If you’ve ever experienced vertigo, you know that the sensation of spinning can be difficult to manage. When someone experiences vertigo constantly, it can make typical daily activities like driving or even walking difficult, and there is often nothing that can stop an episode once it’s started. The cause of vertigo can vary based on things like age, health conditions, and any injuries or illnesses that may be acutely present, but treatments are often similar. One thing that can be very effective is using vestibular rehabilitation and other physical therapy services to help the body better adjust and avoid vertigo.
What Is Vertigo?
Vertigo is a term commonly used to describe the sensation that either you are spinning while your surroundings are still or that your surroundings are spinning while you are still. This is a form of dizziness but specifically requires the motion and stillness dichotomy to be considered vertigo. It may also feel similar to motion sickness in some cases. There are two categories of vertigo generally recognized:
- Peripheral vertigo is the most common form and occurs as a result of the inner ear, or the vestibular nerve, which controls balance, being damaged or compromised.
- Central vertigo results from a problem in the brain. It may be caused by conditions like a stroke or traumatic brain injury, an infection, a brain tumor, migraine, or multiple sclerosis.
The most common cause of vertigo is a condition called benign paroxysmal positional vertigo (BPPV), which is usually brought on by a rapid change in head movement, like a slip and fall injury, blow to the head or whiplash. BPPV is marked by the intense and brief sensation that you are spinning despite being still, though other symptoms include dizziness, unsteadiness, nausea, and vomiting. The condition itself is not usually serious, but it can be associated with other issues or lead to dangerous circumstances.
Other common causes of vertigo include:
- Infection: Viral infections of the vestibular nerve, like vestibular neuritis or labyrinth, may cause intense and constant bouts of vertigo.
- Migraine: Those who suffer from migraine headaches can experience vertigo for hours at a time.
- Meniere’s disease: Excessive fluid buildup in the inner ear can lead to this condition, which can be marked by vertigo that lasts for several hours.
- Neck and head injury: Vertigo is often associated with traumatic injuries to the neck and head, especially when there has been damage to the vestibular system.
- Medications: Some medications can cause vertigo, along with related symptoms such as dizziness, loss of hearing, or a ringing in the ears known as tinnitus.
The Vestibular System
Many people are surprised to learn that the ears have an impact on things like balance, dizziness, nausea, and other symptoms throughout the rest of the body. This is because of the vestibular system, which is a sensory system primarily found in the inner ear. The complex system of organs and receptors in the inner ear are able to send information throughout the body, providing inputs surrounding motion, head position and spatial orientation. This information is used to facilitate motor functions that help us keep our balance, stabilize the body and head during movement, and maintain our posture. When this is not working properly, normal movement and equilibrium become hard, causing symptoms like vertigo.
Diagnosing Vertigo
It is important to remember that not all dizziness is vertigo, and everyone will experience some dizziness in certain scenarios. If you find yourself on top of a very tall building looking down and experiencing vertigo, it is likely not a cause for concern.
But constant episodes, vertigo that lasts a long time, or vertigo that prevents you from participating in normal daily activities should be brought up to a doctor or physical therapist.
When you present with symptoms, the physical therapist will first ask you some questions to understand your symptoms and how they can best treat it. Some questions you can expect may be:
- When did you first notice the symptoms?
- What do you do when you experience vertigo? Is there something you are doing right before, like bending, standing still, rolling over, driving, etc.?
- How long does vertigo last?
- Is this the first time you have had vertigo symptoms?
- Do you have any hearing loss? Ringing or a feeling of fullness in the ear?
- Do you experience nausea with the spinning?
- Do you experience changes in heart rate or breathing?
In addition to this discussion, you may undergo some tests to help determine the cause of vertigo and your risk for things like falling. This may include techniques such as head impulse testing or the Dix-Hallpike maneuver, in which patients are quickly lowered from a seated position to lying down. You may also need to undergo imaging, balance tests, and hearing exams. All of this helps to understand what kind of vertigo you are experiencing and how to best treat the root cause.
Treatment Options for Vertigo
How do you handle vertigo? Depending on the type and cause of your vertigo, there are a number of ways it can be treated. These methods will generally focus on relieving the cause of your vertigo rather than reducing the symptoms themselves, though you may also work on managing each episode safely. In cases where the vertigo is due to permanent damage, you may also use physical therapy and vestibular rehabilitation to address the issue.
Outside of physical therapy, some common treatment options are below.
Homeopathic Remedies
Though there is less evidence for them, several common homeopathic remedies for vertigo are popular. Supplements like ginkgo Biloba and melatonin can assist with sleep during episodes, and essential oils such as lavender and peppermint may be recommended.
Repositioning Maneuvers
The Epley maneuver, or the canalith repositioning maneuver, is a method used to relieve symptoms of BPPV. By moving the head in a specific manner, the canalith crystals (small particles that form in the ear canal and cause vertigo) can become displaced and relieve symptoms. Each treatment session involves holding four positions for 30 to 60 seconds each, then repeating each position several times as needed. You will usually begin this treatment with a healthcare provider and be given guidance on how to perform it at home when vertigo returns.
