What is vertigo and how does it affect daily life. How can the Epley maneuver provide relief from vertigo symptoms. Which natural remedies are effective for managing vertigo at home. What role does hydration play in vertigo prevention. How do essential oils help alleviate vertigo symptoms.

Understanding Vertigo: Causes and Symptoms

Vertigo is a disorienting condition characterized by a false sensation of spinning or movement, even when a person is stationary. This dizziness can significantly impact daily activities and overall quality of life. But what exactly causes vertigo?

Vertigo often results from inner ear problems, such as benign paroxysmal positional vertigo (BPPV), Meniere’s disease, or vestibular neuritis. However, it can also be a symptom of other underlying health conditions, including migraines, brain tumors, or stroke.

Common symptoms of vertigo include:

• Dizziness and a spinning sensation
• Loss of balance
• Nausea and vomiting
• Headaches
• Ringing in the ears (tinnitus)
• Difficulty focusing or concentrating

The duration of vertigo episodes can vary greatly, ranging from a few minutes to several hours. For some individuals, vertigo may be a one-time occurrence, while others experience recurrent episodes until the underlying cause is addressed.

The Epley Maneuver: A Proven Technique for Vertigo Relief

The Epley maneuver is a widely recommended technique for managing vertigo, particularly when caused by BPPV. This series of head and body movements aims to reposition the calcium crystals in the inner ear, which are often responsible for triggering vertigo symptoms.

How effective is the Epley maneuver? According to a report from the Institute for Quality and Efficiency in Health Care, 52 out of every 100 people who use the Epley maneuver experience relief from vertigo symptoms. This significant success rate makes it a valuable first-line treatment option for many vertigo sufferers.

Performing the Epley Maneuver at Home

To perform the Epley maneuver for left-side vertigo:

1. Sit on the edge of a bed and turn your head 45 degrees to the left.
2. Quickly lie down on your back with your head still turned, allowing it to hang slightly off the edge of the bed at a 45-degree angle.
3. Hold this position for 30 seconds.
4. Without raising your head, turn it 90 degrees to the right.
5. Hold for another 30 seconds.
6. Turn your head and entire body to the right side, looking downward.
7. Maintain this position for 30 seconds.
8. Slowly sit up, but remain seated for a few minutes.

For right-side vertigo, simply reverse these directions. It’s important to perform this maneuver consistently, ideally before bed each night, until vertigo symptoms subside for at least 24 hours.

Natural Remedies for Vertigo Management

While the Epley maneuver is highly effective, several natural remedies can complement this treatment approach or provide relief for those seeking alternative options. These home remedies have shown promise in managing vertigo symptoms:

Ginkgo Biloba: Nature’s Vertigo Fighter

Ginkgo biloba, a renowned Chinese herb, has demonstrated effectiveness in alleviating vertigo symptoms. How does it work? Ginkgo biloba is believed to improve blood flow to the brain, potentially addressing the root cause of dizziness and balance issues.

A study published in the International Journal of Otolaryngology found that Ginkgo biloba was equally effective as the medication betahistine in managing vertigo. This natural alternative may be particularly appealing for those seeking non-pharmaceutical options.

Ginger: A Spicy Solution for Dizziness

Ginger has long been celebrated for its anti-nausea properties, but can it help with vertigo? Research published in the Journal of Acupuncture and Tuina Science suggests that ginger root may be even more effective than manual repositioning techniques like the Epley maneuver in reducing vertigo symptoms.

To harness the power of ginger, try steeping ginger root in boiling water for 5 minutes to create a soothing tea. Adding honey can help balance the bitter taste. Consuming ginger tea twice daily may help alleviate dizziness, nausea, and other vertigo-related discomforts.

The Role of Nutrition in Vertigo Management

Proper nutrition plays a crucial role in managing vertigo symptoms and supporting overall inner ear health. Two key dietary elements that may help combat vertigo are almonds and proper hydration.

Almonds: A Nutrient-Rich Snack for Vertigo Relief

Almonds are packed with essential nutrients, including vitamins A, B, and E. While the exact mechanism is not fully understood, consuming a handful of almonds daily may help alleviate vertigo symptoms. It’s possible that the rich vitamin content of almonds helps address underlying causes of vertigo or supports overall inner ear function.

Hydration: A Simple Yet Effective Vertigo Prevention Strategy

Can something as simple as staying hydrated really impact vertigo symptoms? The answer is a resounding yes. Even mild dehydration can trigger vertigo episodes, making proper hydration a crucial aspect of symptom management and prevention.

To stay adequately hydrated, aim for 8 to 12 cups of liquid per day. While this includes all fluids, water is the optimal choice due to its lack of calories, caffeine, and diuretic properties. By maintaining proper hydration, you may minimize dizziness and balance issues associated with vertigo.

Essential Oils: Aromatherapy for Vertigo Relief

Essential oils offer a natural and cost-effective approach to managing vertigo symptoms. These concentrated plant extracts can be used topically or inhaled to potentially ease dizziness, nausea, and headaches associated with vertigo.

Some essential oils that may be beneficial for vertigo include:

• Peppermint oil
• Ginger oil
• Lavender oil
• Lemon oil

To use essential oils for vertigo relief, you can either inhale them through an diffuser or dilute them in a carrier oil before applying topically. It’s important to note that individual responses to essential oils may vary, so you may need to experiment with different oils to find the most effective option for your symptoms.

When to Seek Professional Help for Vertigo

While home remedies and techniques like the Epley maneuver can be highly effective for managing vertigo, there are instances where professional medical intervention is necessary. But how do you know when it’s time to consult a healthcare provider?

Consider seeking medical attention if:

• Your vertigo symptoms are severe or persist for an extended period
• You experience sudden, intense vertigo accompanied by other symptoms like severe headache, difficulty speaking, or loss of consciousness
• Your vertigo is accompanied by hearing loss or ringing in the ears
• Home remedies and self-care techniques provide no relief
• Your vertigo significantly impacts your daily life or ability to perform routine tasks

A healthcare professional can conduct a thorough evaluation to determine the underlying cause of your vertigo and recommend appropriate treatment options, which may include medication, physical therapy, or in some cases, surgical intervention.

