Vertigo, Causes and Treatments Ronald Grisanti D.C., D.A.B.C.O., M.S. People with vertigo may have sudden sensations of spinning or whirling motion that may be accompanied by lightheadedness and loss of balance, and less often by sweating, fatigue, nausea, and vomiting. What Causes Vertigo? Vertigo is most commonly caused by a problem with the balancing mechanism in the middle ear. This is a coiled tube of fluid that lies behind the eardrum called the labyrinth. Viral infections such as a common cold or flu can spread to the labyrinth (labyrinthitis). Less commonly, labyrinthitis is caused by a bacterial infection of the middle ear (otitis media). Short but recurrent attacks of vertigo are often caused by benign positional vertigo. This type of vertigo may also follow a viral infection, or can develop following inflammation or damage to the middle ear. It commonly affects older people, and can be brought on by a sudden movement of the head, such as turning rapidly. The most common form of vertigo is benign positional paroxysmal vertigo (BPPV), in which brief attacks are brought on by certain changes in head position Possible Causes: • Vertigo is felt to be caused by a viral infection of the balance nerve that runs from the inner ear to the brain. Some patients will report having an upper respiratory infection (common cold) or a flu prior to the onset of the symptoms of vestibular neu-ronitis. • Drug reactions • Head injury • Arthritis in the neck - this disorder is usually confined to older people, and can be brought on when the head is turned or tilted. • Poor circulation - may lead to vertigo if insufficient blood reaches the part of the brain that controls balance. • May be associated with impaired glucose metabolism/high triglycerides Vertigo may also be associated with: • Sinusitis • Migraine headaches • Hypothyroidism • Diabetes • Panic attacks • Food allergies Other Considerations in Vertigo Treatment Be Careful with Salon Shampoos Head positions that bring on sudden, acute attacks of vertigo, particularly bending the neck back while looking up, should be avoided. In one report, for example, the head position used in salons for shampooing hair was associated with the onset of vertigo. Trigger Points in Neck Muscles Trigger points are thought by most authorities to potentially cause pain and abnormal function in other parts of the body including vertigo symptoms. Also known as myofascial pain dysfunction (MPD), this condition, when it affects certain muscles of the head and neck, has been associated with vertigo Certain chronic or repetitive body positions may produce painful nodules, calledtrigger points, in the muscles of the head and neck, which can lead to dizziness and possibly vertigo. • These positions include forward bending of the neck as when sleeping on two pillows, backward neck bending as when painting a ceiling, and turning the neck to one side as in some reading positions. Trigger points appear to develop as the result of injury, poor posture, structural abnormalities of the leg or pelvis, emotional tension, and other body stressors. Musculoskeletal healthcare specialists and other practitioners can often treat MPD with a variety of natural therapies, including deep pressure massage. Traditional Medical Approach: Over the counter medication such as dimenhydrinate (Dramamine), meclizine (Bonine), and cyclizine (Marezine) may be helpful. Prescription medications include anticholinergic drugs, such as scopolamine (Transderm Scop), prochlorperazine (Compazine), and meclizine (Antivert), as well as sedatives, including diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax). Natural Alternative Approach Vinpocetine A preliminary trial showed that 15 mg per day of vinpocetine had a moderate or greater effect on reducing the signs and symptoms of vertigo in 77% of patients with this condition. B6 Two preliminary human studies reported that vitamin B6 supplementation reduced symptoms of vertigo produced with drugs in a laboratory setting.23 Vitamin B6 supplementation has not been studied in BPPV or other forms of vertigo and may not share the same causative mechanism as experimentally induced vertigo. Herbal Treatments Ginkgo biloba In a preliminary clinical trial, Ginkgo biloba (GBE) significantly reduced symptoms of vertigo in a group of elderly people with mild cognitive impairment.Participants were given 40 mg three times per day for one year. GBE has also been reported to significantly reduce vertigo of unknown cause in preliminary25 and double-blind trials. The amounts given were 120 mg and 160 mg per day, respectively, for three months. Ginger Ginger (Zingiber officinale) root in a single application has been reported to significantly reduce symptoms of vertigo in one double- blind trial. Vestibular Exercises: Numerous preliminary reports suggest certain vestibular rehabilitation exercises may help some cases of vertigo. While vestibular rehabilitation exercises may be done at home, initial guidance by a qualified practitioner is necessary. The Particle Repositioning Maneuver Technique Vertigo appears to be caused by an accumulation of free-floating cell fragments in the fluid of the inner ear Certain manipulation therapy maneuvers, referred to as particle repositioning maneuvers (PRMs), are intended to relocate this debris to a harmless location, in order to improve symptoms. Most studies report that over 90% of people with BPPV treated one or two times with PRM respond to this treatment, although up to 45% may develop BPPV again within a few years, requiring further treatments. Dr. Grisanti's Comments: Although there are a number of non-drug approaches to the treatment of vertigo, it is important to rule out any underlying causes which may be a factor in your symptoms. I would suggest that you request your doctor investigate the following potential causes before you decide to self-treat. • Head trauma or Cranial Lesion • Viral/bacteria infection via blood tests • Drug Interaction or side effects- review the potential side effects of a new drug and be certain that vertigo or dizziness is not one of the side effects • Poor circulation • Abnormal glucose metabolism This is where I would suggest you start. Ruling out the above is a wise first start.