At-Home Exercises
Some exercises can be performed at home without medical supervision and can help relieve vertigo.
To perform the Semont-Toupet maneuver:
- Sit upright on a flat surface, placing a pillow behind you and keeping your legs outstretched.
- Lie down, turning to your right and looking to your left side, upward.
- Quickly sit up and turn to your left side. Keep your head facing to your left so that you end up looking toward the ground.
- Slowly return to your original position, looking forward and sitting straight up.
If you are in a safe place and won’t be driving soon, you can also perform the Brandt-Daroff exercise:
- Sit on a flat surface, with your legs dangling like they would from a very high chair.
- Turn your head as far as possible to the left, then lay your head and torso down on your right side. Do not move your legs. Hold this position for at least 30 seconds.
- Sit up and return your head to the center.
- Repeat on the opposite side. You can do a set of 5 repetitions as often as 3 times per day, twice a week.
Medication
Antihistamines, which are commonly used to treat allergies, such as Meclizine, can be effective in treating motion sickness and vertigo. However, it can also lead to confusion or even amnesia in older adults and is used sparingly.
Surgery
In certain cases, the underlying cause of vertigo may require surgery to repair. This is common in cases of head injuries and brain tumors.
Physical Therapy and Vestibular Rehabilitation
For people with chronic conditions that can cause vertigo or who do not respond to other treatments, physical therapy can be a useful way to help the body adjust and learn ways to cope. The primary form of physical therapy used in these instances is known as vestibular rehabilitation therapy or VRT, an exercise-based program that focuses on improving balance and reducing risks related to dizziness.
Based on your exact needs and concerns, a physical therapist who specializes in vestibular rehabilitation will create a program to meet your goals. There are three primary methods used in VRT: habituation, gaze stabilization, and balance training.
Habituation
The goal of habituation is to reduce dizziness through repeated exposure to specific stimuli, such as movements or visual stimuli, which provokes the response of vertigo. Each exercise is meant to mildly to moderately cause dizziness in a controlled environment and then teach the brain to ignore the abnormal input. This is especially helpful in those who have permanent damage in their inner ear or find certain stimuli to be problematic. Over time, the intensity of the dizziness decreases, and patients are able to withstand episodes better.
Gaze Stabilization
Gaze stabilization exercises are used to improve the control of eye movements and help vision remain clear when the head is moving. For patients who report vision issues and a “bouncing” or jumping of their surroundings, especially when moving, this can be helpful. An example would be to fixate on an object and repeatedly move your head back and forth, up and down, for several minutes. This may induce an episode of dizziness, but over time the eyes will become stronger and better able to adjust to movement.
Balance Training
One of the largest concerns surrounding vertigo and vestibular issues is the increased risk for falls and related injuries. When someone is unsteady and unable to properly assess their surroundings, they are more likely to lose their balance and become injured. For those who will always have some level of vertigo, balance training is an important way to ensure they can still participate in normal activities safely.
In balance training, your therapist will assess several measures of balance to ensure your program is challenging but not unsafe for you to perform. You may practice walking outside, on uneven ground, or in the dark. A comprehensive program will focus on your ability to sit, stand, walk, turn, bend over, and reach while maintaining balance. Techniques such as gait walking, neck stretching, core strengthening, postural training, and ergonomic education may all be a part of balance training.
Other Methods
Some forms of physical therapy will utilize other methods to compensate for vestibular issues. You may also hear about adaptation, in which nerve impulses in the brain are taught to shift to the incorrect signal from the damaged vestibular system, allowing the brain to recalibrate itself. Substitution also uses a recovery principle, replacing the missing vestibular function with other bodily functions.
The ultimate goal of any physical therapy program will be to help you confidently and safely perform daily activities with as few symptoms as possible.
When to See a Physical Therapist
Experiencing dizziness in certain circumstances can be expected, and as long as it dissipates quickly and can be tied to that event, you likely do not need to seek medical care. However, any recurrent, sudden, severe, prolonged, or unexplained dizziness.
You should seek emergency care if your vertigo is paired with:
- Sudden and severe headache
- Chest pain
- Trouble breathing
- Numbness or paralysis in the arms and legs
- Fainting
- Double vision
- Seizures
- Sudden change in hearing
During periods of vertigo, be sure to limit movement as much as possible and avoid things like driving that can become dangerous.
If you think you may be in need of physical therapy or other treatment related to vertigo symptoms, AICA Snellville can help. In addition to trained physical therapists, we also have neurologists and chiropractors on staff who can help to form a holistic plan for your treatment. With on-site diagnostic imaging and a range of specialists on staff, AICA Snellville is able to address a range of causes and symptoms of vertigo, including trauma such as car accidents. Contact us today to begin treatment.