Vertigo: Beyond the Dizziness

You may have seen Roy Williams, men’s basketball coach for the UNC Tarheels, collapse during a game a few weeks ago. There was a lot of initial speculation about his condition, but he later confirmed that he has vertigo.
Vertigo is a form of dizziness. It’s a helpless feeling of a sense that everything around you is spinning. And if you’ve ever experienced it, it can be absolutely debilitating. When you experience vertigo, you get a sensation of disorientation or motion. Think of it as being motion sick, but you’re not moving. Dizziness can be accompanied by nausea or vomiting, sweating, or abnormal eye movements. Some people have had symptoms that include hearing loss, ringing in the ears, weakness, difficulty seeing, decreased level of consciousness, and difficulty walking. Symptoms can last from minutes to hours, and symptoms can be chronic or episodic.
What causes vertigo?
Vertigo can be the result of sudden head movements, inflammation within the inner ear due to ear infection, tumors, Miniere’s disease, decreased blood flow to the brain, head trauma and neck injury, pregnancy, migraine headaches, complications from diabetes, or multiple sclerosis.
Meniere’s disease is composed of symptoms including episodes of vertigo, ringing in the ears (tinnitus), and hearing loss. People with this condition have the abrupt onset of severe vertigo and fluctuating hearing loss as well as periods in which they do not experience any symptoms. The cause of Meniere’s disease is not fully understood but is thought to be due to viral infections of the inner ear, head injury, or allergies . While vertigo itself is not contagious, Miniere’s disease can be part of your heredity.
Diabetes has a number of complications and one of them is hardening of the arteries which can lead to lowered blood flow to the brain, causing vertigo symptoms.
Changes in hormones during pregnancy along with low blood sugar levels can cause pregnant women to feel dizziness or vertigo, especially during the first trimester. In the second trimester, dizziness or vertigo may be due to pressure on blood vessels from the expanding uterus. Later in pregnancy dizziness and vertigo may be caused by lying on the back, which allows the weight of the baby to press on a large vein (vena cava) that carries blood to the heart.
How do you treat vertigo?
Any signs and symptoms of vertigo should be evaluated by a doctor. The majority of cases of vertigo are harmless. Although vertigo can be debilitating, most causes are easily treated with prescription medications and sometimes over-the-counter medications. Have a doctor check any new signs and symptoms of vertigo to rule out rare, potentially serious, or life-threatening causes. The source of vertigo may be not the ears or balance system and it is very important to rule out other life-threatening causes first.
Commonly prescribed medications for vertigo include the following:

  • meclizine hydrochloride (Antivert)
  • scopolamine transdermal patch (Transderm-Scop)
  • promethazine hydrochloride (Phenergan)
  • metoclopramie (Reglan)bon
  • odansetron (Zofran)
  • diazepam (Valium)
  • lorazepan (Ativan)
  • clonazepam (Klonopin)
  • prednisone

Some over-the-counter (OTC) medications  may also be recommended by your doctor or pharmacist for vertigo, including:

  • diphenhydramine (Benadryl)
  • dimenhydrinate (Dramamine)
  • meclizine (Bonine)

These medications should be taken only as directed and under the supervision of a doctor. Many of these medications can cause drowsiness and should not be taken before driving or working. Talk to your pharmacist to make sure that none of these medications will be counteract other medications that you are taking.
Sometimes, if medications do not work, you may find relief with vestibular therapy through a physical therapist. Vestibular rehabilitation exercises consist of having the patient sit on the edge of a table and lie down to one side until the vertigo resolves itself followed by sitting up and lying down on the other side, again until the vertigo ceases. This is repeated until the vertigo no longer occurs. Another treatment method is called the particle repositioning maneuve. This treatment is based on the idea that the vertigo is caused by displacement of tiny stones in the balance center (vestibular system) of the inner ear. The head is repositioned to move the stones to their normal position. This maneuver is repeated until the abnormal eye movements are no longer visible.
How do you prevent vertigo?
You may be able to prevent some forms of vertigo by limiting sudden movements. For example, get up slowly from your bed or chair.
If you have other risk factors for stroke, controlling high blood pressure and  high cholesterol can help. Stop smoking, too.
Those with Meniere’s disease should limit salt in their diet.
If your balance is affected by vertigo, take precautions to prevent injuries from fall.