Vertigo

What is vertigo?
The 1958 Alfred Hitchcock thriller Vertigo gave many people the wrong impression of the nature of the condition. The hero of that film actually had acrophobia – an acute fear of heights – that triggered the spinning sensations characteristic of vertigo. However, this symptom is not necessarily associated with a fear of heights. Vertigo is the disconcerting sense of movement when you’re standing still, the feeling that the world is whirling around you, and can be brought on by numerous triggers – or by no discernible trigger at all.

What are the symptoms?
Vertigo can be associated with nausea and vomiting as well as the inability to maintain balance. It can be debilitating, especially if it occurs frequently. While the primary symptom is a sensation that you or the room is moving or spinning, there can be other symptoms associated with the condition that is causing the vertigo, including double vision, difficulty swallowing or moving the neck, facial paralysis, slurred speech or weakness in the extremities. Involuntary eye movements and hearing loss may also be present with vertigo.

What are the causes?
Among its many causes are circulatory disturbances in the brain (central nervous system) and damage to the nerves involved in hearing (peripheral nervous system). Vertigo can be triggered by viral infections in the inner ear, injuries to the brain and brainstem, strokes, inflammation and multiple sclerosis. Up to 85% of patients with vertigo have peripheral vertigo, where there is a problem with either the part of the inner ear that controls balance (the vestibular labyrinth or semicircular canals) or with the vestibular nerve, which connects the inner ear to the brainstem. The other 15% of people experiencing vertigo have a central nervous system disorder where problems develop in the brain, particularly in the brainstem or cerebellum (back portion of the brain). Benign positional vertigo can occur recurrently, especially when the head is placed in certain positions.

What is the conventional treatment?
If you suffer from vertigo, the conventional treatment is a drug called meclizine (Antivert, Bonine), which lessens nausea and may also relieve the sensation of spinning, but it doesn’t always work and can cause drowsiness, among other side effects. Additional medications to treat peripheral vertigo may include tricyclic antidepressant drugs like Amitryptaline/Elavil, which may be helpful in reducing the severity of symptoms, but often have side effects such as dry mouth, blurred vision, and constipation that deter their use. Medication typically used for anxiety (Valium, Diazepam) can also help by suppressing the vestibular system and relieving the anxiety that often accompanies vertigo, but it can be sedating and addictive. Antinausea medications such as promethazine (Phenergan) can also be beneficial.

The most effective treatment for benign positional vertigo (thought to be caused by small calcium carbonate crystals that block fluid movement within the inner ear) is a procedure called “Epley’s maneuver.” This involves moving the head in a prescribed sequence into different positions, and is designed to move the obstructing debris or “ear rocks” out of the sensitive part of the inner ear.

There are other exercises that can readjust habitual head movements that may worsen vertigo. Try to avoid head positions like prolonged tilting of the head when speaking on the telephone or rapid alternating head movements. If you are experiencing vertigo, use caution in situations such as driving, walking, or operating heavy equipment. Even short episodes of vertigo may be dangerous while doing these activities.

What therapies does Dr. Weil recommend for vertigo?

• Supplements: Ginkgo biloba, which increases blood flow to the brain, may help reduce symptoms of vertigo. Try two capsules three times a day over two months.
• Mind/Body Medicine: Because stress can worsen symptoms of vertigo, practice breathing exercises – especially Dr. Weil’s relaxing breath – or other relaxation techniques. Meditation, biofeedback, guided imagery and hypnosis are all potentially effective.
• Traditional Chinese Medicine: Experience two to three sessions of acupuncture for symptoms of vertigo that are not improving.
• Other Therapies: Explore the benefits of cranial therapy with a trained osteopath.