Lifestyle Modifications for Long-Term Vertigo Management

In addition to specific treatments and remedies, certain lifestyle modifications can contribute to long-term vertigo management and prevention. These changes can help create an environment that supports inner ear health and reduces the likelihood of vertigo episodes.

Stress Reduction Techniques

Stress can exacerbate vertigo symptoms in some individuals. Incorporating stress-reduction techniques into your daily routine may help minimize vertigo occurrences. Consider practices such as:

• Meditation or mindfulness exercises
• Deep breathing techniques
• Yoga or gentle stretching
• Progressive muscle relaxation

Sleep Hygiene

Proper sleep is crucial for overall health and can impact vertigo symptoms. Establish good sleep hygiene by:

• Maintaining a consistent sleep schedule
• Creating a relaxing bedtime routine
• Ensuring your sleeping environment is dark, quiet, and comfortable
• Avoiding screens for at least an hour before bed

Dietary Considerations

While we’ve discussed the benefits of almonds and proper hydration, other dietary factors may influence vertigo symptoms. Consider:

• Limiting alcohol and caffeine intake
• Reducing salt consumption, especially if you have Meniere’s disease
• Eating regular, balanced meals to maintain stable blood sugar levels
• Incorporating foods rich in vitamins C, D, and E, which support inner ear health

Regular Exercise

Engaging in regular physical activity can improve overall balance and reduce the risk of falls associated with vertigo. Low-impact exercises such as walking, swimming, or tai chi can be particularly beneficial. Always consult with a healthcare provider before starting a new exercise regimen, especially if you experience frequent vertigo episodes.

Technological Advancements in Vertigo Treatment

As medical science progresses, new technologies and treatment approaches for vertigo continue to emerge. These innovations offer hope for more effective management and potentially even permanent solutions for vertigo sufferers.

Vestibular Rehabilitation Therapy (VRT)

Vestibular rehabilitation therapy is a specialized form of physical therapy designed to retrain the brain to process balance information more effectively. This therapy often incorporates virtual reality technology to create immersive environments that challenge and improve a patient’s balance and spatial orientation.

Biofeedback Devices

Biofeedback devices can help individuals with vertigo gain better control over their physiological responses to dizziness and imbalance. These devices provide real-time feedback on factors such as muscle tension, heart rate, and body position, allowing users to develop strategies for managing vertigo symptoms more effectively.

Implantable Vestibular Prosthetics

For individuals with severe, treatment-resistant vertigo, researchers are developing implantable vestibular prosthetics. These devices aim to replace the function of damaged inner ear structures, potentially offering a long-term solution for chronic vertigo sufferers.

While many of these technologies are still in development or early stages of implementation, they represent exciting possibilities for the future of vertigo treatment.

In conclusion, while vertigo can be a challenging and disruptive condition, a combination of proven techniques like the Epley maneuver, natural remedies, lifestyle modifications, and emerging technologies offer hope for effective management and relief. By working closely with healthcare providers and remaining open to both traditional and innovative approaches, individuals suffering from vertigo can find strategies to minimize symptoms and improve their quality of life.

Treatment and the Epley maneuver

We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission Here’s our process.

Medical News Today only shows you brands and products that we stand behind.

Our team thoroughly researches and evaluates the recommendations we make on our site. To establish that the product manufacturers addressed safety and efficacy standards, we:

• Evaluate ingredients and composition: Do they have the potential to cause harm?
• Fact-check all health claims: Do they align with the current body of scientific evidence?
• Assess the brand: Does it operate with integrity and adhere to industry best practices?

We do the research so you can find trusted products for your health and wellness.

Read more about our vetting process.

Was this helpful?

Home remedies for vertigo include a set of exercises known as the Epley maneuver, staying hydrated, gingko biloba supplements, and ginger tea. If these do not help, medication is available.

Vertigo is a feeling of dizziness and spinning, occurring with or without any movement. It is caused when the brain feels the body is off-balance even though it is not. It can limit a person’s activities and make them feel sick.

When feeling dizzy, a person should sit down immediately to reduce the chances of getting hurt if they fall.

Usually, vertigo is a symptom of an underlying medical condition or several different conditions. Sometimes, vertigo will only occur once, but for other people, it will reoccur until the underlying cause is determined.

Fast facts on vertigo:

• Symptoms can last anywhere from a few minutes to a few hours and may come and go.
• Treatment for vertigo will depend on the cause.
• Medication can relieve symptoms of dizziness, nausea, and motion sickness.

Was this helpful?

Vertigo can be managed naturally with a variety of home remedies.

Epley maneuver

The Epley maneuver is often recommended by chiropractors or physical therapists as a way of treating vertigo at home.

One of the most common ways to manage vertigo is a technique called the Epley maneuver. This involves a set of steps done before bed each night until the symptoms of vertigo resolve for at least 24 hours.

A report from the Institute for Quality and Efficiency in Health Care says 52 out of every 100 people who use the Epley maneuver gain relief from vertigo symptoms.

If symptoms of vertigo occur from the left side and left ear, the Epley maneuver can be done by:

• sitting on the edge of a bed and turning the head 45 degrees to the left
• lying down quickly and facing head up on the bed at a 45-degree angle
• maintaining the position for 30 seconds
• turning the head halfway — 90 degrees — to the right without raising it for 30 seconds
• turning the head and entire body to the right side, looking downward for 30 seconds
• slowly sitting up but remaining sitting for at least a few minutes

If vertigo starts on the right side in the right ear, these directions should be done in reverse.

Ginkgo biloba

Ginkgo biloba is a Chinese herb known for resolving the symptoms of vertigo. It works by managing blood flow to the brain to relieve dizziness and balance issues.

A study reported in the International Journal of Otolaryngology finds Ginkgo biloba is just as effective as the medication betahistine in managing vertigo.

Ginger tea

Research published in the Journal of Acupuncture and Tuina Science finds ginger root can reduce the effects of vertigo better than manual repositioning, such as the Epley maneuver, alone.

