What are the symptoms of migraine headaches. How are migraine headaches triggered. What are the treatment options for migraine headaches.

Symptoms of Migraine Headaches

Migraine headaches are characterized by throbbing pain that is usually worse on one side of the head, near the temples, forehead, and eyes. The pain can be severe enough to disrupt daily activities and may last from 4 hours to 3 days if untreated. Migraine sufferers often experience sensitivity to light, sound, or mild exertion, as well as nausea, vomiting, or vision problems.

About 20% of people with migraines will experience an “aura” before the headache begins, which can include seeing flashing lights, wavy lines, or blind spots. Some people also report changes in mood, such as becoming more excitable, irritable, or depressed, or detecting unusual sensations like a strange smell or taste.

Triggers for Migraine Headaches

The exact cause of migraine headaches is not well understood, but it is believed to be related to brain chemicals, blood vessels, and nerves in the brain. Some potential triggers include flickering lights (such as from snow, water, fluorescent bulbs, or screens), emotional stress, skipping meals (leading to low blood sugar), hormonal changes (especially in women), and certain foods high in tyramine (such as aged, fermented, or processed foods).

Keeping a headache diary can help identify personal triggers. Avoiding known triggers, maintaining a regular sleep and meal schedule, and practicing relaxation techniques may help prevent or manage migraine attacks.

Treatment Options for Migraine Headaches

Over-the-counter pain medications like acetaminophen, ibuprofen, or naproxen can provide relief for mild to moderate migraine headaches. For more severe or frequent migraines, prescription medications may be necessary, such as triptans, ergots, CGRP inhibitors, or anti-seizure drugs.

Combination therapies, including pain medication plus caffeine, can also be effective. Preventive treatments like beta blockers, anti-seizure drugs, or Botox injections may be recommended for chronic or debilitating migraines.

Migraine Risk Factors

Women are three times more likely to experience migraines than men. If you have a close relative with migraines, you are also more likely to develop them. Experts believe there may be a genetic component to migraines, as they are often associated with other neurological and hereditary disorders.

Migraines can also affect children, with around 5% of children with headache problems suffering from migraines.

Managing Migraine Triggers

One of the key strategies for managing migraines is to identify and avoid personal triggers. This may involve keeping a headache diary to track warning signs, triggers, and severity of attacks. Some common migraine triggers, such as certain foods, sleep disruptions, and hormonal changes, can often be managed through lifestyle changes.

Practicing relaxation techniques, maintaining a regular sleep schedule, staying hydrated, and managing stress can also help prevent or reduce the impact of migraine headaches.

Seeking Medical Treatment

If over-the-counter medications and lifestyle changes are not providing sufficient relief, it may be necessary to seek medical treatment for migraines. A healthcare provider can prescribe more potent medications, such as triptans or CGRP inhibitors, and recommend preventive treatments like Botox injections or anti-seizure drugs.

Regular checkups and open communication with a healthcare provider can help develop an effective migraine management plan and identify any underlying conditions that may be contributing to the headaches.

Coping with Migraine Attacks

When a migraine attack strikes, it’s important to take steps to manage the symptoms and minimize the disruption to daily life. This may involve resting in a dark, quiet room, applying cold compresses, and avoiding triggers like bright lights or loud noises.

Over-the-counter pain relievers, combined with caffeine, can provide relief for some migraine sufferers. Prescription medications may be necessary for more severe or frequent attacks.

A Visual Guide to Migraine Headaches

A migraine is a headache with throbbing pain that is usually worse on one side of the head. The pain is often severe enough to hamper daily activities and may last from four hours to three days if untreated. More than one in 10 Americans, including one in 6 women, have migraines, but many have been told mistakenly that they have a sinus or tension headache. Foods, stress, and hormones can be migraine triggers.

Throbbing pain typically occurs on one side near the temples, forehead, and eyes. Migraine headaches can make you very sensitive to light, sound, or mild exertion, such as climbing the stairs. Many people have nausea, vomiting, or vision problems. The pain can be disabling, forcing people to miss work or other activities.

