Vertigo and Its Treatment

Caroline Choe

In our everyday lives, we almost take for granted this idea of balance or
equilibrium that is maintained within our bodies. In general, no real thought
processes are required. It is only when something is disturbed within our
balance system that one is able to take notice of changes in the equilibrium.
There may be several different factors that cause a disturbance to our bodies.
One major area pertains to dizziness. Dizziness is found to be "the chief
complaint in 8 million physician visits a year"(1). Vertigo is one type of
dizziness, causing illusions of movement, that is being researched more and
more today because of its widespread symptoms.

In order to better understand vertigo, it is first necessary to look into where

equilibrium and movement are maintained within the body. Equilibrium in our
bodies is coordinated primarily by the brain, specifically at the brainstem,
located in the neck area. The environment provides the information necessary
for the equilibrium center to determine which position to place the body in.
There are three main places in which information is received: the eyes provide
visual information, the ears provide vestibular and auditory information, and
the articulations provide proprioceptive information. In general, the eyes help
position the body according to different horizontal angles in relation to the
ground. The ears allow the body to acknowledge any type of movement, such
as acceleration or deceleration, by registering various sounds (1). Movement is
also processed in parts of the brain, as well as in the ears. The frontal lobes of
the brain initiate and coordinate the planning of movements. The basal ganglia,
in the ears, add control and fluidity to movements, and the cerebellum
processes information from and to the rest of the body.

Vertigo is a classification under dizziness that results in a spinning sensation or

illusion of movement. (Many people who experience dizzy sensations often do
not have vertigo, but instead, are found to have the common lightheadedness).
Vertigo arises from disturbances in the vestibular system or neural structures
such as the cerebellum, the brain stem, and the proprioceptive fibers along the
spine.

Symptoms of vertigo include "an unsteadiness sensation when walking, rotary

sensations, a sensation of being afloat on the air, feeling of a hollow space in
the head, etc" (2). Some autonomic symptoms such as sweating, nausea, and
vomitting are found to accompany vertigo attacks (3). Also, another symptom
found is nystagmus. This is when the eyes move about involuntarily. These
symptoms and sensations can occur at different random times and last
temporarily, or they can be persistent and last permanently. The vertigo
problem can be dervived from the ear or the brain. If it comes from the ear, it is
termed peripheral. Peripheral causes of vertigo include Meniere's Disease, ear
trauma, labyrinthitis, and Vestibular Neuronitis (1). On the other hand, if the
problem comes from the brain, then it is called central. Central causes of
vertigo include stroke/or tumor in the brainstem, multiple sclerosis, migraine,
drugs (sedatives), panic or anxiety, and head trauma. Peripheral dizziness can
be seen to be less severe of the two because it does not severely affect the
brain.

There are three main types of vertigo: spontaneous vertigo, recurrent attacks of
vertigo, and positional vertigo. In order to distinguish what type of vertigo an
individual might have, certain tests are conducted. These tests include a head
CT, a MRI scan of the head, caloric stimulation (testing eye reflexes), and an
EEG (auditory potential stidues). Normally, treatment is not necessary,
especially for symptoms that last for a short time. Out of the three, the most
common type of vertigo is the positional vertigo (4). This is the disorder where
with particular head positions, an abnormal sense of movement is felt. Some
head positions include lying on one side or turning your head back. In these
positions, one might get the sensation that the room around you is moving, or
that you are moving. Positional vertigo is initiated by the position of the head,
while in other types of vertigo, initiation is through movement of the head .
vertigo (4)

The "postsuperior part of the temporal lobe" of the brain is the consciousness
area of the brain. It is in this area that the thinking processes and higher
learning functions like reading, speaking, writing are hindered due to the
attention disorders that are found with vertigo. It is interesting to note that
vertigo, as well as other types of dizziness, gives one the feeling of "imminent
death". Although vertigo has not been found to lead to death, it continues to be
an impediment for those trying to carry out normal daily activities (2) .

Within the body, there are four types of neurotransmitters of the vestibular
system that help to control the effects of vertigo. The first is histamine.
Histamine generally counteracts motion sickness. The second, norepinephrine,
controls the intensity of reactions to vestibular stimulation. Third, dopamine
affects vestibular compensations, and lastly, seratonin works in bringing down
nausea (5) .
Many different types of treatment are being used to help treat those with
vertigo. Often, vestibular suppressants and antiemetic drugs are given to
patients. Vestibular suppressants are drugs that reduce nystagmus, which is
caused by an imbalance in the body. Antiemetics are used to control nausea.
Other drugs used are anticholinergics, antihistimines, and sedative hypnotics.
Anticholinergics help to increase motion tolerance. Chemicals with
anticholinergic effects are vital to treating vertigo (3) .

