Vertigo, that head-spinning, disorienting sensation that affects an estimated one in five people around the world at some point in their lives, is an often-misunderstood condition. It’s commonly confused with dizziness, and it’s also thought of as a disorder of its own, rather than a symptom of a potentially more serious medical concern.
To help straighten out some of those misunderstandings, we turned to Adrian Priesol, MD, FRCPC, Medical Director of Auditory Evoked Response Testing at Massachusetts Eye and Ear, for clarification.
What Is Vertigo?
“Vertigo is a symptom—the feeling that the person or the environment is spinning—and not a specific disorder,” Dr. Priesol says. “Many disorders can cause the symptom of vertigo, especially disorders involving the inner ear balance organ or the brain. Less commonly, cardiac, psychiatric, or systemic disorders, such as severe anemia, can cause vertigo.”
Most vertigo causes aren’t obvious to the person experiencing episodes of unsteadiness and dizziness. If you have any vertigo symptoms, especially if they occur frequently, it’s important to get a medical assessment soon.
How does vertigo differ from dizziness?
“Dizziness is an umbrella term and encompasses various experiences from true vertigo—the feeling of spinning, to lightheadedness, to the feeling of disequilibrium, to a rocking sensation.”
When you talk with a health-care professional about your vertigo symptoms, try to describe your sensations as specifically as possible. Rather than simply say you feel dizzy, try to paint a picture of what you’re feeling. For example, does it feel as though the room is spinning? Does the floor feel unsteady under your feet? Do you feel faint?
What’s typically involved in getting at the cause of a person’s vertigo?
“Since there are many different causes of dizziness, a detailed clinical evaluation is needed,” Dr. Priesol explains. “Traditionally, the quality of dizziness was considered most important, with true vertigo most suspicious for an inner-ear balance disorder, a feeling of disequilibrium most indicative of a neurologic (brain) cause, and lightheadedness indicating either a psychiatric disorder or a heart/circulation problem like low blood pressure.”
He adds that doctors now have a more sophisticated approach, with more emphasis placed on the pattern of dizziness, such as episodic versus constant dizziness, duration of episodic dizziness, and any potential aggravating factors such as head movement, position change (lying down or rolling over in bed), or standing up quickly. To narrow down the vertigo cause or causes affecting you, doctors should also consider any accompanying symptoms, such as headaches, change in vision, slurred speech, limb weakness, hearing loss, ringing in an ear, chest pain, palpitations, and anxiety/panic attacks.
What type of doctor should someone see if they experience vertigo?
“If someone develops sudden-onset vertigo, then an immediate evaluation in the emergency department of the local hospital is needed to exclude a stroke or heart disorder,” Dr. Priesol says. “Once such life-threatening conditions have been excluded, then an evaluation by their internist can help further narrow down the cause of the dizziness, and a referral may be made to an appropriate specialist, such as a neurologist, otolaryngologist, cardiologist, or psychiatrist as needed.”
Often, a specialist will arrange further testing such as magnetic resonance imaging (MRI) scan of the brain, balance testing, hearing tests, or a heart monitor, Dr. Priesol adds. Sometimes, vertigo causes may be difficult to determine and a referral to a subspecialist, such as an otoneurologist or an otologist, is needed. Otologists are surgeons and can sometimes offer specialized surgical vertigo treatment.
What are some of the more common and effective vertigo treatments and management strategies?
“Vertigo treatment depends on the cause,” Dr. Priesol says. “Many inner-ear balance disorders can be successfully treated with vestibular physical therapy. Other inner-ear disorders, such as Meniere’s syndrome, can be treated with dietary restriction—avoiding alcohol, caffeine, and spikes in salt intake—or with medication such as a water pill.”
He adds that migraine is a common neurologic cause of dizziness and can usually be helped by avoiding migraine triggers, including those related to diet, stress, and hormone levels, or with migraine-preventive medications.
“Management of any associated anxiety can be helpful as well,” Dr. Priesol says. “For certain disorders, such as Meniere’s syndrome or migraine, avoiding potential dietary triggers is often the first step in minimizing symptoms.”