About 20% of people who suffer from migraine headaches will have an aura about 20 minutes to an hour before the pain. They may see flashing lights, wavy lines, or dots, or they may have blurry vision or blind spots. These are called “classic migraine headaches.”

Some people may have a change in mood before a migraine begins. They may become more excitable or irritable or depressed. Others may detect a sensation, such as a funny smell or taste. They may feel more fatigued, yawn frequently, or experience muscle tension. About 1 in 4 people experience this prodrome phase, which can occur as early as 24 hours before any head pain.

The exact cause of migraine headaches is still not well understood, but the problem is considered to be neurological (related to the nervous system). It is believed that  brain chemicals, blood vessels, and nerves of the brain are involved.

Migraine headaches may be set off by some specific cause, such as flickering lights. This could be a reflection from snow or water or from fluorescent bulbs or television or movie screens. Wearing polarizing sunglasses outside and using daylight spectrum fluorescent bulbs inside may help.

Emotional stress is a common trigger of migraine headaches. While it’s impossible to completely avoid stress, relaxation exercises can help you cope. Inhale and exhale slowly, letting the air fill you and then deflate like a balloon. Some people find that thinking of a peaceful scene or listening to favorite music can help.

It’s important for people prone to migraine headaches to have a regular pattern of meals and sleep. Low blood sugar from skipping meals can trigger a migraine. Eating too much sugar also can cause a spike, then a “crash” in blood sugar. Drink water throughout the day to avoid dehydration and sleep at least six to eight hours a night.

For many women, migraine headaches are tied to their menstrual cycle, occurring either a few days before or during their period, when estrogen levels drop. Some women may benefit from anti-inflammatory medication before their headaches begin, or hormonal birth control such as pills, patches, or rings. Others may have no benefit or worse migraine headaches with hormonal birth control.

Migraine sufferers often report that certain foods trigger their headaches. Common culprits include MSG, red wine, cheese, chocolate, soy sauce, and processed meats. However, scientific studies haven’t confirmed any particular food as a migraine trigger.

Aged, fermented, and stored foods have higher levels of tyramine, a substance created from the breakdown of the amino acid tyrosine. Tyramine may cause blood vessels to constrict then expand, and it may be a trigger for some migraine headaches. Some headache experts advise limiting fermented or aged foods, such as cheese, soy sauce, pickles, and pepperoni.

When combined with some pain medications, caffeine can help provide relief. Most migraine sufferers can drink a cup or two a day of coffee without any problems. However, too much caffeine can lead to headaches when the stimulant effect wears off. It can work the other way as well. If you are used to having a cup of coffee at about the same time every morning, you may get a headache if you sleep in and your coffee is delayed.

Find out what triggers migraine headaches by keeping a headache diary. Each time you suffer from a migraine, make a note about the warning signs (the “prodrome”), triggers, and severity. If you can discover some of your personal possible triggers (such as food and beverages, sleep patterns, caffeine) you may be able to avoid future headaches.

Women are three times more likely to have migraine headaches than men. If you have a close relative with migraine, you are much more likely to have them, too. Experts believe migraine may be related to mutations in genes that affect certain areas of the brain. Migraine headaches are also more common among people who have epilepsy, depression, asthma, anxiety, stroke, and some other neurologic and hereditary disorders.

About 5% of the children with headache problems suffer from migraine headaches. Both boys and girls can get migraine headaches, but after puberty they are more common among girls. Children may have symptoms other than headache, including stomach pain (abdominal migraine) or forceful and frequent vomiting (cyclic vomiting). If young children become wobbly on their feet, pale, and fussy, or have involuntary eye movements or vomiting, they may have a form of migraine called benign paroxysmal vertigo. Call the doctor right away for any of these symptoms.

Migraine headaches are diagnosed primarily from symptoms, but your doctor may want to do a brain scan to rule out other causes of headaches, such as a brain tumor or bleeding in the brain. A CT scan uses special X-rays to create cross-sectional images of the brain. An MRI uses radio frequency pulses and a magnetic field to create images of the brain.

