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Neurology

Types of vertigo

Vertigo is often described by patients as a false sense of rotational movement. Many patients who experience vertigo feel lost, frustrated, and confused1.

There are two main types of vertigo2:

  • If vertigo arises from a disorder of the ear and the structures around it, it is called peripheral vertigo.
  • On the contrary, if the sensation arises from a disorder in the brain and the structures around it, it is called central vertigo..

Most patients experience peripheral vertigo. However, it is essential to consult doctor if one experiences vertigo. The doctor can assess if the patient has peripheral or central vertigo and help manage the condition.

Most often, peripheral vertigo comes from disturbances in the inner ear2.

Why does disturbances from the inner ear cause vertigo? The inner ear is composed of3:

  • Three semicircular canals filled with fluid and containing hair cells enable us to maintain our balance.
  • Two fluid filled sacs (saccule and utricle) containing mini stones orient us when we are moving up or down and speeding up or slowing down.
  • Cochlea, the snail looking, part enables us to hear.
  • All those parts of the inner ear mentioned above contribute to the smooth running of the vestibular system.

Under the umbrella of peripheral vertigo, many patients experience vertigo due to three specific conditions: benign paroxysmal positional vertigo (BPPV), acute vestibular neuronitis, and Ménière’s disease4.

  1. BPPV is strongly associated with the feeling of positional vertigo, defined as a spinning sensation produced by changes in head position relative to gravity. BPPV comes from a disorder of the inner ear and is characterized by repeated episodes of positional vertigo5. BPPV can manifest itself with the following symptoms6:
  • nausea
  • migraine
  • balance problems

BPPV is usually triggered by movement or positional change. For instance, sitting up or looking up too quickly can bring on BPPV. The resulting vertigo can last between 5 and 30 seconds7. BBPV is very common, and approximately 50% of people experience itat some time7. Many exercises can help prevent further BBPV episodes.

  1. Vestibular neuronitis, characterized by inflammation in the inner ear, can trigger vertigo. More precisely, the vestibular nerve that sends messages to the brain is inflammed8. Vestibular neuronitis manifests itself via different symptoms, such as:9
  • nausea
  • vomiting
  • balance problems

Vestibular neuronitis is often caused by a viral infection, such as a cold or the flu. In contrast to BPPV, symptoms develop over several hours, peaking between 24 and 48 hours9.

Ménière’s disease is also a condition of the inner ear that can cause severe vertigo. Ménière’s disease is characterized by recurrent episodes of vertigo9. In addition to a vertigo attack, if patients have Ménière’s disease, the patient might experience the following symptoms10:

  • a ringing sound inside the ear
  • pressure inside the ear
  • nausea
  • vomiting
  • balance problems
  • hearing loss

Those symptoms can last from minutes to hours. Ménière’s disease can be caused by a viral infection, a head injury, a migraine, or having a family history of Ménière’s disease10.

Vestibular migraine is used to describe all forms of the relationship between migraine and vertigo. Along with migraine, a patient may also experience vertigo and the following additional symptoms11

  • nausea
  • blurred vision
  • tinnitus
  • neck pain
  • increased sensitivity to light or sounds

Migraine does not necessarily mean headache. There are many types of migraine that do not imply a headache12. As a result, vestibular migraine may or may not be accompanied by a headache.

The causes listed above are the most frequent. However, vertigo can be caused by many other conditions. For instance, central vertigo is caused by injury to the brain, such as13:

  • multiple sclerosis
  • brain tumors
  • stroke
  • trauma
Read more about what factors can trigger vertigo

The situation can be much more serious if the dizziness is due to a rarer condition. 

To cope with vertigo, it is important to find its exact cause. In case of symptoms, you need to consult your doctor, follow all his recommendations, and learn about emergency measures for dizziness.

References

  1. VeDA. New Patient Toolkit. https://vestibular.org/article/diagnosis-treatment/new-patient-toolkit/. Published 2020. Accessed October 14, 2020.
  2. RACGP – An approach to vertigo in general practice. https://www.racgp.org.au/afp/2016/april/an-approach-to-vertigo-in-general-practice/. Published 2020. Accessed October 28, 2020.
  3. Encyclopedia Britannica. Inner ear | anatomy. https://www.britannica.com/science/inner-ear. Published 2020. Accessed October 28, 2020.Encyclopedia Britannica. Inner ear | anatomy. https://www.britannica.com/science/inner-ear. Published 2020. Accessed October 28, 2020.
  4. Singh Sura.D, Newell.S. Vertigo-Diagnosis and management in the primary care. Br. J. Medical Pract.. 2010 3(4):a351.
  5. Bhattacharyya N, Gubbels S, Schwartz S et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) Executive Summary. Otolaryngol Head Neck Surg. 2017;156(3):403-416.
  6. NHS. Benign paroxysmal positional vertigo (BPPV). https://www.guysandstthomas.nhs.uk/resources/patient-information/therapies/physiotherapy/benign-paroxysmal-positional-vertigo.pdf.Published 2017. Accessed October 28, 2020.
  7. Ménière’s Society: BPPV. Menieres.org.uk. https://www.menieres.org.uk/information-and-support/symptoms-and-conditions/bppv. Published 2020. Accessed October 14, 2020.
  8. NHS. Labyrinthitis and vestibular neuritis. nhs.uk. https://www.nhs.uk/conditions/labyrinthitis/. Published 2020. Accessed October 14, 2020.
  9. Smith T, Rider J, Cen S. Vestibular Neuronitis (Labyrinthis). https://www.ncbi.nlm.nih.gov/books/NBK549866/. Accessed October 14, 2020.
  10. NHS. Ménière’s disease. nhs.uk. https://www.nhs.uk/conditions/menieres-disease/. Published 2020. Accessed October 14, 2020.
  11. VeDA. Vestibular Migraine – https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/vestibular-migraine/. Published 2020. Accessed October 28, 2020.
  12. Ménière’s Society: Vestibular Migraine. Menieres.org.uk. https://www.menieres.org.uk/information-and-support/symptoms-and-conditions/migraine-associated-vertigo. Published 2020. Accessed October 14, 2020.
  13. Marill.K. Central Vertigo. https://emedicine.medscape.com/article/794789-overview#showall. Accessed October 14, 2020.

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