What Exactly Is Vertigo — And Can You Treat It?
You know that feeling after you’ve been on a boat, when your feet finally touch dry land again, but you still feeling like you’re riding the waves? That’s the sensation someone with vertigo feels—except worse.
“The definition of vertigo is an illusion of movement that is not there,” says Dr. Catherine Cho, clinical associate professor of neurology and otolaryngology at NYU Langone Health.
That can manifest in a couple of ways: There’s rotational vertigo, which is basically a sudden onset of the spins (a.k.a. your worst hangover experience ever) and tends to send people to the ER.
And there’s translational vertigo, where you feel like you’re moving side to side (slightly less alarming, but it would make you certifiable after dealing with it for weeks or even years).
As many as 35 percent of American adults ages 40 and up—that’s approximately 69 million people—have experienced some form of vestibular dysfunction (or issues with the parts of the inner ear and brain that control balance), according to the .
And FYI: The spins aren’t the only vertigo symptoms you need to worry about. Nausea, vomiting, difficulty with balance, minor headaches, ringing ears, and fatigue can come with vertigo. You might also experience nystagmus, a condition that causes the eyes to jerk or bounce around, says Cho.
What Causes Vertigo?
The most common culprit is benign paroxysmal positional vertigo (BPPV), says Cho. That’s when there’s damage to the inner ear, or an interruption of the function of the ear.
“There are little crystals in your ear that act as weights so that your brain can detect translational movement like moving forward or backward or tilting your head up or down,” Cho explains. “Sometimes those crystals break off—we don’t know exactly why, but it’s generally trauma in younger patients or just age-related conditions—and go into the ear canals, which detect rotational movement.”
Those tiny crystals might move around in your ear canal even when you’re not moving. This can irritate your nerve endings, and that can cause you to feel like the room is spinning, Cho says.
BPPV is very position-dependent—if you lie down and turn to one side, within 10 seconds you’ll feel a violent spinning sensation in all directions. The sensation tends to last for about a minute, but it can feel like a treadmill minute: endless. Otherwise, though, you’re fine—maybe just a little woozy.
The second most common cause is a disorder called vestibular neuritis or labyrinthitis, which affects the vestibulocochlear nerve of the inner ear. “The major difference is that this condition involves your hearing,” says Cho. “And if your hearing or ear pain is involved, you should go to the ER immediately, because it could mean there’s an infection.” With vestibular neuritis, that spinning sensation will be constant.
And there’s one rare potential cause: Meniere’s disease. “Meniere’s is an inner-ear disorder characterised, in terms of vertigo, by episodes—anywhere from 20 minutes of vertigo to a whole day,” says Cho.
This condition is also independent of position, and you might feel hearing loss or ear fullness, like you’re wearing noise-canceling headphones, and ringing in the ears at the same time. “It’s not necessarily an emergency, but if you’re experiencing these symptoms, it’s safer to go to the ER because hearing loss could mean an infection or even a stroke.”
That all sounds utterly miserable, right? Fortunately, there are treatment options for all kinds of vertigo. “With BPPV, a lot of people get medicines when they really don’t need them,” says Cho. “The fastest way to get rid of it is to do the Epley maneuver for the correct ear.”
The Epley maneuver is a simple neck maneuver your physician or physical therapist does to move the crystals back to where they belong (just make sure you go to a physician that feels comfortable doing this or look up a vestibular therapist—a physical therapist that specialises in vestibular disorders).of people recover from BBPV with the Epley maneuver, typically within three to five days, according to the .
Treatment options for Meniere’s and vestibular neuritis are really about managing the symptoms. First, a vestibular therapist can help you train your brain to adapt to any vestibular issues and regain your balance. And then there are medical options: “I like to use a very, very low dose of diazepam (or Valium) to suppress the vestibular system, treats the anxieties associated with being uncontrollably dizzy, and it treats nausea,” says Cho.
“You also want to treat the underlying disorder, so generally you see an ENT or a neurologist who can diagnose and treat you with diuretics to reduce fluid retention,” says Cho. “When it gets really bad, they can inject steroids into the ear; surgically decompress the endolymphatic sac, which regulates inner ear fluid levels; or even cut the vestibular nerve—a last resort, as it could result in hearing loss.”
If you ever experience the spins (and not after a night of drinking), chances are you don’t need to be too alarmed; but don’t write it off as general dizziness or lightheadedness if you experience any of the symptoms mentioned above. Vertigo can a red flag for more serious ear issues, and it’s better to play it safe and head to the doc rather than risk your hearing.
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