Ginger root can be steeped in a cup of boiling water for 5 minutes. Honey can help with the bitter taste. Drinking ginger tea twice a day may help dizziness, nausea, and other vertigo symptoms.

Almonds

Almonds are rich sources of vitamins A, B, and E. Eating a daily handful of almonds can help with vertigo symptoms.

How almonds help is unknown, but it is possible the vitamin content can combat the causes of vertigo.

Staying hydrated

Dehydration can cause symptoms of vertigo. Even mild dehydration can trigger the condition.

Staying hydrated can help minimize dizziness and balance issues.

The body needs 8 to 12 cups of liquid per day. While this includes all liquids, water is the best option because it is calorie- and caffeine-free and not a diuretic. Diuretics increase the amount of water and salt the body expels as urine.

Essential oils

Various essential oils, when applied topically or inhaled, may help to ease the symptoms of vertigo.

Essential oils are natural and affordable options for managing the symptoms of vertigo, including nausea, headaches, and dizziness.

Some of the options available for managing vertigo include peppermint, ginger, lavender, and lemon essential oils.

Essential oils are inhaled through an infuser or diluted in a carrier oil before being applied topically. A person may have to experiment with a variety of oils to find the best one to treat their vertigo symptoms.

Apple cider vinegar and honey

Both apple cider vinegar and honey are believed to have curative properties to relieve blood flow to the brain. Two parts honey and one part apple cider vinegar can prevent and treat vertigo symptoms.

Acupressure

Acupressure applies the same concepts as acupuncture, but it is without the needles. The goal of acupressure is to promote wellness and relaxation. It can help manage vertigo by stimulating pressure points throughout the body.

One common method, called the P6 acupressure method, involves an effective pressure point located in the two tendons between the inner forearm and the wrist.

Vertigo may cause headaches, nausea, double vision, or changes in hearing.

In addition to causing a person feelings of being unbalanced or spinning, vertigo can lead to the following symptoms:

• nausea or vomiting
• abnormal eye movements
• headaches
• sweating
• ear ringing
• hearing loss
• double vision
• lack of coordination
• arm or leg weakness

Benign positional paroxysmal vertigo or BPPV is the most common type of vertigo. A buildup of deposits in the inner ear causes BPPV.

The inner ear is responsible for the body’s sense of balance. With BPPV, certain movements may cause dizziness and a spinning sensation for a short time.

BPPV is a common condition. Most people have a lifetime prevalence of 2.4 percent, according to researchers from the University of British Columbia. Also, BPPV recurs 50 percent of the time, according to a 2014 report published in the journal Advances in Otolaryngology.

Other conditions that may cause vertigo include:

• Cold viruses: The common cold can cause ear inflammation. This type of vertigo usually resolves within a few days but can reoccur.
• A head or neck injury: Vertigo is a common symptom that can follow a head or neck injury. Vertigo related to a neck or head injury tends to resolve but can be debilitating and ongoing.
• Stroke: According to the American Stroke Association, someone experiencing a stroke may have vertigo, including symptoms of dizziness and severe imbalance. A stroke will cause dizziness and imbalance rather than just one.
• Vestibular neuritis or VN: VN is a condition affecting the vestibulocochlear nerve in the inner ear. This nerve is responsible for balance and head-positioning signals received in the brain. When the nerve is inflamed, the brain misinterprets balance and head positioning.
• Meniere’s disease: Meniere’s is a condition that affects hearing in one ear. It causes symptoms of vertigo, tinnitus or ringing in the ears, hearing loss, and a feeling of “fullness” in the ear. Some people with Meniere’s disease have severe vertigo, causing balance loss and falls.

Most of the time, vertigo resolves without treatment, as the brain can compensate for changes to the inner ear to restore someone’s balance.

Medications, such as steroids, can reduce inner ear inflammation, and water pills can reduce fluid buildup.

For people who have recurrent episodes of vertigo, a physical therapy called vestibular rehabilitation can help. Vestibular rehabilitation encourages the central nervous system to compensate for inner ear problems.

Anyone who has reoccurrences of vertigo should see their doctor. For most people, vertigo is usually not harmful, but the underlying cause needs to be identified. A doctor can also prescribe medications and other treatments to lessen symptoms, especially if home remedies do not help.

Read the article in Spanish.

The home remedies listed in this article are available for purchase online.

• Shop for Ginkgo biloba.
• Shop for ginger tea.
• Shop for almonds.
• Shop for apple cider vinegar.
• Shop for peppermint essential oil.
• Shop for ginger essential oil.
• Shop for lavender essential oil.
• Shop for lemon essential oil.
• Shop for carrier oils.

Treatment and the Epley maneuver

We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission Here’s our process.

Medical News Today only shows you brands and products that we stand behind.

Our team thoroughly researches and evaluates the recommendations we make on our site. To establish that the product manufacturers addressed safety and efficacy standards, we:

• Evaluate ingredients and composition: Do they have the potential to cause harm?
• Fact-check all health claims: Do they align with the current body of scientific evidence?
• Assess the brand: Does it operate with integrity and adhere to industry best practices?

We do the research so you can find trusted products for your health and wellness.

Read more about our vetting process.

Was this helpful?

Home remedies for vertigo include a set of exercises known as the Epley maneuver, staying hydrated, gingko biloba supplements, and ginger tea. If these do not help, medication is available.

Vertigo is a feeling of dizziness and spinning, occurring with or without any movement. It is caused when the brain feels the body is off-balance even though it is not. It can limit a person’s activities and make them feel sick.

When feeling dizzy, a person should sit down immediately to reduce the chances of getting hurt if they fall.

Usually, vertigo is a symptom of an underlying medical condition or several different conditions. Sometimes, vertigo will only occur once, but for other people, it will reoccur until the underlying cause is determined.

Fast facts on vertigo:

• Symptoms can last anywhere from a few minutes to a few hours and may come and go.
• Treatment for vertigo will depend on the cause.
• Medication can relieve symptoms of dizziness, nausea, and motion sickness.

Was this helpful?

Vertigo can be managed naturally with a variety of home remedies.

Epley maneuver

The Epley maneuver is often recommended by chiropractors or physical therapists as a way of treating vertigo at home.

