Q.  Hi, Ben! Yesterday I had another experience with vertigo.  I visited a doctor last year, and we are using a nasal spray to help make my Eustachian tubes more pliable to help pressurize when I go skiing.  I thought it was to help alleviate my vertigo issue as well.  This seems to happen a couple times a year, and it’s very debilitating.  The last two times, I’ve done the Epley maneuver, and I’ve been able to go about my day within six hours versus the normal all day in bed affair.  I’m not sure if it’s the factor that is helping.  I’m wondering if there is something else I can do to prevent this occurrence. –Amy

A.  Thanks, Amy, for your question! Vertigo is often a term used to describe many different sensations including the feeling of being dizzy, nauseous, swimmy, or lightheaded. Vertigo is a false sensation that your surroundings are moving or spinning. It can be horribly debilitating and can last from seconds to minutes to days. Although there are many potential causes of vertigo, three of the most common forms include:

• Benign paroxysmal positional vertigo (BPPV) – BPPV can occur for many reasons. The condition is characterized by its sudden onset. This occurs when the tiny crystals that are present in your inner ear get loose and float around in the fluid in your inner ear without becoming reabsorbed correctly. In my clinical experience, I have seen this occur many times after a fall or bump on the head or from tossing and turning while sleeping. Most cases are idiopathic–meaning from an unknown cause.
• Vestibular neuronitis – Vestibular neuronitis may be described as acute, sustained dysfunction of the peripheral vestibular system with nausea, vomiting, and vertigo. This disorder is characterized by a sudden severe attack of vertigo, caused by inflammation of the nerve to the semicircular canals (part of the vestibular system, which helps control balance).  Although it’s not entirely clear, vestibular neuronitis is likely caused by a virus. Hearing is usually not affected.
• Meniere’s disease – Meniere’s disease is a disorder of the inner ear that not only causes vertigo, but it’s also associated with intermittent bouts of hearing loss. This chronic condition can include permanent hearing loss; ringing in the ear (tinnitus); and fullness and pressure in the ear. This disease is most commonly diagnosed in people in the 40s to 50s age range.

When first experiencing symptoms of dizziness, it’s always wise to check with your medical doctor. If you’re suffering from vertigo, I recommend that you at least try the Epley maneuver that Amy mentioned above. It’s very simple to perform and can produce immediate results. Many YouTube videos demonstrate how to correctly perform the Epley maneuver. I recommend the following: Epley Maneuver to Treat BPPV Vertigo and Epley Maneuver: How to Perform.

If the Epley maneuver doesn’t eliminate your symptoms, then additional medical consultation will likely be needed. Your medical professional may administer the Dix-Hallpike, the associated test to be performed prior to the Epley maneuver, to determine if BPPV is present and potentially treatable.

Amy, it sounds like the Epley maneuver has been somewhat beneficial in reducing the time it takes you to feel functional again. If you’re experiencing vertigo on a regular basis, you may consider other potential causes or aggravating factors which may lead to your episodes.  If you don’t have a definitive diagnosis for the cause of the vertigo or dizziness symptoms, consider the following:

• Cervical (Neck) Dysfunction or Derangements – Skeletal muscle spasms or cervical vertebral dysfunctions associated with the upper neck, particularly along the C2/C3 (upper cervical) region, can cause dizziness symptoms.
• Dehydration – Dehydration can result from excessive alcohol, caffeine use, poor fluid intake, and other medications, including diuretic use.
• Electrolyte Imbalances – Any type of electrolyte imbalance that affects the normal sodium, potassium, and calcium levels of the body can cause dizziness related symptoms.
• Hypoglycemia – Low blood sugar is usually associated with diabetes, but anyone can experience the symptoms (which include dizziness and lightheadedness) as well as gait ataxia, slurred speech, or declining cognitive function.
• Medication Side Effects – Dizziness is a potential side effect of many commonly used over-the-counter and prescription medications. Even if you have been taking a particular medication for a long time, you can still develop a side effect. Please consult with your medical physician and/or pharmacist if you suspect a medication issue.
• Migraine Headaches – This type of headache can also be associated with vertigo and dizziness.
• Orthostatic Hypotension – This condition occurs when your blood pressure doesn’t regulate fast enough upon standing or sitting up, and it’s associated with dizziness. Please see your medical physician for treatment.
• Other Medical Conditions – Stroke, known as a cerebral vascular accident (CVA); Transient Ischemic Attack (TIA); Multiple Sclerosis; and Cerebellar Hemorrhages (brain tumors) can all cause associated vertigo or dizziness symptoms. You should be screened as necessary by your physician.
• Recent Trauma – Any trauma that affects the head or neck area could lead to vertigo. If you experience symptoms after an associated trauma, please seek competent medical advice.
• Sinus Infections – Sinus infections can cause excessive pressure to build up in the ear canal. This includes symptoms of the common cold and allergies as well. Any fluid buildup in the ear canals (whether or not associated with an infection or Eustachian tube related issues) can lead to dizziness symptoms.
• Tooth Infections – Tooth or gum infections can affect the sinus canals in both the head and face area and can lead to dizziness symptoms.
• Vertebro-basilar Insufficiency – When the vertebral artery (a critical artery to supply blood to the brain) isn’t supplying adequate amounts of blood, dizziness or a lightheaded feeling can occur. This insufficiency can be due to atherosclerosis, plaque buildup in the arteries which causes hardening and narrowing. This should be diagnosed and addressed by your physician.

Although this list of potential causes or aggravating factors isn’t conclusive, it demonstrates how complex it can be to treat dizziness and vertigo. The good news is that most of the time, the symptoms resolve rather quickly. In cases of BPPV (when the proper treatment technique is performed), the resolution of symptoms can be almost immediate. If your symptoms persist and can’t be definitely attributed to a particular diagnosis, then I strongly suggest that you seek a specialist who treats dizziness and vestibular related issues.

Thanks, Amy, for the question, and I hope you find relief from your vertigo episodes. It’s best to continually challenge your vestibular system by remaining active, and in particular, moving your head more.  For more information on dizziness and vertigo, please refer to How Do I Improve Balance? (Part I), and also consider trying the Vestibular Ocular Reflex (VOR) exercise described in How Do I Improve Balance? (Part II).

Do you know which factors might trigger your vertigo? Have you discovered a way to successfully treat your vertigo?  Additional discussion can help others to manage his/her vertigo.  Please leave your comments below.

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