Another option for individuals with vertigo is to have surgical treatment

performed. Surgical treatment of vertigo is done very few times a year, and is
generally not prescribed for patients. There are two categories of surgical
treatment. The first is corrective surgical treatment. In many cases, "the process
of diagnosis is controversial, or the treatment itself is controversial" (6) .
Therefore, the second treatment is more frequently administered. The second
process is termed destructive surgical treatment. The word destructive is used
to point out that these types of procedures are done to eliminate vertigo.
However, in the process, hearing may be lost. When medical treatment or
vestibular rehabilitation is not adequate to control the vertigo, patients often
take this option. This treatment is done frequently with patients who have
Meniere's disease, those with a disorder in the middle ear who suffer with
vertigo or dizziness symptoms (7).

Current research is providing new insights to more useful and effective medical
treatments for vertigo patients. There is hope that new antiemetics, those that
are 5-HT3 antagonists (such as ondansetron, Zofran, and Kytril), will be more
reliable in treating the nausea that comes with vertigo. Antiemetics have not yet
been found to be effective in suppressing motion sickness (8) . The major
concern with these new medications is that they are extremely high in cost and
are therefore not prescribed on a normal basis.

Several other new agents are also being tested for treatment of vertigo.
Although all the effects of these new drugs have not yet been confirmed, there
is growing hope and promise for many vertiginous individuals. On the top of
the list are calcium channel blockers, ie. flunarizine, cinnarizine, and
verapamil. They are currently being used outside the US. Verapamil has
"strong constipating effects", but this effect may aid in controlling diarrhea that
results from vestibular inbalance. Calcium channel blockers are advantageous
in that they carry anticholinergic and antihistiminic activity. There is ongoing
research in trying to discover the importance of calcium channel blocking. So
far, these agents have been used primarily on individuals with Meniere's
disease, in hopes of alleviating migraine attacks. Many of the individuals tested
have found these new drugs effective. The U.S., however, has not yet approved
of these new chemicals (8).

Another agent being studied is the sodium channel blocker, specifically

phehytoin (Dilantin). This drug is found useful against motion sickness,
although further studies are still required. Another sodium channel blocker is
Neurotin. This has been used to suppress nystagmus. Other promising agents
include anticonvulsants and steroids, which reduce the duration of the
vertiginous episodes (8) .

Although vertigo is not a fatal disorder, it continues to plague many individuals

by giving them symptoms of dizziness along with other unsteady sensations of
movement. Ongoing studies are starting to open new paths of treatment,
especially with drugs such as antiemetics, calcium channel blockers, and
sodium channel blockers. Even though many of these new treatments have yet
to be approved, there is definitely an optimistic outlook for these individuals.
If fear of vertigo keeps you away from giant wheels at amusement parks and breath-taking views
from a height, then scientists suggest some simple head movements that will keep dizziness at bay
and will help you join the fun!

Till date, scientists don't know which of the many available treatments for vertigo works best. Now,
a review of study data by Harvard Women's Health Watch has found the most effective therapy is a
safe, easy sequence of head movements.

Vertigo is not just the average dizzy spell, it's actually a false sense of motion-a feeling of tilting,
spinning, or swaying when you're not actually moving. It's often accompanied by nausea, vomiting,
and sweating.

Benign paroxysmal positional vertigo (BPPV), the most common form, occurs mainly in people ages
60 and over, mostly women, and is triggered by certain changes in position, particularly head
position-such as turning in bed or tilting the head backward to look up.

BPPV results from a malfunction of the vestibular (balance) system, which is housed in an inner ear
structure called the labyrinth. The malfunction that causes BPPV can have several causes, including
age-related changes in the inner ear, infection, and head injury.

It is believed that BPPV occurs when calcium carbonate crystals become dislodged from part of the
vestibular system and fall into one of the semicircular canals (part of the inner ear), interfering with
normal movement of the fluid in the inner ear and disrupting signals to the brain. This results in
vertigo when the head shifts.

Read more: Head Movements to Solve the Vertigo Problem http://www.medindia.net/news/Head-

Movements-to-Solve-the-Vertigo-Problem-40208-1.htm#ixzz1DlPSqQD9