Before you begin treatment, your doctor may want to assess your “headache burden” — how much your life is affected by migraine headaches. A simple questionnaire asks how many times you have missed work, school, or family or leisure activities because of headaches.

Combinations of common pain relievers and anti-inflammatories may help: acetaminophen (Panadol, Tylenol), aspirin (Bayer, Bufferin), ibuprofen, (Advil, Motrin, Nuprin), or naproxen sodium (Aleve, Naprosyn). Some have been formulated specifically to treat migraine headaches. However, overuse may actually make headaches worse or may lead to ulcers or other gastrointestinal problems.

Triptans and ditans are the most common medications prescribed for migraine headaches. They are most effective when taken early in an attack. They include almotriptan, eletriptan (Relpax), frovatriptan (Frova), lasmiditan (Reyvow), naratriptan (Amerge), rizatriptan (Maxalt) and sumatriptan (Imitrex, Onzetra Xsail, Sumavel, Tosymra, Zembrance) and zolmitriptan (Zomig). People with high blood pressure, heart disease, stroke, and other conditions may not be able to take triptans. And because of possible serious drug interactions, you should talk to your doctor about other medications you take, such as antidepressants or anti-seizure drugs. Side effects of triptans include nausea, dizziness, tingling, numbness, and chest pain.

If triptans don’t give you relief, your doctor may prescribe dihydroergotamine (D. H.E. 45, Migranal) or ergotamines (Cafergot or Migergot) as tablets, nasal sprays, or injections. An inpatient infusion of dihydroergotamine is a common choice and is more effective than triptans. These drugs narrow the blood vessels and can cause nausea, dizziness, muscle pain, or a bad taste in the mouth. They may have some interactions with other drugs. CGRP antgonists are a new class of drugs that block the effects of CGRP. They include rimegepant (Nurtec ODT) and ubrogepant (Ubrelvy). 

After you have treated two or three headaches, ask yourself some simple questions. Are you getting the relief you need? If not, you should ask your doctor about altering treatment. Be sure you take medications early in the attack — at least within two hours of migraine pain. If medications are not working, your doctor may prescribe use of an external medical device that stimulates the trigeminal nerve, the vagus nerve or nerves in the back of the head that are linked to migraines.

Overuse of medications can sometimes lead to chronic headaches. You shouldn’t take prescribed medication more than two times per week. You can get rid of the chronic headaches by tapering and discontinuing medication — under a doctor’s supervision. Pain medicines containing narcotics should be taken only at the direction of your physician because they can be habit-forming.

If migraine headaches are frequent or very severe, you may need to take a drug every day to prevent attacks. A class of drugs called CGRP inhibitors have proven effective in preventing migraines. It includes eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy), or galcanezumab (Emgality). Lasmiditan (Reyvow) can be used by those who don’t respond well to triptans. Drugs used to treat high blood pressure can be prescribed for this purpose. They include beta blockers and calcium channel blockers. Several types of antidepressants can also be used to prevent migraine, as well as anticonvulsants. Even Botox, which is normally used to treat wrinkles, can keep migraines at bay for some people.  

Biofeedback and relaxation training, including yoga and meditation,” can give you relief that is similar to the help you get from medications. Biofeedback uses a monitor to train you to recognize the onset of muscle tension and changes in body temperature that are signals of stress.

Acupuncture is a form of Chinese medicine that uses very fine needles inserted in specific spots to balance the body’s energy flow. Some researchers have found acupuncture causes the brain to release chemicals that affect pain. However, studies on the effectiveness of acupuncture for migraine symptoms has been mixed.

Migraine headaches most often strike in the prime of life – between the ages of 20 and 60. While elderly people still get migraine headaches, they often decrease in severity and frequency as we age, or even disappear entirely. Good management of migraines may help you get rid of migraine headaches for good.

Any new headache that is unusually severe or lasts more than a couple of days should be checked by a doctor. It’s also important to let your health care provider know if the pattern of headaches changes — for example, if there are new triggers. If you have a headache accompanied by paralysis, confusion, fever, or stiff neck, seek emergency medical care.

