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Vertigo

 

Vertigo Introduction

The terms “vertigo” and “dizziness” are non-interchangeable. Vertigo is defined as “a sensation of irregular or whirling motion, either of oneself or of external objects.” [1] Physical signs of dizziness may be related to vertigo, but usually result from different causes. In short, all manifestations of vertigo include dizziness, but not all dizziness is vertigo.

The actual sensation of vertigo has a relationship with many conditions. True vertigo is usually related to an inner ear disorder known as benign positional paroxysmal vertigo (BPPV). While the cause of this peripheral condition is largely unknown, it is thought to result from the dislodgement of normal crystalline structures located in the part of the ear involved with sensing balance. For some, it can follow an upper respiratory infection or mild head injury. Attacks last for 30-60 seconds and can be triggered when rolling over in bed or reaching for something. It can have associated hearing loss and ringing in the ears. BPPV may occur in an episodic nature as well, with attacks occurring over the period of a few days and sometimes weeks. Solitary attacks may also occur without any precipitating factors.

It has also been theorized that Vertigo is caused by a condition known as Meniere’s disease. Meniere’s is another condition of the ear. This condition is marked by a pronounced swelling in the inner ear, and has been associated to attacks of vertigo. Meniere’s disease has an elusive cause. It may be related to viral infections, injury, or specific allergens.

Central neurologic disorders, involving connections between the brain stem and cerebellum, tend to cause more long-term bouts of vertigo but are usually less intense than peripheral disorders. There is no associated hearing loss, but there could be other concomitant symptoms, such as the uncontrolled jerking of the eyes back and forth (nystagmus). Conditions such as multiple sclerosis, epilepsy, brain tumors, and neck injury, could cause associated vertigo due to their involvement in the central nervous system.

Cervical vertigo may be caused by damage to the nerves in the neck. When these nerves are damaged, the brain is challenged in keeping track of the relative position of the neck and trunk. Whiplash injuries, blunt injuries to the top of the head, or severe arthritis in the neck may cause cervical vertigo. [2] The brain depends on feedback from all parts of the body (especially for positioning) in order to maintain balance. When this feedback is skewed, such as in the case of injury to the nerve plexi of the neck, the brain has difficulty interpreting where the body is in space. This often results in the sensation of vertigo.

Drugs, including sedatives, anticonvulsants, antipsychotics, excessive use of alcohol, bacterial or viral conditions in the inner ear (labyrinthitis), Paget’s disease, and some tumors can all cause vertigo. These causes should be kept in mind when investigating the reasons for the onset of vertigo symptoms. In fact, vertigo is not necessarily a disease process in of itself. It is most often thought of as a symptom of some other process that is occurring. With this in mind, it is important for one to obtain an accurate diagnosis prior to beginning treatment.

Diagnosis of vertigo is based on specific questioning, diagnostic physical exams, and possibly, imaging. The eyes are often checked for abnormal movements, such as nystagmus. Abnormal eye movements suggest that a disorder is affecting the inner ear or nerve connections in the brain stem. In order to help make a diagnosis, doctors will, at times, induce nystagmus by infecting cold water directly into the ear. The direction in which the eyes move gives an indication of where the complication may lie. If cervical vertigo is suspected, persons are given special glasses to wear and are then seated in a swivel chair. Depending on their experience of vertigo while moving in the chair and/or severity of nystagmus, the doctor can then make an official diagnosis for cervical vertigo.