One of the most common ways to manage vertigo is a technique called the Epley maneuver. This involves a set of steps done before bed each night until the symptoms of vertigo resolve for at least 24 hours.

A report from the Institute for Quality and Efficiency in Health Care says 52 out of every 100 people who use the Epley maneuver gain relief from vertigo symptoms.

If symptoms of vertigo occur from the left side and left ear, the Epley maneuver can be done by:

• sitting on the edge of a bed and turning the head 45 degrees to the left
• lying down quickly and facing head up on the bed at a 45-degree angle
• maintaining the position for 30 seconds
• turning the head halfway — 90 degrees — to the right without raising it for 30 seconds
• turning the head and entire body to the right side, looking downward for 30 seconds
• slowly sitting up but remaining sitting for at least a few minutes

If vertigo starts on the right side in the right ear, these directions should be done in reverse.

Ginkgo biloba

Ginkgo biloba is a Chinese herb known for resolving the symptoms of vertigo. It works by managing blood flow to the brain to relieve dizziness and balance issues.

A study reported in the International Journal of Otolaryngology finds Ginkgo biloba is just as effective as the medication betahistine in managing vertigo.

Ginger tea

Research published in the Journal of Acupuncture and Tuina Science finds ginger root can reduce the effects of vertigo better than manual repositioning, such as the Epley maneuver, alone.

Ginger root can be steeped in a cup of boiling water for 5 minutes. Honey can help with the bitter taste. Drinking ginger tea twice a day may help dizziness, nausea, and other vertigo symptoms.

Almonds

Almonds are rich sources of vitamins A, B, and E. Eating a daily handful of almonds can help with vertigo symptoms.

How almonds help is unknown, but it is possible the vitamin content can combat the causes of vertigo.

Staying hydrated

Dehydration can cause symptoms of vertigo. Even mild dehydration can trigger the condition.

Staying hydrated can help minimize dizziness and balance issues.

The body needs 8 to 12 cups of liquid per day. While this includes all liquids, water is the best option because it is calorie- and caffeine-free and not a diuretic. Diuretics increase the amount of water and salt the body expels as urine.

Essential oils

Various essential oils, when applied topically or inhaled, may help to ease the symptoms of vertigo.

Essential oils are natural and affordable options for managing the symptoms of vertigo, including nausea, headaches, and dizziness.

Some of the options available for managing vertigo include peppermint, ginger, lavender, and lemon essential oils.

Essential oils are inhaled through an infuser or diluted in a carrier oil before being applied topically. A person may have to experiment with a variety of oils to find the best one to treat their vertigo symptoms.

Apple cider vinegar and honey

Both apple cider vinegar and honey are believed to have curative properties to relieve blood flow to the brain. Two parts honey and one part apple cider vinegar can prevent and treat vertigo symptoms.

Acupressure

Acupressure applies the same concepts as acupuncture, but it is without the needles. The goal of acupressure is to promote wellness and relaxation. It can help manage vertigo by stimulating pressure points throughout the body.

One common method, called the P6 acupressure method, involves an effective pressure point located in the two tendons between the inner forearm and the wrist.

Vertigo may cause headaches, nausea, double vision, or changes in hearing.

In addition to causing a person feelings of being unbalanced or spinning, vertigo can lead to the following symptoms:

• nausea or vomiting
• abnormal eye movements
• headaches
• sweating
• ear ringing
• hearing loss
• double vision
• lack of coordination
• arm or leg weakness

Benign positional paroxysmal vertigo or BPPV is the most common type of vertigo. A buildup of deposits in the inner ear causes BPPV.

The inner ear is responsible for the body’s sense of balance. With BPPV, certain movements may cause dizziness and a spinning sensation for a short time.

BPPV is a common condition. Most people have a lifetime prevalence of 2.4 percent, according to researchers from the University of British Columbia. Also, BPPV recurs 50 percent of the time, according to a 2014 report published in the journal Advances in Otolaryngology.

Other conditions that may cause vertigo include:

• Cold viruses: The common cold can cause ear inflammation. This type of vertigo usually resolves within a few days but can reoccur.
• A head or neck injury: Vertigo is a common symptom that can follow a head or neck injury. Vertigo related to a neck or head injury tends to resolve but can be debilitating and ongoing.
• Stroke: According to the American Stroke Association, someone experiencing a stroke may have vertigo, including symptoms of dizziness and severe imbalance. A stroke will cause dizziness and imbalance rather than just one.
• Vestibular neuritis or VN: VN is a condition affecting the vestibulocochlear nerve in the inner ear. This nerve is responsible for balance and head-positioning signals received in the brain. When the nerve is inflamed, the brain misinterprets balance and head positioning.
• Meniere’s disease: Meniere’s is a condition that affects hearing in one ear. It causes symptoms of vertigo, tinnitus or ringing in the ears, hearing loss, and a feeling of “fullness” in the ear. Some people with Meniere’s disease have severe vertigo, causing balance loss and falls.

Most of the time, vertigo resolves without treatment, as the brain can compensate for changes to the inner ear to restore someone’s balance.

Medications, such as steroids, can reduce inner ear inflammation, and water pills can reduce fluid buildup.

For people who have recurrent episodes of vertigo, a physical therapy called vestibular rehabilitation can help. Vestibular rehabilitation encourages the central nervous system to compensate for inner ear problems.

Anyone who has reoccurrences of vertigo should see their doctor. For most people, vertigo is usually not harmful, but the underlying cause needs to be identified. A doctor can also prescribe medications and other treatments to lessen symptoms, especially if home remedies do not help.

Read the article in Spanish.

The home remedies listed in this article are available for purchase online.

• Shop for Ginkgo biloba.
• Shop for ginger tea.
• Shop for almonds.
• Shop for apple cider vinegar.
• Shop for peppermint essential oil.
• Shop for ginger essential oil.
• Shop for lavender essential oil.
• Shop for lemon essential oil.
• Shop for carrier oils.