Causes, Symptoms, Treatment, and More

Vertigo is dizziness that creates the false sense that you or your surroundings are spinning or moving.

The condition can feel similar to motion sickness, but it’s not the same as lightheadedness.

There are two categories of vertigo: peripheral vertigo and central vertigo.

Peripheral vertigo

Peripheral vertigo is the most common type of vertigo. It occurs as a result of a problem in the inner ear, or the vestibular nerve, which controls balance.

Read more about peripheral vertigo here.

Central vertigo

Central vertigo occurs as a result of a problem in the brain. It can be caused by a variety of different conditions, including:

• stroke
• brain tumor
• migraine
• traumatic brain injury
• infection
• multiple sclerosis

Common causes for vertigo include:

• Benign paroxysmal positional vertigo (BPPV). This is the most common cause of vertigo and creates an intense, brief sense that you’re spinning or moving. These episodes are triggered by a rapid change in head movement, such as a blow to the head.
• Infection. A viral infection of the vestibular nerve, called vestibular neuritis or labyrinthitis, can cause intense, constant vertigo.
• Meniere’s disease. When excessive fluid builds up in the inner ear, the result can be sudden episodes of vertigo that last for several hours.
• Migraine. Migraine-induced vertigo can last minutes to hours.
• Head or neck injury. Vertigo is a common symptom after a traumatic injury to the head or neck, especially if there is damage to the vestibular system.
• Medications. Certain medications can cause vertigo, along with other symptoms like dizziness, hearing loss, and tinnitus, or a ringing in the ears.

Benign positional vertigo

Although benign paroxysmal positional vertigo can be bothersome, it’s rarely serious, except when it increases the chance of falling.

Symptoms may include:

• dizziness
• a sense that you or your surroundings are spinning or moving
• a loss of balance or unsteadiness
• nausea
• vomiting

Read more about benign positional vertigo here.

Can stress cause vertigo?

Although stress doesn’t cause vertigo directly, it can worsen it. What’s more, 2016 research suggests that severe stress could increase your risk of stroke, which could potentially cause vertigo.

One of the most common symptoms of vertigo is dizziness, which usually worsens with head movement. It’s typically described by patients as a spinning sensation, with the room or objects around them seeming to move.

Other symptoms of vertigo include:

• increased sweating
• nausea
• vomiting
• headache
• ringing or buzzing in your ears
• hearing loss
• involuntary eye movements
• loss of balance

Treatment options for vertigo can depend on the underlying cause. To improve symptoms, vestibular rehabilitation therapy as well as medications, such as meclizine (Antivert), have been found to be effective.

Repositioning maneuvers

The canalith repositioning maneuver, also known as the Epley maneuver, is used to relieve symptoms of BPPV.

These specific head maneuvers can help displace canalith crystals (small particles that can cause vertigo) from the canals of the inner ear.

Each treatment session involves holding four positions for 30 to 60 seconds each and repeating each position several times, as needed.

A healthcare professional can guide you through each movement during the session. They may also provide additional guidance on how to perform this procedure at home.

Medication

Meclizine is an antihistamine, which is a class of medication often used to treat allergies.

Meclizine is effective in treating motion sickness or vertigo. However, it might lead to confusion or even amnesia in older adults.

Exercises

There are several exercises used to help alleviate symptoms of vertigo. They typically involve marching in place or holding specific positions to improve balance.

These exercises are similar to the ones used in vestibular rehabilitation therapy (VRT).

VRT involves exercises designed according to each person and their symptoms. After a thorough clinical examination, one of three main methods is applied:

• habituation, which improves dizziness
• gaze stabilization, which improves control of eye movements so vision can be clear during head movement
• balance training, which improves steadiness

However, if you have severe vertigo, it’s best to reach out to an experienced physical therapist for additional guidance, instead of performing these exercises on your own.

Read more about exercises for vertigo here.

Surgery

Surgery may be necessary for the treatment of certain underlying conditions that can cause vertigo, such as a brain tumor or head injury.

There are several ways to naturally relieve discomfort caused by vertigo.

