Ask Dr. Pat

Dr. Pat Consults: Vertigo—Causes, Symptoms, Diagnosis, and Treatment

 

Diagnosis and Treatment

If you experience significant vertigo that lasts longer than a few minutes, you should be evaluated urgently by a physician. If the symptom is associated with any other neurologic deficit, like difficulty speaking or swallowing, double or blurry vision, numbness or weakness, or incoordination, you should be seen immediately, as this could be a sign of a stroke.

During the evaluation, the doctor will do a complete physical and neurologic exam, and do some specific tests of your balance and movements of your eyes. A physical test called the Dix-Hallpike and/or head impulse tests (see video below) are generally done. If there is any concern that a stroke or some other more serious problem is present, an imaging test can be performed, usually an MRI or CT of the head. However, these tests are often not necessary and should only be performed when indicated.

In the initial period, vertigo is frequently treated with a few different classes of medications:

  • Antihistamines, especially meclizine, which appears to suppress the nerve signals from the inner ear.
  • Antiemetics, including prochlorperazine and metoclopramide, which generally treat the severe nausea associated with the vertigo.
  • In refractory cases, benzodiazepines, such as lorazepam and diazepam, which can both relieve the vertigo and the frequent anxiety associated with it by decreasing the excitability of neurons in the brain.

The Epley maneuvers (video below) often successfully relieve the symptoms immediately in patients with BPPV. Chronic symptoms can be managed with the medications above–although benzodiazepines should be avoided, if possible, due to dependence that can develop with chronic use. Sometimes treatment with steroids is appropriate when an inflammatory cause is suspected. Physical therapy, specifically vestibular therapy, is the most important treatment to make chronic symptoms manageable.

Dora, do see a specialist in vertigo at the university medical center. After a thorough evaluation you may find ways to cope with these symptoms of vertigo and be able to improve your quality of life.

 

 

References

Lipton, R. B., Stewart, W. F., Diamond, S., Diamond, M. L. and Reed, M. (2001), Prevalence and Burden of Migraine in the United States: Data From the American Migraine Study II. Headache: The Journal of Head and Face Pain, 41: 646–657. doi: 10.1046/j.1526-4610.2001.041007646.x

Vuković, V., Plavec, D., Galinović, I., Lovrenčić-Huzjan, A., Budišić, M. and Demarin, V. (2007), Prevalence of Vertigo, Dizziness, and Migrainous Vertigo in Patients With Migraine. Headache: The Journal of Head and Face Pain, 47: 1427–1435. doi: 10.1111/j.1526-4610.2007.00939.x

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  • Louise Eldridge August 4, 2015 at 9:17 am

    My first episode last a few minutes, second one required an ambulance and a 3 day hospital stay with no vision in one eye and I was walking sideways due to loss of balance. Now, a year later, my head feels like a ‘bobblehead’. I have lost much of my peripheral vision, and am now seeing an ENT, who has prescribed exercises moving my head back and forth staring at an object. Also walking a balance beam width on the floor with eyes closed. He has determined after a year of testing that I have vestibular neuronitis. I am thankful I have improved this much, as a year ago, this was very scary.

    Reply
  • Jan-Michael August 4, 2015 at 7:54 am

    I have primary progressive MS am age 64 diagnosed at age 50. I last year was suddenly “sucked” to floor in a nano-second. I felt glued to floor and managed to get o a couch…the room was spinning though I had eyes closed. I now take Serc 2 twice daily. I had started to lower to once per day but as falls are back I am back to 2xpd. My ear on right feels full, my head seems inflated but without headache. I also have a feeling of pain in high area of right nostril so will see ENT doctor. I am able to walk carefully but have a walker in the house car and outside.

    Reply
  • Andrea July 27, 2015 at 12:25 pm

    Thank you Dr.Allen (Pat and Baxter) for an informative article !! I know several women experiencing these symptoms and have no information available.

    Reply
  • Jane Lockett July 27, 2015 at 7:32 am

    In addition there is Postural Orthostatic Tachycardia Syndrome. (POTS) or dysautonomia. How can you tell the diference between vertigo and dysautnomia without medical tests like tilt table and blood tests? This set of symptoms can be similar to vertigo at some point, and then change.

    Reply