Dizziness

Like all functional disorders, dizziness is not “real”, it is “ everything happens in the mind “. A person can’t just pick it up and turn it off. After a while, this sensation becomes obsessive and constant, it can be compared with tinnitus. In PPPG, one thing leads to another. The constant feeling of feeling dizzy leads to anxiety and fear. Worry about dizziness often revolves around the cause of the condition (so-called health anxiety). Although if someone spoke to you about this it is not the same.

Anxiety about health is when someone cannot calm down even when he has received full information about his condition and continues to be nervous, although he understands that fears are irrational. Anxiety in PPPV may be centered around the fear of falling and the consequences of falling. These fears are common in patients with PPPG. It has been shown that the pathways responsible for anxiety and dizziness are very close in the brain. Anxiety is very debilitating for the brain. Therefore, fatigue and asthenia are common symptoms in PPPG. Often feelings of anxiety and dizziness occur at the same time and patients describe this condition as a “cotton head”, it seems to them that their brain is “clouded”. All these symptoms are accompanied by a decrease in concentration.
People with PPPV become sensitive not only to their own movements, but also to moving objects in their environment. This is called visual vertigo (vertigo) – although, strictly speaking, this condition is not true vertigo.

Patients with PPPV experience discomfort in large spaces such as supermarkets, on public transport, or when looking at patterned surfaces. The feeling of discomfort forces people to leave the premises and they often ask to be taken out of the premises.

Another consequence of PPPG may be dissociation. This state is described in more detail in the corresponding section of the site. It is often described as a “disconnection” from reality, a “stretching of space”. Patients with PPPV may feel as if they are walking on uneven ground. There are other reasons for this condition, and PPPV is one of them. Neck movement can cause dizziness in some people with PPPV (or other balance disorders).
If you try to avoid excessive movement of the neck, it causes pain in the neck and headache (due to overexertion of the muscles). Headache combined with dizziness makes the person’s condition even worse. PPPD is a motion perception problem. Problems with increased sensitivity to light and sound, and sometimes nausea due to increased sensitivity to smells, are common in patients with PPPV. PPPG may be one of the components of chronic fatigue syndrome. Treatment of PPPG/functional vertigo. Specific treatment for PPPG is time consuming and does not have a quick fix, but can respond well even after months and years of symptoms.

Treatment includes:
1. Pure positive diagnosis and explanation of the mechanism of symptoms helps to cope with this problem. Understanding how the nervous system becomes sensitive (sensitized) helps to work on its desensitization.

2. Recognition of all other symptoms that accompany PPPV. Dissociation, neck pain, anxiety, asthenia and decreased concentration require discussion and clarification of causal relationships, because. these symptoms may exist separately from PPPV and require special treatment.

3. Physiotherapy / movement desensitization. Because PPPV patients try to avoid eye, head, and body movements, they require specific physiotherapy and vestibular exercises to help speed up the desensitization process of the nervous system and restore normal movement patterns.

4. Medicines. Various means can be used to desensitize the nervous system, but the greatest role belongs to the group of antidepressants. There is evidence for the use of antidepressants in patients without anxiety and depression for the treatment of PPPG, but this issue requires further study.

5. Psychological counseling. The interaction between the patient and the doctor in the format of mutual respect and openness contributes to the deactivation of fears and improves the treatment process. Conversations with the doctor allow you to evaluate the treatment process, as well as correct maladaptive behavior (bad habits). Matthew Whalley, a psychologist from Berkshire, UK, and Debbie Cane from the Manchester Audiology Center have published a very helpful guide to the psychological treatment of PPPV. Treatment and consultation with a psychologist does not mean that your symptoms are made up. Below is a diagram showing the treatment process and the targets of therapeutic intervention. Various causes of dizziness. Dizziness is very difficult to describe, which is a significant problem not only for patients, but also for doctors. Ive added this section to help patients describe their dizziness more easily and communicate with doctors about their problem.

Most PPPV patients have several types of vertigo and this text will help patients describe each. Dizziness can be divided into several types:

1. Feeling of lightness in the head, reminiscent of the feeling that you are about to faint (presyncope). If you’ve fainted, then you know the feeling! If you have not had such an experience, then this may be a new sensation for you. Usually, fainting happens when people stand for a long time or stand up abruptly. A characteristic picture of pre-fainting is a feeling of lightness in the head, accompanied by tinnitus and darkening of the eyes and a feeling of nausea. Doctors call this condition presyncopal (presyncope). If a person falls because of this condition, then in this case it is called fainting (syncope). This condition is caused by various reasons: rapid getting up, painful stimuli (treatment by a dentist, blood sampling). Fainting can also happen in hot weather or while eating. Men are more prone to this condition, especially during urination (at night). Unclear, vague sensations can occur when people breathe quickly and deeply (hyperventilation). This can happen during a panic attack. Presyncope is not a functional symptom, but it is important to be aware of this reaction, as syncope may contribute to the development of functional symptoms.

2. The sensation of an imaginary rotation of the body or objects around is called vertigo. This sensation is similar to the rotation of the body around its axis or resembles rocking in a boat. There are many causes of vertigo. The most common of these is damage to the inner ear, which is responsible for the sense of gravity and balance. In the inner ear there is a system of semicircular canals, in which calcium crystals sometimes form, which irritate the receptors of the inner ear and cause an attack of vertigo (benign paroxysmal vertigo). Migraine also causes vertigo. Vertigo is not a functional symptom, but along with syncope, it can contribute to the formation of functional symptoms. In many patients, vertigo is the cause of the development of functional symptoms. Patients with vertigo develop a pathological attitude – they try to limit movement of the head and neck, which leads to headaches and pain in the neck. People often develop a combination of headache, neck pain, and dizziness, and pain syndromes may persist after the dizziness disappears.

3. Dissociation – a specific feeling of the unreality of the surrounding space or a violation of one’s own feelings about one’s body. See the relevant section on the website for more details. Patients with vertigo may have several types of vertigo. Some patients, especially those with a feeling of fatigue (asthenia), may use even more vague descriptions of vertigo, such as a “wobbly” or “foggy” head. 4. Bodily sensation of instability (Dysequilibrium). This sensation is sometimes compared to the sensation of ice skating. In general terms, it can be compared to an internal feeling of “reeling”, which can lead to a fall.