For example, certain supplements can help improve sleep while dealing with vertigo, including ginkgo biloba and melatonin.

There are also many exercises for vertigo that you can perform at home, such as Brandt-Daroff exercises, the Semont maneuver, and the Foster maneuver.

Read more about home remedies for vertigo here.

Essential oils for vertigo

Essential oils such as lavender may help stop dizziness and nausea.

However, it’s important to keep in mind that there is currently no research available to support the use of essential oils for vertigo.

A healthcare professional can diagnose vertigo by performing a clinical exam and collecting information about your symptoms and medical history.

Certain clinical tests and observations can be helpful when assessing for vertigo. These include head impulse testing or the Dix-Hallpike maneuver (patients are quickly lowered from a seated position to lying down).

In some cases, additional testing may be needed to diagnose vertigo, including imaging, hearing exams, and balance tests.

The signs and symptoms of BPPV can come and go, with symptoms commonly lasting less than a minute.

In cases of Meniere’s disease, an episode of vertigo can last for longer than 20 minutes.

Migraine-induced vertigo can last minutes to hours.

Learn more about the duration of vertigo here.

Although vertigo and dizziness are often confused, vertigo is typically described as feeling like the world is spinning, even when there is no movement.

While dizziness is a more ambiguous term, patients will often interpret it as a sense of imbalance within their own space.

According to a 2020 study, vertigo is the most commonly reported vestibular symptom during the first trimester of pregnancy.

BPPV is particularly common during pregnancy. According to 2017 research, which categorized participants as women and men, BPPV affects women more frequently than men with a ratio of 2-to-1.

Factors that can cause vertigo during pregnancy include:

• fluctuations in hormone levels
• prolonged bed rest
• changes in the metabolism of certain nutrients, including vitamin D and calcium

Many people also experience dizziness during pregnancy. This could be caused by several factors, including unstable blood sugar levels.

During the third trimester, the baby can put pressure on some of the major abdominal veins when the parent lies on their back, which can also cause dizziness.

In some cases, vertigo can be hereditary. Also known as familial benign recurrent vertigo, hereditary vertigo is a form of migrainous vertigo because it’s strongly associated with migraine attacks.

Vertigo can be caused by many factors, including infections, migraines, injuries, and several other health conditions.

Treating the underlying cause of your vertigo is the most effective way to decrease discomfort and provide long-term relief. There are also many home remedies, exercises, and medications that may be beneficial.

If you experience vertigo, it’s best to talk with a doctor to determine the cause and find a treatment plan that works for you.

If you need help finding a primary care doctor, then check out our FindCare tool here.

Treatment of dizziness in St. Petersburg | Doctor SAN

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An appointment with a neurologist is required for treatment of vertigo. In our clinic, neurologists with extensive clinical experience conduct daily appointments. At the appointment, the doctor will listen to complaints and conduct an examination. And, as a rule, already at the initial appointment, the doctor will prescribe a treatment for dizziness.

Genuine dizziness is quite rare (such dizziness is accompanied by increased sweating, nausea and vomiting). As a rule, bacterial and viral infectious diseases, lesions of the vestibular apparatus of various etiologies, and tumors are behind complaints of dizziness.

In some cases, it may be necessary to conduct a highly informative examination to identify the true cause of the deterioration in well-being. Usually, a minimal examination for complaints of dizziness includes a complete blood count, glucose measurement, ECG, and x-ray of the cervical spine.

Depending on the diagnosis, the doctor will select the necessary drugs for the treatment of dizziness and give recommendations on how to take them. In addition to drug therapy, physiotherapeutic procedures can also be prescribed that enhance the overall therapeutic effect, for example: TES therapy, therapeutic massage, acupuncture.

Doctor’s consultation on the treatment of dizziness:

+7 (812) 407-18-00

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• Neurologists with extensive clinical experience
• Accurate diagnosis of the cause of dizziness
• Complete neurological examination

Types of dizziness

Joint work of visual, tactile, vestibular and proprioceptive systems is responsible for the sense of balance. These systems are associated with subcortical formations and the cerebral cortex. Histamine receptors and acetylcholine are responsible for the transmission of signals from the systems to the vestibular analyzers and lateral vestibular nuclei. Almost any violation in this chain can cause dizziness. In medicine, dizziness is usually divided into vestibular and non-systemic.

