Dizziness and vertigo are at the top of the list of symptoms that lead individuals to seek medical attention. Some clarification of the differences between dizziness, disequilibrium, and vertigo may be helpful in understanding these symptoms and describing them to a healthcare provider.
- Dizziness – often described as “lightheadedness” or feeling as if one is going to faint. Spinning is typically not associated with dizziness.
- Disequilibrium – a loss or alteration in our sense of balance. Disequilibrium is often associated with the feeling of being on a boat, or the effects of alcohol on the way we walk (i.e. drunken gait).
- Vertigo – derived from the Latin “vertere”, meaning to turn. Vertigo is always associated with a sensation of turning or spinning. This is true whether the individual feels they are spinning or that the room is spinning.
Nausea and/or vomiting often accompany vertigo and although less often, may be associated with dizziness and disequilibrium. Dizziness and disequilibrium typically do not lead to vertigo. However, untreated vertigo will often lead to these symptoms due to compensatory changes within the brain. Any of these symptoms can be frightening and debilitating.
Dizziness, disequilibrium, and vertigo have many potential causes. Inner ear disorders, blood pressure issues, medication side effects, anxiety, drug and alcohol use, metabolic issues (e.g. blood sugar related), sedentary behavior, and brain injury are just a few that I have seen in my clients over the years in clinical practice.
Dizziness has many causes, a list too exhaustive to explore here, but many cases are related to:
- Medication side effects (it is one of the most common side effects across all classes of medications).
- Changes in heart rate and blood pressure (postural hypotension and vasovagal syncope).
- Anxiety disorders and panic attacks may lead to dizziness as well.
Disequilibrium is often related to an alteration in brain feedback from any of the major systems related to balance including visual, muscle and joint, and inner ear systems. The number of metabolic, physical, and functional conditions that may affect these systems is quite lengthy as you could imagine! Alcohol, recreational and therapeutic drugs, environmental exposures, and head injuries, among many other triggering agents, can play a large role in the disruption of equilibrium. As noted, untreated vertigo will also lead to symptoms of both dizziness and disequilibrium.
The leading cause of Vertigo, by far is related to debris (otoconia) made up of calcium carbonate crystals that dislodge from their proper place within the inner ear canal system. This condition, called Benign Paroxysmal Positional Vertigo (BPPV), is due to the disruption of signals transmitted to the brain regarding angular acceleration of the head from this debris in the affected ear canal. Fortunately this condition is treated with great success via head positioning maneuvers designed to relocate the debris to its proper location, followed by rehabilitation for the inner ear vestibular (balance) organs. Aging and head trauma are the two main predisposing factors for BPPV. The one major drawback is that this condition is often not assessed appropriately, therefore leading to incorrect or non-treatment.
Other causes of vertigo include:
- Vestibular neuritis or neuronitis, which, as its name implies, involves inflammation of the inner ear. Although treated with anti-inflammatory agents, symptoms often persist and require rehabilitation of inner ear balance organs.
- Meniere’s disease, which consists of a triad of symptoms including vertigo, tinnitus (ringing in the ears) and progressive hearing loss, is caused by an increase in a certain type of fluid within the inner ear causing pressure on balance and hearing centers. A more ominous and poorly understood condition, certain types of therapeutic interventions can be effective, especially with regard to the vertigo component.
- Perilymph fistula is a defect in the membrane, or window, between the middle and inner ear causing pressure changes affecting the inner ear.
- A certain class of antibiotic medications, aminoglycosides, can cause damage to the eighth cranial nerve leading to vertigo and hearing loss.
It is critical for anyone who is experiencing dizziness or vertigo to seek proper assessment and intervention to feel steady once again. Many people walk around for months and even years with mild to severe challenges in navigating their everyday world before getting adequate care. Even when care is sought, vertigo and dizziness often go under-treated because these symptoms are frequently overlooked or dismissed by many healthcare providers. Worse yet, they are often improperly treated.
Treatment for all of these disorders is wide ranging and the effectiveness of any given treatment is dependent upon the accurate diagnosis of the condition creating the symptoms. All conditions affecting balance will benefit from active rehabilitation of the involved systems once the causative factor has been established. Although, to the individual experiencing these symptoms, it appears that the prognosis is hopeless, long term outcomes are favorable for the vast majority of conditions outlined!
For comprehensive evaluation and intervention aimed at eliminating the cause of these symptoms and not just covering them up, one should seek the services of a qualified Functional Neurologist (visit the doctor locator at www.acnb.org). In addition to comprehensive neurological evaluations of the many systems related to balance, many functional neurologists utilize diagnostic testing services such as Computerized Assessment of Postural Systems (CAPS) and testing of eye movements with videonystagmography (VNG), among others. More importantly, they train the deficiencies identified in the various systems in order for the brain to realize what “normal” is once again. Once the brain is re-trained to process environmental input more efficiently, the likelihood of symptoms returning is greatly reduced!
Over the past 15 years in clinical practice, it has been my experience that the vast majority of these cases can be very successfully treated. Let me introduce to you one of the hundreds of cases of dizziness and spinning I have personally worked with that resulted in a complete reduction in symptoms. Please meet Bonnie:
Story: Bonnie was in her mid-50s when she presented to me for generalized dizziness that impacted her everyday activities. Bonnie had become socially withdrawn, could not drive, and had given up her greatest passion in life, knitting. She had been to numerous doctors and placed on the standard medications, which did not work and tended to make her feel increasingly anxious, nauseous and withdrawn.
Problem: The moment Bonnie walked through my door I instantly noticed two striking things that spoke volumes about her symptoms. Number one, her eyes jumped all around as she talked to me; number two, she could not walk a straight line. Neither of these issues had been addressed prior to my examination of her. Her inability to perceive the environment appropriately through her eyes was aggravating her balance system and causing extreme dizziness, among other symptoms.
Details: Through routine neurological examination and sophisticated testing of eye moments (VNG) and balance (dynamic posturography), it was quickly and easily uncovered that Bonnie had severe deficits in her balance due to the poor feedback from her eyes to her balance system. These deficits were as great as 85% as compared to standardized age and gender matches. It is no wonder she was so dizzy!
Results: Two days into a 5-day course of brain training designed to improve her eye movements and their impact on her balance system, Bonnie began to feel much less dizzy. She reported decreases in her symptoms of up to 75%. By the end of the 5 days her dizziness was gone, as was the anxiety that went along with it. Eye and balance re-testing after she completed training revealed no more than 12% deficits in the very functions that were causing her symptoms. To her delight, once the dizziness lessened, Bonnie was able to return to a happy and productive life that included socializing, driving, and knitting.
Although to Bonnie it may have seemed so, this was no “miracle story.” Her situation was as routine as they come for centers that deal with and understand the brain’s control over movement and balance, as well as the role the eyes and other systems play in maintaining equilibrium. We can only hope that others who are suffering from dizziness or vertigo find such a place for themselves.
About the Author:
Dr. Michael Trayford is a Board Certified Chiropractic Neurologist and co-founder of APEX Brain Centers in Asheville, NC. APEX is a progressive intensive brain training program that helps individuals with learning and behavioral issues, peak performance, and neurological issues such as brain injury and movement and balance disorders. www.ApexBrainCenters.com, 828.708.5274.