Dizziness | Gorbacheva F.E., Natyazhkina G.M., Chuchin M.Yu.

D Dizziness is one of the most common complaints patients come to the doctor with. In different age groups, the frequency of this complaint ranges from 5 to 30%. Dizziness is an illusion of movement of the person himself or the surrounding objects around him. Dizziness can be a symptom of a large number of diseases, both benign and life-threatening.

The term “dizziness” is often misused by patients. Sometimes patients call dizziness a feeling of dizziness, an approaching loss of consciousness, a feeling of emptiness, “lightness in the head.” These complaints are characteristic of a fainting state and are combined with vegetative-visceral disorders: pallor of the skin, palpitations, nausea, darkening of the eyes, hyperhidrosis. A similar condition – lipothymia is observed in cardiovascular pathology (ventricular arrhythmias, aortic stenosis), with orthostatic hypotension (drug, due to autonomic failure, hypovolemia), with hypoglycemia, anemia.

Quite often, patients understand dizziness as an imbalance – unsteadiness, staggering when walking. These disorders occur, as a rule, in organic processes of the nervous system (extrapyramidal, cerebellar disorders, proprioceptive disorders), and, of course, are not true dizziness.

Another variant of complaints, sometimes regarded by patients as dizziness, is a feeling of heaviness in the head, “internal dizziness”, a state similar to intoxication, a feeling of faintness – most characteristic of psychogenic dizziness observed in neurosis, depression.

And, finally, true, systemic dizziness with a sensation of rotation, falling, tilting or rocking of surrounding objects or one’s own body. Often it is accompanied by vegetative symptoms – nausea, vomiting, hyperhidrosis. Systemic vertigo is characteristic of lesions of the vestibular system, its peripheral or central divisions.

Vestibular dizziness is more often paroxysmal, episodic. Constant dizziness can develop with the use of ototoxic drugs, with damage to the brain structures responsible for vestibulo-ocular reflexes.

Paroxysmal vestibular vertigo (vertigo) develops when both the peripheral and central parts of the vestibular analyzer are affected, and depending on the causes that caused it, it may have certain features.

Vertigo caused by lesions of the labyrinth are observed in various diseases, among which the following are most common:

• Meniere’s disease This is severe dizziness with nausea, vomiting, noise in the ear, a feeling of pressure, fullness in the ear, and often hearing loss. The attack lasts several hours. All patients have horizontal or rotatory nystagmus. In the early stages of the disease, auditory disorders regress completely, later becoming irreversible. Audiometry reveals a characteristic hearing loss of more than 10 dB at 2 different frequencies. The cause of Meniere’s disease is labyrinth edema, which develops as a result of the expansion of the endolymphatic system. As the disease progresses, the membrane separating the perilymph from the endolymph may rupture, resulting in hearing and balance disorders. The healing of the rupture and restoration of the composition of the endolymph leads to the normalization of these functions. Some studies suggest that unexplained vertigo should be treated as Ménière’s disease even in the absence of further evidence of progression of hearing loss. It has been shown that Meniere’s disease is often reversible in cases of early diagnosis of the disease and adequate treatment.
• Labyrinthitis also cause bouts of systemic vertigo and hearing impairment, which regress slowly over several weeks or even months as the underlying cause subsides. Bacterial labyrinthitis is known – as a complication of inadequate therapy of otitis media and viral (herpes zoster virus – herpes zoster and herpes simplex virus).

  Herpes zoster ( herpes zoster ) is known to cause damage to the geniculate node in the fallopian canal with the development of peripheral paresis of the facial nerve with impaired taste in the anterior 2/3 of the tongue, dry eyes or, conversely, lacrimation, as well as hyperacusis and herpetic eruptions in the external auditory canal. The above clinical picture is well known to neurologists as Hunt’s syndrome. But one of the most severe variants of this syndrome is possible, when, in addition to the above symptoms, the patient develops dizziness with severe vestibular ataxia, nystagmus and autonomic reactions in the form of nausea or vomiting, as well as hearing loss. In this variant of the Hunt syndrome (variant IV), herpes zoster also causes a lesion, most likely (in addition to the geniculate node), also of the Scarpa vestibular node and the auditory ganglion located in the inner ear.

• The most common vertigo is benign paroxysmal positional vertigo (BPPV), which is characterized by the occurrence of dizziness with a rapid change in the position of the head and body when the patient is in a horizontal position or when bending forward and tilting the head back. As a rule, dizziness quickly passes on its own – its duration is from a few seconds to 1 minute. BPPV may persist for several months. Among patients over 50 years of age with dizziness, the proportion of BPPV is 34–41%. With age, the frequency of BPPV increases. In women, this pathology occurs 2 times more often than in men. In the pathogenesis of BPPV, the leading role is played by cupulolithiasis – the deposition of a clot of calcium carbonate crystals on the cupula – a gelatinous mass covering the receptor zone of the semicircular canal, and an increase in the sensitivity of the receptors of the semicircular tubules.
• Another syndrome of systemic vertigo of unclear etiology is revealed – vestibular neuronitis . This is a sudden, prolonged severe dizziness, accompanied by nausea, vomiting, imbalance, a feeling of fear. Symptoms are aggravated by moving the head or changing the position of the body. Patients are very difficult to tolerate this condition and do not get out of bed. Spontaneous nystagmus is characteristic. Sometimes there is noise and congestion in the ear. Hearing does not decrease, the results of the audiological examination remain normal. There are no other neurological symptoms. In almost half of the cases, attacks recur after a few months or years. There is no evidence of an infectious nature of this disease. However, the development of neuronitis after infection of the upper respiratory tract has been noted.
• Post-traumatic dizziness . The thin bony membranes of the labyrinth can be damaged by trauma. Immediately after the injury, vestibular dizziness, nausea, and vomiting occur due to the shutdown of one of the labyrinths. Less often, dizziness is caused by transverse or longitudinal fractures of the pyramid of the temporal bone, which are accompanied by hemorrhage in the middle ear or damage to the tympanic membrane. Horizontal spontaneous nystagmus and imbalance are characteristic. Symptoms are aggravated by sudden movements of the head.