Non-systemic dizziness

Non-systemic dizziness, or physiological dizziness, is triggered by irritation of the vestibular apparatus due to prolonged circling, observation of moving objects, a sharp change in speed of movement or being at a height. Sometimes non-systemic dizziness in women can be harbingers of fainting.

When non-systemic dizziness occurs, a person feels unsteady and has difficulty maintaining the body in a certain position. This condition goes away on its own, without any medical help.

Systemic dizziness

Systemic dizziness is a symptom of damage to the vestibular apparatus. It is central and peripheral, depending on the location of the lesion. With peripheral dizziness, the work of the cerebellum and the vestibular nuclei of the brain stem is disrupted; at the central – nerves, semicircular canals and vestibular ganglia.

With systemic vertigo, there is an illusion of the movement of one’s own body in space: it can sway, as if on waves, fall through unsteady soil or rise above the ground. This condition can last from a few minutes to several days and requires medical attention.

Treatment of dizziness in St. Petersburg is carried out at: st. Marata, 78. You can sign up for a consultation with a neurologist by calling the round-the-clock phone number or using the online schedule on our website.

Treatment of dizziness in our clinic

Diseases that cause dizziness

Dizziness can be a symptom of various diseases. Therefore, in order for the doctor to be able to identify the true cause and prescribe the necessary treatment for dizziness, it may be necessary to undergo a highly informative examination.

Meniere’s disease

Meniere’s disease is accompanied by severe dizziness, nausea, vomiting, noise and pressure in the ears. The cause of this pathological condition is the expansion of the endolymphatic system and swelling of the labyrinth. The disease is reversible, however, if treatment is not started in advance, a person may lose hearing and the ability to navigate in space for a while when the membrane separating the relymph and endolymph is ruptured.

Labyrinths

Inflammation of the inner ear causes severe dizziness and hearing loss. The so-called labyrinthitis can be caused not only by hypothermia, but also by various viral and bacterial diseases (for example, influenza, measles, rubella, mumps). As a rule, without treatment, the disease proceeds for a long time, from several weeks to several months.

BPPV

Benign paroxysmal positional vertigo (BPPV) occurs when lifting or bending over. About half of the world’s population suffers from this disease, which progresses to old age. Its causes are the deposition of calcium carbonate on the cupula and increased irritability of the receptors of the semicircular tubules.

Vestibular neuronitis

Vestibular neuronitis (vestibular neuritis, acute peripheral vestibulopathy) is characterized by severe dizziness accompanied by anxiety, nausea and vomiting, congestion and tinnitus. People suffering from vestibular neuronitis usually lie in bed for several days until their health improves. As practice shows, neuronitis occurs after the transfer of acute infectious diseases of the upper respiratory tract.

Post-traumatic dizziness

In case of severe blows to the head, as well as due to a fracture of the bones of the skull, post-traumatic dizziness, nausea and vomiting may occur. Sometimes such trauma can lead to hemorrhage in the middle ear and damage to the eardrum, which also adversely affects the ability to keep balance.

Barotrauma

Rupture of the membrane between the middle and inner ear can cause dizziness. As a rule, a fistula occurs with barotrauma (for example, when jumping into the water, straining hard, or even coughing). Sometimes barotrauma is accompanied by hearing loss.

Cholesteatoma

Chronic inflammation of the inner ear causes a tumor (cholesteatoma). Over time, the tumor destroys the walls of the eardrum and leads to the formation of a fistula. Pathology leads to hearing problems and regular dizziness. Vestibular nerve damage Depending on the degree of intoxication, in addition to dizziness, hearing problems appear.

Damage to the brainstem

Poor circulation in the cerebellum and brainstem can cause dizziness. As a rule, acute circulatory disorders are also accompanied by problems with articulation, phonation, swallowing and diplopia. Occasionally, such individuals may experience cold extremities, visual disturbances, and paresthesias.

