Vertigo – what does it mean?

The term vertigo is often associated with a spinning sensation. However, patients who attend physiotherapy for vestibular rehabilitation will often describe symptoms other than spinning. These can include:

– Feeling imbalanced
– A swaying sensation
– Light-headedness
– Fuzziness
– Feeling woozy or faint
– Unsteadiness
– A swimming sensation
– Hypersensitivity to crowds or busy environments
– Spatial disorientation

These symptoms may be linked to certain movements such as turning in bed or bending over. They may be linked to certain situations such as being in a busy supermarket. Or you may not be able to pin point any patterns.

The first thing to remember is that vertigo is a symptom, not a diagnosis. My job is to figure out what is causing your vertigo… or light-headedness… or fuzziness… And the list of possible causes is as long as the list of different symptoms patients describe to me! These possible causes include:

– Cardiovascular
– Neurological
– Metabolic
– Vestibular
– Visual impairment
– Psychological
– Diet and nutrition
– Medication
– Head injury
– Drugs/alcohol

As the name would suggest, vestibular rehabilitation involves working with the vestibular system. This is the part of your inner ear that controls balance and spatial awareness. It is reported that about 1/3 of all dizziness reported to healthcare professionals, comes from the vestibular system. Once we have established that the cause is vestibular, a treatment plan can be formed.

Treatment strategies differ from patient to patient; depending on what way their vestibular system is affected. Some patients will require a repositioning manoeuvre, which involves moving the head around to remove calcium carbonate crystals, or otoconia from a specific part of the inner ear. Other patients will require an individualised exercise programme to address their vestibular dysfunction. Some may need both.

The good news is that when applied appropriately, vestibular rehabilitation has been shown to be a very effective treatment for vertigo, dizziness and the myriad of symptoms I described above (Hall et al, 2016). For some conditions, 90% of people will only need to be seen once (Prokopakis et al, 2005).

The plan for the next two blogs is to discuss the most common cause of vertigo- BPPV, or benign paroxysmal positional vertigo. This is the most common disorder of the inner ear, accounting for 42% of vertigo cases diagnosed in the primary care setting (Parnes et al, 2003). This is reflected in my practice and I would estimate that about half of my vestibular rehabilitation caseload is made up of BPPV cases. Thankfully it is one of the most satisfying to treat! It is quite a big subject, so the first blog will examine the causes and symptoms associated with BPPV. The second will discuss the diagnosis and treatment of BPPV.

If you are experiencing any of the symptoms listed above and think you may benefit from vestibular rehabilitation, contact us to book an appointment.

Hall CD, Herdman SJ, Whitney SL, Cass SP, Clendaniel RA, Fife TD, Furman JM, Getchius TSD, Goebel JA, Shepard NT, Woodhouse SN. Vestibular rehabilitation for peripheral vestibular hypofunction: an evidence based clinical practice guideline. J Neurol Phys Ther 2016. 40(2):124-55

Propakis EP, Chimona T, Tsagournisakis M, Christodoulou P, Hirsch BE, Lachanas VA, Helidonis ES, Plaitakis A, Velegrakis GA. Benign paroxysmal positional vertigo: 10 year experience in treating 592 patients with canalith repositioning procedure. Laryngoscope.2005. 115(9):1667-71

Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ 2003; 169(07):681-693