What Causes Vertigo Symptoms?

Vertigo is a type of dizziness in which people feel as if they are moving or as if the room is moving around them, even if they are still.

Symptoms of vertigo include:

• Feeling as if you are
  • Spinning (or the room is spinning around you)
  • Tilting 
  • Swaying
  • Off balance
• Symptoms can come and go and last for seconds to days
• Changing position, moving the head, coughing, or sneezing may worsen symptoms

Depending on the cause, other symptoms may also occur including:

• Nausea 
• Vomiting
• Headache 
• Sensitivity to light and noise
• Double vision
• Trouble speaking or swallowing
• Weakness
• Shortness of breath
• Sweating
• Tinnitus
• Racing heartbeat

Vertigo is diagnosed with patient history and a physical exam. The doctor will usually test:

• Eyes
  • Follow an object with your eyes
  • Focus on something while moving your head from side to side
• Balance and gait 
  • The doctor will watch you walk, to see if you lean or tilt to one side
  • Balance check while you stand still
• Hearing 
• Additional tests may include a magnetic resonance imaging (MRI) scan of the brain

The goal of treatment for vertigo is to address the underlying cause, relieve symptoms, and aid in recovery.

If the cause of vertigo is known, treatments may include: 

• Benign paroxysmal positional vertigo (BPPV)
  • Often goes away on its own
  • It May be treated with a procedure called canalith repositioning (also called the Epley maneuver) that moves the head in specific ways to move the calcium to a part of the inner ear where it will be reabsorbed 
• Meniere disease is a lifelong condition but it may be treated with:
• Lifestyle changes
  • Diet: avoid salt, monosodium glutamate (MSG), caffeine, and alcohol
  • Don’t smoke
• Medications
  • Medicines to treat dizziness and nausea 
  • Diuretics
  • Steroids
  • Exercises to help with balance 
  • Surgery in severe cases
  • Hearing aid, for permanent hearing loss
• Migraine headache treatments can also treat vestibular migraine
  • Pain relievers
  • Triptans
  • Triptans combined with nonsteroidal anti-inflammatory drugs (NSAIDs) 
  • Antiemetics (anti-nausea medications)
  • Lasmiditan (Reyvow), a selective serotonin 1F receptor agonist 
  • Calcitonin-gene related peptide (CGRP) antagonists
  • Ergots
  • Neuromodulation 
  • Transcranial magnetic stimulation (TMS) 
  • Noninvasive vagus nerve stimulation 
  • Opioids and barbiturates should not be used, except as a last resort 

Medications used to treat vertigo may include:

• Antihistamines
  • Meclizine (Antivert)
  • Dimenhydrinate (Dramamine) 
  • Diphenhydramine (Benadryl)
• Antinausea medicines 
  • Ondansetron (Zofran)
  • Promethazine (Phenergan)
  • Metoclopramide (Reglan)
• Benzodiazepine sedatives 
  • Diazepam (Valium)
  • Lorazepam (Ativan)
  • Clonazepam (Klonopin)

Other treatments for vertigo may include: 

• Vestibular rehabilitation
  • Works to help the brain adjust its responses to changes in the vestibular system and to help train the eyes and other senses to “learn” how to adapt
  • A physical therapist teaches patients exercises to do at home
• Manage the environment and reduce the risk of falls
  • Falling is a hazard for people with vertigo
  • Get rid of household hazards such as loose electrical cords, slippery rugs, and clutter
  • Wear sturdy shoes
  • Avoid walking in unfamiliar and dark areas