When many patients arrive at our medical clinic, BalanceMD, they report that they were diagnosed with “vertigo”. Vertigo is defined as the sensation a person has that they or objects around them are moving when they are not. There are many medical conditions that might include vertigo as a symptom, most commonly migraine, benign paroxysmal positional vertigo (BPPV), vestibular neuritis or labyrinthitis, and Meniere’s disease.
Vertigo is a symptom, not a diagnosis, much in the same way that chest pain is a symptom, not a diagnosis. There are many things that might cause chest pain, such as a heart attack, pneumonia, or a broken rib. As it is important to determine the underlying cause of chest pain, it is also important to determine the underlying cause of vertigo.
While there are many conditions that might cause vertigo, there are only a handful that present most commonly and are listed above. Differentiating between these conditions is best accomplished with a detailed clinical history, physical exam, and when needed, vestibular function testing and an audiogram (hearing test). While migraine is the most common cause of recurrent spells of vertigo, BPPV is a vertigo-causing condition which can be quickly identified and cured. Typical symptoms of BPPV include brief vertigo often lasting 10-15 seconds and triggered by lying back or sitting up in bed, rolling over in bed, and looking up or down. Benign Paroxysmal Positional Vertigo is easy to evaluate and to treat. If BPPV is not present, then vestibular function testing is typically necessary to evaluate for other inner ear or brain-related causes of vertigo.
Vestibular function testing is the test of choice in the identification of an underlying cause for vertigo. This type of testing analyzes both inner ear and brain function associated with vertigo. Vestibular function testing includes Videonystagmography (VNG), rotational chair, Vestibular Evoked Myogenic Potential (VEMP) and an audiogram.
Once the underlying cause for dizziness or vertigo is determined, a targeted treatment can be administered. Because of advancements in our knowledge and technology over the past 20-25 years, we are much better able to arrive at a precise diagnosis. We now know that while meclizine (Antivert), a commonly prescribed medication for those suffering with vertigo, may reduce vertigo symptoms for some conditions, it does not fix the underly problem causing vertigo. Those who have been given meclizine (Antivert) for treatment of the symptom of vertigo and continue to suffer with vertigo should seek an evaluation from a specialist who is able to arrive at a diagnosis for the cause of vertigo and administer the most appropriate treatment and/or cure.