Vertigo is one of the most common presenting complaints in the GP setting. It is a symptom, rather than a condition itself. It is mostly described as a spinning sensation of the environment that may result in disability to stay upright or feeling nauseous. The attack may last for a few seconds or longer. Most of the time, it is associated with loss of balance which can lead to difficulty to stand or walk and feeling sick or dizziness. Life can be very disabling if the vertigo is constant and severe.
During the consultation, the most frequent questions asked by patients would be the causes of vertigo that they are currently facing. Causes of vertigo may include:
- Infection of the inner ear known as Labyrinthitis
- Benign paroxysmal positional vertigo (BPPV) in which certain position may trigger vertigo experienced by the patient.
- Central vertigo such as severe headache including migraines
- Benign tumour of the brain and in this case is the vestibular nerve known as acoustic neuroma (This condition is normally associated with tinnitus and progressive hearing loss)
- Inflammation of the vestibular nerve known as Vestibular Neuritis
- Fluid build up in the inner ear causing Meniere’s Disease
- Vertigo of unknown cause
In some cases, vertigo is self-limiting. It may improve over time without any treatment. Nevertheless, if vertigo persists, the best treatment for it would depend on the underlying cause.
- Epley manoeuvre is a series of head movement that is used in the treatment of BPPV.
- Most of the time, Labyrinthitis is caused by viral infections and self-limiting. In rare cases, antibiotics may be needed if the inner ear infection is caused by bacteria.
- Vestibular rehabilitation may be needed in cases of vestibular neuritis refractory to conservative treatment.
- Pain killer, beta-blocker, or antiepileptic such as sodium valproate for migraine as treating migraine can heal vertigo.
Symptomatically, there are various alternatives that can be done such as medication and bed rest. During the vertigo attack, lying still in a quiet and dark room may ease the symptoms of nausea and spinning sensation. In cases where central vertigo occurs or vertigo of unknown causes happen, medication such as prochlorperazine and antihistamines can be used. In the long run, medication such as betahistine can be advised to use.
Vestibular rehabilitation training is another form of treatment in which it involves a certain programme of exercises that encourage your brain to adapt to abnormal messages sent from the inner ear. This exercise encourages you to move despite feeling dizzy so that our brain relies on information from other parts of your body, rather than the abnormal signals from the ear. This will help to minimize any dizziness and maintain balance.
Having vertigo does not only impact our own body, but safety issues affecting the surrounding people may also arise.
- Operating machine or climbing ladder can be problematic with vertigo.
- There is an increased risk of falls
- Vertigo may influence the ability to drive and concentrate. Driving should be avoided in cases where patients experienced vertigo.
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