  With barotrauma (when diving, straining, coughing), it is also possible to break the membrane in the area of ​​the oval or round holes and form a perilymphatic fistula, through which pressure changes in the middle ear are transmitted to the inner ear. Intermittent or positional vestibular vertigo and non-permanent sensorineural hearing loss develop.

• Cholesteatoma – a tumor that sometimes develops in chronic bacterial inflammation of the inner ear, destroys the walls of the tympanic cavity and leads to the formation of a perilymphatic fistula and, accordingly, to the appearance of systemic dizziness and hearing loss.

Vestibular nerve injury

Combined damage to the labyrinth and vestibulocochlear nerve is possible with narcotic and drug intoxication (antiepileptic, antirheumatic, antibacterial drugs, salicylates). In this case, in addition to vestibular disorders, there is often a violation of the auditory function. After discontinuation of the drug, there is an improvement in vestibular and auditory function. However, some patients, especially the elderly, may not fully recover.

The clinic of neurinoma of the VIII pair of cranial nerves begins with vestibular dizziness, most often its first symptom is hearing loss, which is often not noticed by patients or is not given due importance. The patient goes to the doctor mainly only when there is instability when walking or numbness of the face.

Damage to the brainstem and other structures of the posterior cranial fossa

The next level of damage to the vestibular analyzer, in which systemic dizziness develops, is brainstem . Vestibular vertigo and imbalance are common symptoms of stem stroke (Walenberg-Zakharchenko syndrome, Gasperini, etc.), as well as with cerebellar focus. Usually an acute circulatory disorder in the vertebrobasilar system, in addition to vestibular disorders, is accompanied by impaired articulation, phonation, swallowing or diplopia. The exception is organic foci of an ischemic or hemorrhagic nature, located in the flocculonodular regions of the cerebellum, in which there are no typical cerebellar disorders and systemic dizziness with imbalance is the only symptom. In medical practice, unreasonably often vestibular dizziness, imbalance are regarded as manifestations of a transient disorder of cerebral circulation in the vertebrobasilar basin. If repeated attacks of dizziness are not accompanied by other signs of ischemia of the brain stem, occipital lobes of the cerebral hemispheres with visual disturbances, then they are usually not caused by vertebrobasilar insufficiency, but by peripheral vestibulopathy, labyrinth hydrops.

Dizziness, transient disturbances of balance and coordination are possible with stenosis of the subclavian artery (subclavio-vertebral syndrome). These symptoms may be associated with optical disturbances, as well as with paresthesias, pallor, and coldness of the hand. There is a weakening of the pulse on the radial artery, a decrease in blood pressure, and sometimes noise in the subclavian region.

Volumetric processes in the posterior cranial fossa, carcinomatosis of the membranes, paraneoplastic cranial polyradiculoneuritis (Garsin’s syndrome) may be accompanied by dizziness, often positional imbalance, nystagmus. But at the same time, other neurological symptoms are also detected, characteristic of damage to structures located in the posterior cranial fossa.

Vertigo in paroxysmal conditions

Systemic vertigo can be the leading manifestation of simple and complex partial epileptic seizures if the epileptic focus involves the vestibular cortex zones (superior temporal gyrus and association zones of the parietal lobe). Dizziness is often accompanied by nystagmus, paresthesias in opposite limbs. Seizures are short-lived. Often such attacks are combined with typical manifestations of temporal lobe epilepsy (chewing, hypersalivation, discomfort in the epigastric region, sometimes visual illusions, auditory hallucinations). Disturbance or narrowing of consciousness is characteristic. As a rule, seizures are stereotyped. Electroencephalography helps in the diagnosis.

Dizziness may be a symptom of basilar migraine. The attack includes visual, sensory disturbances and, as a rule, a headache.

Vertigo due to pathology of the cervical spine

The appearance of dizziness is also possible after an injury to the cervical spine, with spondylosis of this region. The cause of dizziness in these cases may be pathological impulses from the proprioreceptors of the cervical muscles. In this case, there is more often an imbalance, jolts to the side and a feeling of slight dizziness that occurs when turning the head.

Dizziness in children

Causes of vestibular vertigo in childhood are largely similar to those in adults. The cause of dizziness in children can be complex partial seizures that occur when the focus is localized in the temporal areas of the cortex. Dizziness is also observed with migraine attacks.

Benign paroxysmal vertigo also occurs in childhood.

Benign paroxysmal vertigo – DPG (mild paroxysmal dizziness) – a disease of young children. Most seizures begin between the ages of 1 and 3 years (maximum in the second year of life). Boys and girls are equally affected. The provoking factors of the disease are usually not detected, rarely there is information about the transferred ear infection. Relatively often there is a family history of migraine (up to 50%).

DPH is represented by infrequent and short (in most cases, the frequency varies from 1 to 4 attacks per month, and the duration from a few seconds to 5 minutes) episodes of severe instability, during which the child very often falls. Sometimes the fallen person may lie on the floor and refuse to move. At the time of the attack, you can notice the blanching and sweating of the child, as well as identify nystagmus. Nausea may occasionally be reported, but vomiting is usually not observed. Consciousness is always preserved, however, with a short paroxysm, one may get the impression of its loss, especially with the first seizure and fear of the parents. The verbal communication of the child of the first years of life, which has not been mastered sufficiently, leads to the fact that children very rarely describe their feelings during an attack. In the presence of a description by the child of his feelings, there is little doubt that an acute attack of dizziness took place. An extremely characteristic sign at the time of paroxysm is the child’s desire to find support – to grab onto something, cling to something, lie down on a sofa, bed, etc. Occasionally, at the time of paroxysm, a forced position of the head can be noted. In children under one year of age, conditions described as paroxysmal torticollis have also been associated with DPH. In this case, the attack lasts more often for several minutes, but it can last for hours, the child is pale, tries not to move, nystagmus is not noted. This condition also requires differentiation from Sandifer’s syndrome (gastroesophageal reflux).

Outside of DPH attacks, the child is clinically healthy, hearing does not suffer.

