Vertigo: Causes, Symptoms & Treatment
Vertigo is not a fear of heights, contrary to popular opinion.
Credit: Deklofenak | Shutterstock.com

Immortalized by the 1958 Alfred Hitchcock film of the same name, "vertigo" is a frequently misused term. Many people mistakenly say "vertigo" when they mean fear of heights or simple dizziness. In medical circles, though, vertigo refers specifically to a false sensation of movement. 

The University of Maryland Medical Center defines vertigo as, "the perception of motion when no movement is present, or the abnormal perception of motion in response to movement." Acrophobia, not vertigo, describes a fear of heights. The two conditions can interact. For example, being at a high altitude, looking down from a high perch or gazing up at a tall object can cause the swirling sensations of vertigo. Those vertiginous feelings can contribute to a fear of heights.

Several other types of movement, such as walking, or changes in visual perspective (gazing out a car window, for instance) can also trigger vertigo.

The problem lies in the inner ear. The inner ear helps to regulate balance, and when it isn't working properly, a person can become dizzy. A person may also experience hearing issues or increased dizziness when the head is tilted in certain positions. 

The most common type of vertigo is benign paroxysmal positional vertigo (BPPV), according to the Mayo Clinic. There is usually no known cause for BPPV, but it can sometimes be caused by a minor to severe blow to the head, damage to the inner ear or prolonged lying down. 

BPPV is often triggered by tipping the head a certain way. Or, calcium carbonate crystals (which are normally part of the body's balancing mechanism) may come loose and bounce around in the inner ear, triggering the balancing mechanism incorrectly, according to the University of Iowa.

Common inner ear problems that produce vertigo are vestibular neuritis, which is usually a viral infection of the nerve that is most important in regulating your balance; and Meniere disease, which is a disorder that may result from a change in fluid pressure and salt concentrations in the inner ear, said Dr. Andrew Tarulli, a neuromuscular neurologist at Overlook Medical Center's Atlantic Neuroscience Institute in Summit, New Jersey.

There are many other causes of vertigo. Problems affecting the brainstem, which is where the body's balance center is located, can also result in dizziness, said Dr. Howard Derman, a neurologist with Houston Methodist hospital. Dehydration, motion sickness, certain medications and sudden drops in blood pressure can also cause vertigo.

"Other causes of vertigo include multiple sclerosis, strokes and brain tumors (both benign and malignant), but the majority of vertigo cases are caused by inner ear issues," said Derman.

Vertigo most often strikes the elderly and is experienced by women more than men. About 30 percent of people over 60 years old have problems with vertigo. Falls, often caused by dizziness, is the leading cause of accidental death in people older than 65, according to a paper published by the journal Frontiers in Neurology.  

For the most part, symptoms of vertigo are harmless and fleeting. Vomiting and nausea frequently accompany vertigo and are typically nothing to worry about. 

"Some symptoms of vertigo that are dangerous (i.e. due to a brain rather than inner ear problem) include double vision, slurred speech, weakness or numbness of the face, clumsiness, and falls," said Tarulli. "If these symptoms occur, a patient should be evaluated immediately in the emergency room for dangerous causes of their vertigo."

Some people may experience vertigo once and not have a problem with it again. Continuous bouts of vertigo may be a sign of a medical problem, though. "If vertigo persists, then the person should see either their primary care physician, a neurologist or an ear nose and throat specialist for treatment or possible testing," said Derman.

Treatment for vertigo depends on the cause, and can vary from prescribed head movements to medication or surgery. During treatment, the medical professional will use the patient's medical history to look for causes and will perform examination to diagnose vertigo. 

"It is helpful for a doctor to know what provoked the vertigo and what made it better, whether you have been sick recently, whether there is hearing loss or fullness in your ears, and whether there are warning symptoms (including double vision, slurred speech, weakness or numbness of the face, clumsiness, and falls)," said Tarulli. 

In many cases, the medical professional will attempt to cure or treat the cause of vertigo. Changes in diet, avoiding nicotine and head-tilting exercises, which can often be done at home, can also help. BPPV is treated with particle-positioning maneuvers, which involve exercises that position the head so that loose calcium carbonate crystals will reposition inside the inner ear.

In the case of vestibular disorders, vestibular rehabilitation therapy (VRT) may be prescribed. This type of physical therapy uses specific head, body, and eye exercises designed to retrain the brain to recognize and process signals from the vestibular system, according to the Vestibular Disorders Association

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