibular Rehabilitation Therapy (VRT) is used – a longer process rooted in exercises developed by Drs. Cawthorne and Cooksey in Britain over 80 years ago.
“The exercises incorporate eye and head movements of increasing difficulty to help recalibrate the brain after a vestibular injury,” says Hogan. Examples of these exercises begin with staring at a fixed point while slowly moving the head up, down and side to side while seated, and progress to tracking a moving target while simultaneously moving the head in the opposite direction, while walking or standing on an uneven surface. For safety, Hogan cautions patients to not attempt this while home alone.
Bushyhead says primary care providers often prescribe medications to help manage symptoms and improve one’s quality of life, but these do not consistently resolve the issue or treat the underlying cause. Instead, if symptoms persist or worsen, it’s a collaboration with audiology, ENT and physical therapy that is far more successful than any single approach.
“Ultimately, it is important to remember the basics when ill, regardless of diagnosis: stay well hydrated, keep a record of your symptoms when presenting to any provider and the health you carry into illness is always your best predictor of outcome,” he says.
