Vertigo Overview (cont.)
Danette C. Taylor, DO, MS, FACN
Dr. Taylor has a passion for treating patients as individuals. In practice since 1994, she has a wide range of experience in treating patients with many types of movement disorders and dementias. In addition to patient care, she is actively involved in the training of residents and medical students, and has been both primary and secondary investigator in numerous research studies through the years. She is a Clinical Assistant Professor at Michigan State University's College of Osteopathic Medicine (Department of Neurology and Ophthalmology). She graduated with a BS degree from Alma College, and an MS (biomechanics) from Michigan State University. She received her medical degree from Michigan State University College of Osteopathic Medicine. Her internship and residency were completed at Botsford General Hospital. Additionally, she completed a fellowship in movement disorders with Dr. Peter LeWitt. She has been named a fellow of the American College of Neuropsychiatrists. She is board-certified in neurology by the American Osteopathic Board of Neurology and Psychiatry. She has authored several articles and lectured extensively; she continues to write questions for two national medical boards. Dr. Taylor is a member of the Medical and Scientific Advisory Council (MSAC) of the Alzheimer's Association of Michigan, and is a reviewer for the journal Clinical Neuropharmacology.
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
In this Article
- What is vertigo?
- What causes vertigo?
- What are the risk factors for vertigo?
- What are the signs and symptoms of vertigo?
- How is vertigo diagnosed?
- What is the treatment for vertigo?
- Are home remedies effective for treating vertigo?
- What is the prognosis for vertigo?
- Can vertigo be prevented?
- Balance Disorders - Slideshow
- Take the Vertigo Quiz
- Tinnitus: Why Are My Ears Ringing? - Slideshow
- Vertigo and Balance Disorders FAQs
- Find a local Ear, Nose, & Throat Doctor in your town
How is vertigo diagnosed?
During an evaluation for vertigo, the health care professional may obtain a full history of the events and symptoms. This includes medications that have been taken (even over-the-counter medications), recent illnesses, and prior medical problems (if any). Even seemingly unrelated problems may provide a clue as to the underlying cause of the vertigo.
After the history is obtained, a physical examination is performed. This often involves a full neurologic exam to evaluate brain function and determine whether the vertigo is due to a central or peripheral cause. Signs of nystagmus (abnormal eye movements) or incoordination can help pinpoint the underlying problem. The Dix-Hallpike test is done to try to recreate symptoms of vertigo; this test involves abruptly repositioning the patient's head and monitoring the symptoms which might then occur. However, not every patient is a good candidate for this type of assessment, and a physician might instead perform a "roll test," during which a patient lies flat and the head is rapidly moved from side to side. Like the Dix-Hallpike test, this may recreate vertigo symptoms and may be quite helpful in determining the underlying cause of the vertigo.
If indicated, some cases of vertigo may require an MRI or CT scan of the brain or inner ears to exclude a structural problem like stroke. If hearing loss is suspected, audiometry may be ordered. Hearing loss is not seen with BPPV or other common causes of vertigo. Electronystagmography, or electrical evaluation of vertigo, can help distinguish between peripheral and central vertigo, but is not routinely performed.
What is the treatment for vertigo?
Some of the most effective treatments for peripheral vertigo include particle repositioning movements. The most well-known of these treatments is the Epley maneuver or canalith repositioning procedure. During this treatment, specific head movements lead to movement of the loose crystals (canaliths) within the inner ear. By repositioning these crystals, they cause less irritation to the inner ear and symptoms can resolve. Because these movements can initially lead to worsening of the vertigo, they should be done by an experienced health care professional or physical therapist.
Cawthorne head exercises, or vestibular rehabilitation habituation exercises, are a series of eye and head movements which lead to decreased sensitivity of the nerves within the inner ear and subsequent improvement of vertigo. These simple movements need to be practiced by the patient on a regular basis for best results.
Medications may provide some relief, but are not recommended for long-term use. Meclizine is often prescribed for persistent vertigo symptoms, and may be effective. Benzodiazepine medications like diazepam (Valium) are also effective but may cause significant drowsiness as a side effect. Other medications may be used to decrease nausea or vomiting. It is should be recognized that medications can provide symptomatic relief, but are not considered "cures" for vertigo.
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