Is Vertigo a Sign of Serious Illness?

Vertigo is a medical term used to describe the sensation that you, or the environment around you, is moving or spinning.

Often described as dizziness, for some people, the sensations are barely noticeable and last only seconds. For others, episodes of vertigo can last for several minutes or even hours. In severe cases, the unsettling sensations can occur frequently over weeks or months and make it difficult to stay balanced and carry out the tasks of daily life. Feelings of nausea often accompany prolonged episodes of vertigo.

Although not usually a serious health concern, vertigo can be a symptom of an underlying medical condition and should always be evaluated by a doctor to determine what treatment, if any, is needed.

Potential Causes of Vertigo

Brief and temporary episodes of vertigo may occur due to dehydration, cold viruses or inner ear infection/inflammation. In these cases, the symptoms typically resolve when the virus clears; the infection is treated; or the body is rehydrated.

Recurring episodes of vertigo that do not go away on their own may be caused by a problem related to the inner ear or the brain. There are two main types of vertigo, each presenting with a distinct set of symptoms:

Central Vertigo. Caused by a problem in the brain, central vertigo can be linked to serious conditions such as stroke, brain tumor and multiple sclerosis. Symptoms develop gradually and are typically mild but constant and may include gait instability and loss of coordination. This type of vertigo is not affected by head position and movement and is most often diagnosed and managed by a neurologist.

Peripheral Vertigo. Far more common, peripheral vertigo is caused by a problem in the part of the inner ear that controls balance. Symptoms are usually of sudden onset and may be more severe than those experienced with central vertigo. This type of vertigo is triggered by sudden changes in head position and/or movement and may cause nausea and/or vomiting. Gait and coordination are not usually affected.

The most common type of peripheral vertigo is Benign Positional Paroxysmal Vertigo or BPPV. As its name suggests, BPPV is a benign condition, meaning it is not cancerous or harmful. However, its symptoms can be alarming and affect one’s quality of life.

What Causes Benign Positional Paroxysmal Vertigo (BPPV)?

To understand BPPV and why it occurs, it’s important to have a basic understanding of the anatomy of the inner ear and its functions. The inner ear has three main parts:

• Cochlea – a snail-shaped, fluid-filled organ responsible for hearing
• Semi-circular canals – fluid-filled channels that sense head position and regulate balance
• Otolith organs – tiny sacks that connect the semi-circular canals. These sacks contain small calcium crystals (canaliths) that help detect movement and maintain balance.

If the crystals contained in the otolith organs become dislodged, they can move into the semi-circular canal and become trapped there. This disrupts the signals sent to your brain about your position and can cause the intense dizziness associated with BPPV. Crystals can become dislodged due to head trauma, normal aging of the inner ear, other inner ear disorders or after an upper respiratory infection. In some cases, the cause is unknown.

How Is BPPV Diagnosed?

Your doctor will first take a complete medical history and conduct a physical exam.

“The most important part of the evaluation will be your description of the dizziness and when it occurs,” says UH ear, nose and throat specialist, Sarah Mowry, MD. “For most people with BPPV, the dizziness is a short-lived but intense sensation of room spinning that occurs when you roll over in bed toward the affected ear, look up at something or flip your head over while using the hairdryer, to mention a few examples. It is provoked by movement and goes away within 90 seconds. Some people also experience a sensation of being off balance even when they are not moving their heads.”

“The most useful physical exam for the diagnosis of BPPV is the Dix-Hallpike maneuver, which is designed to provoke dizziness if it is caused by BPPV. While this examination may be briefly uncomfortable, it is key in making the diagnosis,” adds Dr. Mowry.

Effective Treatments Are Available for BPPV

Although BPPV can be bothersome, it's rarely serious. The dizziness associated with BPPV is generally short lived (less than 90 seconds) and can usually be decreased by fixing your vision on a stationary object when it happens.

Your doctor may also recommend additional treatments, which may include:

• Canalith Repositioning Procedure (CRP) – a simple, noninvasive series of head movements that help move the dislodged crystals out of the semi-circular canals and back into the otolith organs where they belong. Although one time through the procedure is often enough to resolve symptoms, your doctor can teach you how to do these movements at home in the event your BPPV recurs.
• Vestibular Therapy – a type of physical therapy which helps people with dizziness and balance problems.

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Although vertigo is not usually a sign of serious illness, it should always be evaluated by a doctor. The ear, nose and throat (ENT) specialists at University Hospitals have the advanced training and experience to evaluate, diagnose and treat a wide range of conditions, including balance disorders.