Vertigo is a symptom, rather than a condition itself. It is the sensation that you, or the environment around you, is moving or spinning.

This feeling may be barely noticeable, or it may be so severe that you find it difficult to keep your balance and do everyday tasks.

Attacks of vertigo can develop suddenly and last for a few seconds, or they may last much longer. If you have severe vertigo, your symptoms may be constant and last for several days, making normal life very difficult.

Other symptoms associated with vertigo may include:

  • loss of balance – which can make it difficult to stand or walk
  • feeling sick or being sick
  • dizziness

Vertigo is commonly caused by a problem with the way balance works in the inner ear, although it can also be caused by problems in certain parts of the brain.

Causes of vertigo may include:

  • benign paroxysmal positional vertigo (BPPV) – where certain head movements trigger vertigo
  • migraines-severe headaches
  • labyrinthitis– an inner ear infection
  • vestibular neuronitis – inflammation of the vestibular nerve, which runs into the inner ear and sends messages to the brain that help to control balance

Depending on the condition causing vertigo, you may experience additional symptoms, such as a high temperature, ringing in your ears (tinnitus) and hearing loss.

One type of vertigo is BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV). This is a disorder of the inner ear balance organ, the semi-circular canals . It presents as sudden, short-lived episodes of vertigo, dizziness or spinning, generally lasting less than a minute. Symptoms can be brought on by quick high movements. Rolling over in bed, looking up and down and getting in and out of bed are the most common movements to trigger symptoms.

BPPV occurs when tiny chalk like crystals called otoconia which are embedded within the inner ear become free and move around, and then get stuck in one of the canals in the inner ear balance system. Rolling over or tilting your head, these crystals move and send abnormal messages to the brain and eyes, causing spinning or dizziness. Symptoms settle within a minute on keeping your head still.

BPPV may be associated with head trauma, osteoporosis, other inner ear problems, diabetes, migraine, high blood pressure, dental surgery, or prolonged periods of time lying in bed (as a consequence of illness, surgery or preferred sleep side).

BPPV is one of the most common causes of dizziness and most cases happen for no reason. Anyone can get BPPV. Incidence increases with age, and women are twice as likely to get it than men and is more common post menopause. It can also occur after a head injury or following inner ear problems such as an infection.

Symptoms of BPPV include:

  • dizziness, spinning or vertigo
  • imbalance and a general disorientation
  • nausea and occasionally vomiting
  • headaches may occur but usually are mild
  • anxiety and avoidance behaviour may develop due to a fear of triggering or increasing dizziness
  • keeping the head still and upright stops the spinning, and if a person chooses to sleep propped up on several pillows, they may develop a stiff neck

BPPV is one of the most common inner ear problems, and for most, symptoms resolve without treatment. It is easily diagnosed and treated with simple head movements. Medication does not treat it effectively. Other tests and scans generally are not required.

The diagnosis can be made based on symptoms and the history of when and how it started, and aggravating and easing factors. The physiotherapist will perform movements of your head which may bring on symptoms and will look closely at your eye movements. This may involve your head being supported as it hangs back off the bed or is moved to different positions when you are lying  down, helping the physiotherapist chose the right treatment manoeuvre. The most common canal repositioning manoeuvre used is the Epley manoeuvre.

I am a member of the Association of Chartered Physiotherapists in Vestibular Rehab (ACPIVR). This association has excellent resources available for patients suffering with vestibular and balance issues and also gives a directory of chartered physiotherapists who treat these issues in Ireland and the UK. It is well worth looking up their website to get great information on this subject.