Vertigo
Background
Begin With a Key Distinction: Vertigo vs. Dizziness
Is the dizziness associated with a feeling of rotation — to where it feels like the room is spinning in a circle? Is it amplified by rapidly moving your head up and down and side to side while sitting? If yes, you have vertigo. If not you have dizziness.
If vertigo, this is usually caused by an infection or other problem affecting the middle ear.
If it begins about 2-6 weeks after a viral respiratory infection (you won’t even tie them together unless you think about it) and lasts under 6 weeks (see treatment and treat ASAP. You don’t want to put up with it for 6 weeks!), it most often is a "viral labrynthitis." It’s scary and uncomfortable, but generally benign. It goes away on its own it 6-8 weeks, or usually in under a week if treated early.
If it lasts over 6 weeks, see an ENT (Ear/Nose/Throat) physician, and other causes will be looked for, including caloric testing (put hot/cold water in each ear to see which ear is triggering the vertigo) and X-ray/MRI to look for things pushing on the nerve, such as:
- CPA or CerebelloPontine Angle tumor or vestibular schwannoma (acoustic neuroma). These are usually benign but may need to be removed.
- Meniere’s Disease. This is a buildup of fluid inside the inner ear of unknown cause. It effects over 600,000 Americans (most 40-60 years old). It is evidanced by recurrent vertigo and ringing in the ear, feeling of fullness in the ear and transient loss of hearing. It usually just affects one ear. It requires an evaluation to rule out other causes first.
- Benign positional vertigo. This is caused by the build up of crystals in the middle ear canals. The vertigo is caused by specific head movements. The Dix-Hallpike maneuver is a simple diagnostic exam for this.
- If no cause is found, treatment is symptomatic. BUT if you also have symptoms of fatigue or widespread pain (see Fibromyalgia), empiric antibiotic treatment for possible infections (including Lyme’s and others, for which testing is simply not reliable) may be needed. You will need a holistic doctor for this.
- Motion sickness.
If it is unsteadiness without a spinning feeling, then this reflects dizziness or lightheadedness. This can have many causes and requires a medical exam, especially if severe or accompanied by passing out (Syncope).
Common causes
When mild and transient:
- Low blood sugar (see Low Adrenal), with anxiety/irritability helped by eating.
- Tight neck muscles.
- Motion sickness.
- Hyperventilation.
- Orthostatic dizziness, which is transient dizziness and low blood pressure on standing. This includes POTS (Postural Orthostatic Tachycardia Syndrome) and NMH (Neurally Medicated Hypotension). If mild and transient, lightheadedness on standing is common, especially in children, and if it has been going on for months or more it is most often benign. If associated with fatigue, insomnia and "brain fog," POTS and NMH often are part of fibromyalgia and CFS.
When severe and sudden, especially if associated with passing out:
- Abnormal heart rhythms.
- Vasovagal Syncope (also called the "common faint," as when fainting at the sight of blood). This occurs from a transient slowing of the pulse and is both benign and common.
- Transient strokes.
As you can see, there are many causes, and an evaluation by ones physician is needed, even if the cause may be benign.
Treatments
Treatment depends on the cause. Once the evaluation has determined the cause, treatment is usually clear.
There are a number of areas where the doctor may not have much to offer (beyond ruling out dangerous causes, which is important).
Here are a few points:
- If the person is passed out, call 911. Lay the person down and raise their legs. Consider pouring a packet or teaspoon of sugar between their lower lip and gum.
- For general dizziness, ginger is very helpful (either as capsules or tea).
- For dizziness with standing (orthostatic) in the absence of heart disease, increasing salt and water intake is helpful. If associated with fatigue and brain fog, consider a condition called POTS.
- For low blood sugar episodes, see Adrenal.
- If associated with anxiety, see Anxiety.
- If associated with fatigue and brain fog, see Chronic Fatigue Syndrome.
- For Benign Positional Vertigo, see Dizzy Fix which is easy and side-effect free!