Vertigo

Vertigo is the sensation of movement (usually spinning) when no movement is actually occurring.

Vertigo accounts for 54% of cases where patients experience dizziness and affects up to 10% of the population. There is no single cause of vertigo and therefore no single treatment.

When assessing what treatment is best for vertigo we have to look at where the source of the problem presides. To start we have to determine if the problem is central or peripheral. Let’s take a minute to talk about what it means when we say “central or peripheral.”

Vertigo is caused by a dysfunction in your vestibular system. Just like your visual system has peripheral receptors(the eyes) your vestibular system has peripheral receptors which are located in your inner ear. Each receptor(the right and the left) is made up of 3 Semicircular canals, an anterior(aka superior), lateral(aka horizontal), and posterior. These canals are filled with fluid called endolymph and have little stones floating in them known as otoliths. As your head experiences acceleration in different directions it will move the stones in one of the canals based on which direction you are moving. For example, if you put your head back or fall backwards the stones in the posterior canal fire off the receptors in that corresponding canal.

Once this signal is generated it is sent to the brain via the vestibulocochlear nerve and is translated into a sensation of movement. If we return to our previous example of the posterior canal firing, that information is sent to central processing centers and then you perceive the sensation of moving backwards.

Vertigo can be a problem in this peripheral receptor or the central processing unit. This is what we are referring to when we say we have to figure out if the problem is central or peripheral. If the problem is peripheral it will usually have a positional component. What that means is a specific head movement will be able to reproduce the symptoms (e.g. if the problem is with your right posterior receptor than putting your head back and to the right will aggravate the vertigo symptoms). When the problem is with the vestibulocochlear nerve you will often experience hearing loss or tinnitus (ringing in the ears).

Vertigo can also be a problem with the brain and not the peripheral receptor (a central cause of vertigo). In this case the receptors are functioning correctly but your brain is unable to translate the information it is given. You then develop a sensory mismatch in which you perceive movement that is not actually happening.

After we have fully determined the cause of your vertigo we have to treat the specific areas of dysfunction. Often if it is a peripheral problem, treatment includes repositioning the stones that may have become stuck in a specific canal and are continually firing that receptor. In the case of a centrally mediated problem we have to perform complex neuro exercises to reprogram how your brain deals with and perceives movement.

It should be noted that medication designed for vertigo does not differ depending on the cause and is only intended to mask symptoms.

Sometimes people confuse balance issues with vertigo. Click on the video below to learn more about balance disorders vs. Vertigo.