Vertigo or dizziness is due to a problem with the inner ear which is responsible for maintaining our balance.  It is an unpleasant sensation that the environment around you or your body is spinning or moving.  It may happen even if you are sitting or lying down.  Vertigo can develop suddenly (known as a vertigo attack) and can last from a few seconds to a few hours.  There may be a trigger factor such as sudden change in weather or body position.  Other associated symptoms include;

• feeling nausea or vomiting
• loss of balance
• unable to stand or walk
• ringing sound in the ear also known as tinnitus
• jerking eye movements known as nystagmus
• headache

Causes of Vertigo

There are many causes for vertigo which may be difficult to diagnosed because there is a degree of overlap between them.  Some of the common causes include;

• Benign Paroxysmal Positional Vertigo (BPPV) where certain head movements can trigger vertigo
• Meniere’s disease where there is a buildup of fluid in the ear associated with tinnitus or hearing loss
• Labyrinthitis where there infection of the inner ear
• Vestibular neuronitis where there is inflammation of the vestibular nerve
• Migraine
• Previous head or neck injury
• Brain tumour or stroke
• Anxiety 
• Postural hypotension due to low blood pressure or anaemia

Treatment of Vertigo

Fortunately, most cases of vertigo may improve over time without any treatment.  However, some patients get recurrent episodes which may or may not have any trigger factors.   Treatment for vertigo depends on the cause.  Your ENT specialist would be able to treat middle ear infection and Meniere’s disease while your GP doctor or neurologist would be able to treat your migraine and prescribe medication for you.

Medication

Medication are usually prescribed for 4 to 14 days depending on the severity of the condition.  The common medicines prescribed are;

• Prochlorperazine (Stemetil) helps to relieve nausea and vomiting associated with vertigo.  They may have some side effects such as tremors (shaking) and involuntary body or facial movements as well as making you feel sleepy or drowsy
• Antihistamines helps to relieve nausea and vertigo symptoms..  They include Cinnarizine (Stugeron) or promethazine (Phenergan).  They may have some side effects such as making you feel sleepy or drowsy and headaches or stomach discomfort.  
• Betahistine (Serc) helps to relieve vertigo in Meniere’s disease

Exercise Treatment for BPPV

• Simple head movements (known as the Epley manoeuvre) can used by your physiotherapist to treat vertigo due to BPPV
• Vestibular rehabilitation training (VRT) can help patients with balance problems associated with vertigo

Prevention and Self Care

DO sleep with your head slightly raised using 1 or 2 pillows

DO get out of bed slowly and sit on the edge of the bed for a minute before standing

DO gentle regular exercises such as walking

DON’T bend down to pick up items

DON’T extend or stretch your neck such as looking behind when reversing the care 

DON’T do sudden movements

Discuss the treatment options with your doctor or pharmacist