Most seizures resolve spontaneously by 4 years of age. Significant improvement is observed within a year from the onset of paroxysms. Some children later develop migraine, which, along with a family burden for this pathology, gives reason to attribute DPG to children’s “migraine equivalents” (Lanzi G, Balotti U, Fazzi E 1994, Abu-Arafch I, Russel G 1995).

Dizziness is also observed in a rare hereditary disease that debuts in childhood – familial periodic ataxia type 2 . The disease often manifests with bouts of dizziness, nystagmus, and loss of balance; lasting from several hours to several days. The episode is accompanied by dysarthria, tinnitus, and paresthesia. Outside the attack, it is often possible to fix nystagmus (especially “beating down”) and ataxia, which often progresses. EEG dysrhythmia and cerebellar atrophy on neuroimaging are characteristic. In the treatment of seizures, diacarb is effective, there may be an effect from diphenin or carbamazepine (Donat J.R, Auger R 1979, Brandt T 2000).

Dizziness caused by unilateral or bilateral loss of vestibular function may be part of the structure of congenital anomalies caused by intrauterine infection, toxins, rare syndromes of Mondini, Calman, Usher, CHARGE, etc. (Bower C.M., Cotton R.T. 1995, Brandt T. 2000).

Vertigo diagnosis

Thus, the multiplicity of causes that cause systemic dizziness and the multilevel nature of possible damage to the vestibular analyzer, leading to the development of dizziness, creates certain difficulties in diagnosis. However, it should be remembered that dizziness in combination with impaired function of the brainstem – double vision or impaired sensation in the face or limbs – indicates a central cause, while dizziness in combination with hearing complaints is usually of a peripheral labyrinthine origin. Vertical nystagmus almost always indicates damage to the brainstem or midline structures of the cerebellum.

Collecting anamnestic data , it is necessary to clarify whether the patient feels the rotation of surrounding objects or his own body, what is the nature of dizziness – constant or paroxysmal, whether changes in head position affect the occurrence of dizziness, is there tinnitus, hearing loss, have whether there is nausea or vomiting, whether there has been an injury to the head and neck, what is the visual acuity and whether the patient uses glasses, whether the patient is taking medications and what, and whether he uses alcohol, drugs.

With a detailed medical history, the following general practitioner will help the general practitioner to correctly identify the cause of dizziness: minimally necessary studies – complete blood count, blood glucose level, ECG and general therapeutic examination, radiography of the cervical spine.

In the absence of changes in cardiac activity (rhythm disturbance, aortic stenosis) and peripheral blood (anemia, hyperglycemia), it is necessary to send the patient to a specialist (otolaryngologist or neuropathologist), because. to clarify the level of damage to the vestibular analyzer, an assessment of the neurological status, otoneurological status, total audiometry, possibly electrocochleography, MRI of the brain, will be required.

Treatment of dizziness

Treatment of systemic vertigo is more common is symptomatic . Etiological therapy is possible only with a limited range of diseases (bacterial labyrinthitis, stem stroke, temporal lobe epilepsy, basilar migraine, cholesteatoma and other tumors involving the vestibular analyzer, as well as with a viral disease). In case of herpetic lesions of the vestibular node of Scarpa, aciclovir , which is preferable to be administered intravenously (5 mg/kg 3 times a day) for 3-5 days, and then switch to oral administration – 400 mg 5 times a day for 2 weeks, while it is important to prescribe it early – within 1 day from the moment the rash appears. It is desirable to combine antiviral therapy with the appointment of corticosteroids 50–60 mg/24 h for 5–7 days, followed by gradual withdrawal of the drug.

To relieve dizziness, vestibulolytic drugs are used, acting at the level of vestibular receptors or central vestibular structures, mainly the vestibular nuclei of the trunk.

An important role in the functioning of the vestibular structures is played by the histaminergic system. The transmission of impulses from the vestibular nuclei is provided mainly by histaminergic neurons. The histaminergic system also provides transmission between the vestibular nuclei and the vomiting center. Therefore, for the treatment of systemic dizziness, antihistamines (meclozine, promethazine), as well as tranquilizers (diazepam, lorazepam) to reduce anxiety. Nausea, painful vomiting relieves metoclopramide. With a prolonged attack, dehydration is performed (theophylline 2. 4% 10.0 ml intravenously, mannitol 15% 200 ml), diazepam 1.0 ml is administered intravenously.

In recent years, the drug has been successfully used to relieve dizziness, as well as to prevent seizures Betaserc (betahistine dihydrochloride) having a structural similarity to histamine, affinity for blocking H ₃ – and stimulation H ₁ – receptors. By blocking H ₃ receptors, betahistine dihydrochloride increases the release of neurotransmitters from the nerve endings of the presynaptic membrane (histamine prevents the release of mediators), exerting an inhibitory effect on the vestibular nuclei of the brain stem, improving the blood supply to the inner ear.

In an animal experiment, Betaserc caused a stable (up to 50%) increase in cochlear blood flow and had a dose-dependent effect on the electrical activity of polysynaptic neurons in the vestibular nuclei. According to Doppler and rheovasographic studies, Betaserc improves cerebral blood flow in patients with vertebrobasilar insufficiency, and the latest studies SPECT reveal an improvement in blood perfusion in the cerebellum.

In recent years, data have been obtained on the influence of Betaserc on the rate of venous outflow from the cranial cavity of the transverse sinuses and the inner ear, which indicates its pathogenetic effect in somatogenically caused lesions of the labyrinth.

The recommended daily dose for adults is 48 mg in 3 divided doses. The tablet contains 16 mg of betahistine dihydrochloride.

A positive effect of Betaserc in Meniere’s disease was noted. Conducted studies to evaluate the effectiveness of the drug, including double-blind studies, indicate the high effectiveness of betahistine dihydrochloride in Meniere’s disease and other conditions accompanied by systemic dizziness. At the time of the attack, taking 2-3 tablets of betahistine dihydrochloride helps to relieve dizziness. The drug reduces the frequency of attacks of systemic dizziness and reduces balance disorders.

In Meniere’s disease, Betaserc can be prescribed for a long time, as it is not addictive, does not have a toxic effect on the body, does not have a sedative effect, does not affect blood pressure and heart rate.