Paroxysmal conditions

Often, an epileptic focus affects the vestibular areas of the cerebral cortex. Such dizziness may be accompanied by tinnitus, numbness of the extremities, and some signs of temporal lobe epilepsy (eg, headache, increased salivation, hallucinations, and impaired consciousness).

Pathology of the cervical spine

Injuries to the cervical spine, as well as some neurological diseases, can cause dizziness. Dizziness in the pathology of the cervical spine, as a rule, is associated with impaired conduction of nerve impulses from the cervical muscles.

We recommend that you do not neglect the scheduled examination in case of complaints of dizziness, as frequent bouts of dizziness are usually a symptom of a disease. In addition, the effectiveness of the treatment of dizziness directly depends on the diagnosis based on the results of highly informative diagnostics.

Date of update: 01/14/2022

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Fedosova Svetlana
Narzulloevna

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Neurologist, epileptologist, vertebrologist

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Belyasnik Andrey
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Neurologist, doctor of functional diagnostics

Work experience 14 years

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Treatment of dizziness Yaroslavl

Dizziness is the second reason patients seek medical attention after headaches. There are many reasons, more than 80 diseases are accompanied by dizziness.

About 60 patients out of 100 dizziness is caused by pathology of the inner ear (peripheral part of the vestibular system).

The dizziness room diagnoses and treats the causes of dizziness and unsteadiness. The purpose of the office is to help every patient with dizziness and unsteadiness, regardless of age, duration of the disease and comorbid disorders.

Dizziness and balance disorders are among the most common medical problems. Often, these feelings are explained by age. Indeed, over time, walking speed decreases, muscle strength decreases somewhat, and reaction speed slows down. These changes are inevitable, but it is possible to adapt to them if the rehabilitation program is timely and correctly drawn up.

However, as a rule, the cause of dizziness and unsteadiness is not age at all. Many diseases, originating in middle or old age, are manifested by these symptoms. Often, dizziness and balance disorders are caused by a combination of several diseases affecting the nervous system, the vestibular apparatus of the inner ear, vision, and the musculoskeletal system.

It is important that many of these diseases are curable, and then, regardless of age and their prescription, dizziness and unsteadiness go away. It is only necessary to determine the cause and choose a treatment.

Dizziness can present in many ways, from occasional unsteadiness or unsteadiness when walking to severe bouts of rotational vertigo accompanied by nausea and vomiting.

In the clinical examination of a patient with vertigo, spontaneous nystagmus (SpN) is of significant diagnostic value. This parameter may indicate a peripheral or central genesis of the lesion of the vestibular system.

Peripheral spontaneous nystagmus appears as a result of asymmetry that occurs between the vestibular nuclei of the brain.

Diseases associated with peripheral nystagmus:

1. Vestibular neuronitis
2. Meniere’s disease (non-inflammatory disease of the inner ear)
3. Benign paroxysmal positional vertigo

Central spontaneous nystagmus is observed in the presence of a pathological focus in various parts of the central nervous system involved in maintaining balance and oculomotor reactions (cerebellum, medial longitudinal bundle, structures of the reticular formation, etc. )

Central spontaneous nystagmus is also observed in the intact function of both vestibular analyzers, for example, in stroke of the brain and cerebellum or transient ischemic attack.

One of the most important characteristics of spontaneous nystagmus, in addition to the direction and intensity when looking in different directions, is the assessment of latent spontaneous nystagmus, i.e. its change in the absence of fixation of the gaze. In the absence of gaze fixation, peripheral SpN increases. This is the fundamental difference between peripheral spontaneous nystagmus and the central one.

To visualize latent SpN glasses with high magnification lenses are used to eliminate the effect of gaze fixation in the form of a mask with limited lateral fields of vision and built-in eye illumination.

Frenzel glasses are an indispensable tool for the clinical examination of a patient with vertigo.

Appointment includes in the vertigo treatment room:

• standard neurological examination to collect anamnesis, complaints, etc.