Computed tomography (CT) can show fractures, infections, and tumors, which may help to shed light on the possible causes vertigo. Magnetic resonance imaging (MRI) can reveal issues involving the brain stem and cranial nerves as well. If multiple sclerosis or a brain infection is suspected, a spinal tap (lumbar puncture) may be performed to obtain a sample of cerebrospinal fluid from the spine. If doctors suspect that the blood supply to the brain is decreased, angiography, doppler ultrasonography, or magnetic resonance angiography (MRA) of the head, may be performed to narrow the diagnosis. [3]

Vertigo Symptoms

As stated above, vertigo is a sensation of disorientation in motion of oneself or other external objects. However, it can also cause additional signs and symptoms, including;

  • Nausea or vomiting
  • Sweating
  • Abnormal eye movements
  • Hearing loss
  • Ringing in ears
  • Visual disturbances
  • Weakness
  • Difficulty speaking
  • Decreased level of consciousness
  • Difficulty walking

Vertigo Statistics

  • Doctors in the Untied States reported 5,417,000 patient visits in 1991 because of dizziness or vertigo. [4]
  • About 545,000 people in the U.S. have Meniere’s disease, with 38,250 being newly diagnosed each year. [5]
  • The number of people affected by BPPV each year has been estimated to be between 10 and 64 per 100,000 people. However, some experts believe that even more people may be affected.[6]
  • In the general U.S. population, which speaks to all ages, 347,000 hospital days per year in the United States are incurred because of “vertiginous syndromes;”
  • 202,000 because of labyrinthitis (otitis interna),
  • 184,000 because of ‘labyrinthitis unspecified,”
  • And several thousands more accounted for by other balance and dizziness related disorders. [7]

Vertigo Treatment

If vertigo is due to an avoidable cause, circumventing the triggers can prevent an attack. For example, if vertigo is due to motion sickness, avoiding driving on a windy road can prevent an attack. For those with BPPV, there is a technique known as the Epley Maneuver, in which a practitioner may be able to realign the crystals in the semicircular canals (which is a purported cause of the condition), and often cure the associated vertigo. [8]

If vertigo is coupled with nausea, medications such as antihistamines may help to relive this symptom and when taken preventively, may halt vertigo from developing. Sometimes anxiety is produced because of severe vertigo. Anxiolytics can bring some relief by reducing the nervous component. With cervical vertigo, structural stability can bring some relief. A cervical collar and physical therapy can provide extra support to the neck and help with symptoms. In other severe cases of vertigo such as with Meniere’s disease, surgery is a drastic, but viable option. However, these options are often pursued only in cases where vertigo may prevent a person from functioning normally. In the most extreme of cases, some individuals are so nauseated and dizzy that they cannot leave home or work place.

Supplements helpful for Vertigo

Zingiber officinale (Ginger) Ginger is widely known for its use as a spice, but its medicinal uses date back thousands of years. Today, Ginger is used to treat a number of conditions, including stomachaches, diarrhea, toothaches, and nausea. [9] A study done in 1982 provided the first documented research, touting ginger to be a more superior treatment for nausea and vomiting than Dramamine. [10] Since then, several studies have supported this claim. Other studies have shown that ginger, when taken orally, may reduce symptoms of vertigo, including nausea. However, the occurrence of nystagmus was not reduced in this particular study. [11]

Ginger has also been shown to reduce the hypergastric motility present with motion sickness. [12] This seems to be its mechanism of action when reducing symptoms of motion sickness, but there have also been claims that ginger has an effect on the inner ear and the brain. [13] More research is necessary to validate this claim.

Ginkgo biloba Ginkgo biloba is often referred to as a living fossil, as the ginkgo tree dates back more than 200 million years to the fossils of the Permian period. [14] Its medicinal uses have roots in China and is now well known is the Western world for its ability to help with brain function. The use of gingko is widely applied in medical conditions involving cognition, memory, and learning. It is among the leading prescribed medicines (including standard pharmaceuticals) in both Germany and France.

The oral administration of ginkgo leaf seems to improve symptoms of vertigo and certain equilibrium disorders. [15, 16, 17] Two clinical studies demonstrate that ginkgo leaf extract is more effective than placebo in reducing symptoms of vertigo, and potentially just as helpful as betahistine for improving vertigo caused by vascular vestibular disorders; as well as other vestibular disorders of unknown cause. [18, 19, 20]

Pyridoxine (Vitamin B6) Vitamin B-6 is critical for the metabolism of many nutrients, including amino acids, lipids, and carbohydrates. It is also involved in approximately 60 different enzyme systems. Vitamin B6 plays a significant role in healthy brain function because of its function in the production of the neurotransmitters serotonin, dopamine, melatonin, epinephrine, and norepinephrine.

