Vertigo is a false sensation of motion or dizziness– like the feeling of having just stepped off a rotating amusement ride. There are different types of vertigo and they can be a bit different than feeling lightheaded. Someone with vertigo may feel like they are spinning, or the world is spinning around them.
Vertigo is not a condition itself. It is a symptom of several other medical conditions. There are two different types of vertigo. Central vertigo is caused by an issue in the brain, specifically in the back of the brain (the cerebellum) or the brain stem. Peripheral vertigo is more common, attributed to 80% of all vertigo, and is caused by a problem in the inner ear that interferes with balance.
Vertigo is more than a nuisance. It can interfere with work, driving, and everyday tasks. We will look at two types of vertigo and their causes as well as treatments to help you manage your symptoms.
The semicircular canals, or vestibular labyrinth, are located within the inner ear. They sense head rotation from self-induced movements and from external forces. The vestibular nerve is also located in the inner ear. It sends messages about head position and balance to the brain. Issues in these areas can lead to peripheral vertigo, which is more common and often more severe than central vertigo.
Common causes of peripheral vertigo include:
Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo, and typically presents as frequent but brief episodes of dizziness. BPPV occurs when small crystals in the inner ear canals become dislodged and stimulate the tiny hairs in the inner ear. This stimulation confuses the brain leading to a sensation of dizziness.
The labyrinth and vestibular organs collect information about motion and changes within space and send these messages to the brain to create a sense of balance. Influenza (the common flu), measles, Epstein-Barr, and other viruses and infections can inflame the labyrinth or vestibular organs, causing labyrinthitis and vertigo symptoms (which are usually temporary.)
Meniere’s disease also affects the fluid-filled labyrinths located within the inner ear. Symptoms include dizziness and hearing loss, typically only in one ear. While the exact cause of Meniere’s is unknown, it is believed to be linked to an abnormal amount of fluid in the inner ear, possibly due to stress, genetics, or infections.
Vestibular neuritis is a condition that affects the vestibular nerve connecting the inner ear to the brain, usually as a result of infection. In addition to abrupt episodes of dizziness, someone with vestibular neuritis may experience jumping eye movements, nausea, and vomiting.
It is also possible for someone to experience peripheral vertigo after an injury to the head or from taking certain medications that may be toxic to inner ear structures. Some antibiotics and diuretics, for example, can cause dizziness and other vertigo symptoms.
The cause of central vertigo can be found in the brain. Injury or disease can lead to spinning or the sense that the room is spinning, along with nausea, vomiting, hearing loss, balance loss, and difficulty focusing the eyes.
Possible causes of central vertigo include:
As mentioned above, vertigo is always a symptom of another underlying medical issue. It is essential to discover the underlying cause of vertigo to determine the most effective way to treat it.
After your healthcare provider has confirmed a diagnosis, they may recommend physical therapy to improve vertigo symptoms. Physical therapy is one element of a comprehensive treatment plan for vertigo.
Depending upon the cause of your vertigo, your physical therapist may utilize vestibular rehabilitation therapy and/or prescribe a series of exercises to improve symptoms.
Vestibular rehabilitation therapy (VRT) is an exercise-based form of physical therapy designed to help people experiencing vertigo from a head injury, BPPV, and some vestibular disorders.
Vestibular rehabilitation has three primary components:
Even if an individual’s deficits are permanent, VRT can still improve function through something called compensation. In a medical context, compensation happens when the brain learns to engage other senses to substitute for deficiencies in the vestibular system. Through PT-aided compensation, a return to daily activities may be possible.
There are two exercises that can be helpful for those with BPPV, the most common type of vertigo. (Always check with your physical therapist or healthcare provider before attempting these exercises. They are not recommended for individuals with certain neck or back problems.)
The Epley Maneuver is designed to dislodge the calcium crystals (canaliths) that have detached from the larger fluid-filled cavity (utricle) in the labyrinth and landed in the semicircular canals. The movement of these crystals is a common cause of vertigo.
1. Begin by sitting on a bed.
2. Turn your head 45 degrees in the direction of the affected ear. (For this example, we will focus on the right ear.)
3. Lie back quickly while keeping your head turned until your shoulders are on the pillow.
4. Wait 30 seconds.
5. Without raising your head, turn it 90 degrees to the left.
6. Wait 30 seconds.
7. Turn your head and body another 90 degrees to the left onto the bed.
8. Wait 30 seconds.
9. Sit up on the left side.
Symptoms may disappear immediately after a single maneuver, or it make take a few repetitions to work. You may experience mild symptoms for a few days after the Epley maneuver. Tell your physical therapist and physician if your symptoms change or worsen.
Brandt-Daroff exercises are also commonly used to improve symptoms for people with dizziness due to BPPV. Like the Epley maneuver, the goal of Brandt-Daroff exercises is to break up and dislodge calcium crystals that cause vertigo symptoms.
1. Begin by sitting on the edge of a couch or bed.
2. Lie down on your left side while turning your head to look up. Aim to do this motion in 1-2 seconds.
3. With your head looking up at a 45-degree angle, wait for 30 seconds.
4. Sit up for 30 seconds.
5. Repeat the steps above on your right side.
6. Sit up.
It’s normal to feel light-headed after this exercise. Wait for any dizziness to pass before standing up.
Although physical therapy cannot treat the underlying condition causing vertigo, it can have a significant improvement in your symptoms. Even if vertigo is related to a permanent injury or chronic illness, PT helps your brain compensate by engaging your other senses through exercise.