When The World is Spinning and You Don’t Know Why: The Many Causes of Vertigo
A sense of balance should not be taken for granted. Without a sense of a physically stable world around you, even the most simple tasks become disorienting and unfeasible. For instance, even turning your head sideways and nodding your head up and down becomes a spinning nightmare.
For those with a number of health issues, such a lack of balance is a reality termed vertigo. On its own, vertigo is not a condition, but rather a symptom. It is characterized by feeling as if either you or your environment is in motion, despite the fact that the perceived spinning is not representative of what is actually occurring with you or your environment. Furthermore, the motion perceived can range from subtle to severe, and the onset of vertigo can range from sudden and temporary to gradual and long-lasting. Thus, there is a wide range of variability in the severity, onset time, and duration of the vertigo. Essentially, the mere experience of motion without cause is vertigo, yet the specific incident may be so brief that it is innocuous, or so enduring and chronic that it is debilitating. Nevertheless, having an episode of vertigo can be rather alarming, and is one of the most common reasons for a doctor’s visit.
Just as vertigo varies in terms of intensity and duration, the cause of vertigo—or the underlying condition that is causing the vertigo—is just as variable. Most of these conditions are related to dysfunction in the ear or brain, although several conditions unrelated to the ear and brain cause vertigo. One of the most common conditions that causes vertigo is termed benign paroxysmal positional vertigo (BPPV). The vertigo associated with this condition is typically triggered by specific changes in the position of the head, such as when getting up from laying down after waking from a night of sleep. Oftentimes the vertigo leads to other symptoms, such as dizziness, nausea, and vomiting. More severe symptoms, which require emergency care, include fever, difficulty speaking or walking, double vision or vision loss, hearing loss, and muscle weakness.
Physically, benign paroxysmal positional vertigo (BPPV) arises when crystals inside the otolith organs of the ear become dislodged and move into the semicircular canals. The crystals are meant to monitor movements of the head with particular sensitivity to gravity. Meanwhile, the semicircular canals are located inside an organ of the ear termed the vestibular labyrinth, and these loop-shaped canals contain fluid as well as hair-like sensors to monitor the rotation of the head. Nevertheless, when the crystals of the otolith organs move into the semicircular canals, the system that keeps track of head movements suddenly becomes overly sensitive to motion, and thus, responds to movements that normally do not warrant a response—causing the vertigo.
It is important to note that BPPV may be triggered by other underlying conditions, and thus, a medical examination is useful to explore more subtle causes of the BPPV. In terms of risk factors for BPPV, the condition typically affects older adults and is likely to develop with age. Other possible causes of vertigo include inflammation within the inner ear, such as labyrinthitis or vestibular neuritis. This inflammation is associated with infections in the inner ear, which are distinct from the ear infections that children usually experience. Such infections can either be bacterial or viral, and the inflammation lasts until the infection subsides. Vestibular neuritis is an inflammation within the inner ear, affecting specifically the vestibular nerve, which is a structure that sends signals to the brain for the purpose of maintaining balance.
Another common cause of vertigo is Meniere’s disease, which consists of a triad of symptoms— vertigo, ringing in the ear, and hearing loss. This condition causes episodes of severe vertigo, and fluctuations in hearing loss. Oftentimes, this condition causes anxiety and panic for patients, as there is a threat to hearing that can potentially be severe. The cause of this condition is not fully known, but is thought to be triggered by allergies, viral infections, injuries to the head or neck, and hereditary factors.
More common health issues that may be causing vertigo include migraines and other headaches, motion sickness, head or neck trauma, and diabetes. For diabetes, arteriosclerosis, which is characterized by tightening and hardening of the arteries, lowers blood flow to the brain, which in turn may cause the symptoms associated with vertigo. Pregnancy may also cause vertigo, as hormonal changes coupled with low blood sugar levels may lead to vertigo in all trimesters of the pregnancy, especially the first. For the second trimester, the expanding uterus places pressure on blood flow, which can additionally cause dizziness and vertigo. For the third trimester, simply laying on the back causes vertigo, as there must be compensation for blood flow to the heart, since the weight of the baby constricts vessels to the heart.
A more serious health illness that may cause vertigo is multiple sclerosis. The episodes that occur with MS are usually abrupt, and may also cause inability in moving certain eye muscles. In terms of an explanation for why this occurs, lesions in the brainstem or cerebellum due to MS disrupt balance, which therefore causes the symptoms of vertigo and dizziness. Similarly, strokes and tumors may also be associated with vertigo. In fact, clots in the blood flow to the brain, especially if in the back of the brain, are often characterized and marked by vertigo.
Overall, the causes of vertigo are plenty—and all are serious and worthy enough to warrant a visit to the doctor. However, it is important to note that understanding the cause of your own vertigo may be a journey that requires more than just one medical examination. Whether the vertigo signals a more severe underlying issue, or is simply a manifestation of BPPV and migraines, treatment options— ranging from medication, to physical therapy, to surgery—are available to assist you in becoming a vertigo-free you.
References:
https://www.webmd.com/brain/vertigo-symptoms-causes-treatment
https://www.mayoclinic.org/diseases-conditions/vertigo/symptoms-causes/syc-20370055
https://medlineplus.gov/dizzinessandvertigo.html
https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Dizziness-and-Vertigo
https://www.mayoclinic.org/diseases-conditions/menieres-disease/symptoms-causes/syc-20374910