The dietary supplementation of vitamin B6 may prove especially relevant to vertigo sufferers, as it has been very helpful in those suffering from nausea and vomiting. In a study involving 59 expecting women, 31 received vitamin B6 in a regimen of oral tablets every 8 hours for 72 hours, while 28 received a placebo in the same manner. At the completion of the study, only eight of 31 patients in the vitamin B6 group had any vomiting, as opposed to 15 of 28 patients in the control group. [21]

References

[1] The American Heritage® Stedman’s Medical Dictionary Copyright © 2002, 2001, 1995 by Houghton Mifflin Company. Published by Houghton Mifflin Company.

[2] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

[3] ibid

[4] Vital and Health Statistics, The National Ambulatory Medical Care Survey, 1991 Summary, National Health Survey, Series 13, No. 116, DHHS Publication No. (PHS) 94-1777, May 1994, p. 21. See Table R.

[5] National Strategic Research Plan – 1991, 1992, 1993, National Institute on Deafness and Other Communication Disorders, U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, NIH Publication No. 95-3711, pp. 159-160.

[6] See Froehling, D.A., Silverstein, M.D., Mohr, D.N., Beatty, C.W., Offord, K.P., and Ballard, D.J. “Benign Positional Vertigo: Incidence and Prognosis in a Population-Based Study in Olmsted County, Minnesota.” Mayo Clinic Proceedings, 66(6):596-601, 1991.

[7] National Strategic Research Plan 1991, 1992, 1993, National Institute on Deafness and Other Communication Disorders, U.S. Department of Health and Human Services, Public Health Service, NIH Publication No. 95-3711, p. 159.

[8] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

[9] Leung A: Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics. John Wiley & Sons, New York, 1980, pp 184-186

[10] Mowery D and Clayson D: Motion sickness, ginger, and psychophysics. Lancet, 655-657, 1982

[11] Grontved A, Hentzer E. Vertigo-reducing effect of ginger root. A controlled clinical study. Orl J Otorhinolaryngol Relat Spec 1986;48:282-6.

[12] Stewart JJ, et al.: Effects of ginger on motion sickness susceptibility and gastric function. Pharmacology 42, 111-120, 1991

[13] Grontved A and Hentzer E: Vertigo-reducing effects of ginger root. OTO Rhinolaryngology 48, 282-286, 1986

[14] Murray, Micheal T, The Healing Power of Herbs: P 145, Prima publishing 2nd Edition © 1995

[15] Diamond BJ, Shiflett SC, Feiwel N, et al. Ginkgo biloba extract: mechanisms and clinical indications. Arch Phys Med Rehabil 2000;81:668-78.

[16] Cesarani A, Meloni F, Alpini D, et al. Ginkgo biloba (EGb 761) in the treatment of equilibrium disorders. Adv Ther 1998;15:291-304

[17] Haguenauer JP, Cantenot F, Koskas H, Pierart H. [Treatment of equilibrium disorders with Ginkgo biloba extract. A multicenter, double-blind drug vs. placebo study]. [Article in French]. Presse Med 1986;15:1569-72.

[18] Cesarani A, Meloni F, Alpini D, et al. Ginkgo biloba (EGb 761) in the treatment of equilibrium disorders. Adv Ther 1998;15:291-304

[19] ibid

[20] Haguenauer JP, Cantenot F, Koskas H, Pierart H. [Treatment of equilibrium disorders with Ginkgo biloba extract. A multicenter, double-blind drug vs. placebo study]. [Article in French]. Presse Med 1986;15:1569-72.

[21] V Sahakian, D Rouse, S Sipes, N Rose, and J Niebyl,Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study, Obstetrics & Gynecology 1991;78:33-36