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Dizziness and Vertigo: Spinning the Facts
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here is a common misunderstanding when defining or describing the terms dizziness and vertigo. Dizziness is a feeling of imbalance that includes symptoms such as lightheadedness, weakness or unsteadiness. The word dizziness is often used to describe motion sickness associated with airplane, rollercoaster or boat travel. By contrast, vertigo is a feeling of movement in which either the external world appears to be spinning or moving or the individual feels as if he/she is revolving in place. Common descriptions of vertigo include additional complaints such as ringing in the ears or changes in ear pressure. Vertigo frequently accompanies or even precedes a migraine headache. Both dizziness and vertigo are considered to be vestibular disorders (pertaining to the
inner ear). Yearly, over ten million Americans experience balance or dizziness problems lasting three months or longer. Several studies have indicated that vestibular disorders are consistently under diagnosed and poorly treated. Dizziness and vertigo are more prevalent in middle-aged and elderly populations and significantly contribute to the increased risk of falls in these individuals. Both disorders may be caused by a number of factors including medications, infection and blood pressure changes. Dizziness and vertigo are not life-threatening, but may result in interruption of daily activities and a significant decrease in the patient’s quality of life. Treatment of both conditions is non-traditional and may consist of position changes, surgery, and avoidance of triggering factors. The signs and symptoms of these problems are listed in the accompanying table. continued on back
Signs and Symptoms of Dizziness and Vertigo* Typical Signs and Symptoms
When to Consult your Doctor
Loss of balance
Head injury
Nausea
A new, different or severe headache
Unsteadiness
Fever ≥ 101 F
Wooziness
Very stiff neck
Lightheadedness
Blurred vision
Faintness
Hearing loss
Weakness
Speech impairment
Fatigue
Leg or arm weakness
Difficulty concentrating
Loss of consciousness
Blurred vision during quick head movements
Falling or difficulty walking
You or your surroundings are spinning/moving (vertigo)
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Chest pain or rapid or slow heart rate Numbness or tingling
* Adapted from: Dizziness; MayoClinic.com, 2008 (Accessed 20 October 2009)
Dizziness and Vertigo: Spinning the Facts reduction in episodes of dizziness. When performing the procedure, the physician moves the patient’s head in a number of specific positions for a short period of time. This procedure can move crystals from the extremely sensitive part of the ear to a more benign location, thus reducing the frequency and severity of symptoms. If necessary, this method of treatment can be repeated.
Causes of Dizziness and Vertigo
A sense of dizziness or vertigo may arise unexpectedly. Vertigo may specifically be caused by benign paroxysmal positional vertigo (BPPV), a condition related to movement of crystals in the inner ear from one area to a location of greater sensitivity. This results in severe spinning accompanied by nausea For other vestibular conditions, you Photo by: michele cat Name: your medication for dizziness may cause dizziness used under Creative Commons License; http://www.flickr.com/photos/asv/2573670832/. (Accessed 20 October 2009) and vomiting. Vertigo may also be may be instructed by a physical caused by inflammation in the inner therapist to perform several ear, migraine headache, acoustic neuroma balance exercises involving movement or vertigo is severe as these symptoms may (non-cancerous growth of a nerve in the of the head. You may be advised to take be a sign of a bacterial or viral infection or inner ear), or rapid changes in motion. over-the-counter (OTC) medications other serious disease. Meniere’s disease is a relatively common such as meclizine (Antivert, Bonine) or cause of vertigo that, in its severe form, dimenhydrinate (Dramamine). Prescription isiting your hysician can be incapacitating. The disease is due to drugs such as diazepam (Valium) may be excessive accumulation of fluid in the inner Since dizziness is often short-lived and used to relieve anxiety while corticosteroids ear. Faintness, whether associated with difficult to describe, patients should be well such as prednisone are beneficial for inner dizziness or vertigo, is generally due to a prepared to discuss their problem during ear problems related to inflammation. sudden drop in blood pressure upon rapid their doctor’s appointment. It is important Scopolamine patches (TransdermScop) standing. In addition, faintness may occur to consider a few factors related to the event. placed behind the ear are often effective in in conditions in which the heart may not The following points should be evaluated at preventing dizziness and motion sickness supply sufficient blood such as heart failure, the time you experience dizziness or vertigo: associated with travel. Meniere’s disease is blocked arteries due to high cholesterol, often treated with diuretics to reduce the • What activity were you performing? irregular heartbeat, etc. Other causes of volume of fluid in the inner ear while surgery • What did you recently eat? lightheadedness include other disorders of is a potential option in resistant cases. the inner ear, anxiety and hyperventilation. • Did you take any medication(s) just prior Vertigo associated with migraine headaches to the event? Recurrent imbalance problems may be is generally best managed by avoiding due to sensory disorders, joint and muscle triggering factors such as stress and • Have you been experiencing symptoms of problems or allergies. Medications such specific foods. In addition, your physician a viral or bacterial infection? as analgesics (pain relievers) and muscle may prescribe migraine medication and • Have there been any major changes in relaxants can also be a source of dizziness. recommend that you maintain regular your lifestyle or additional stress? Caution is always advised when a patient patterns of sleep and exercise. Lastly, other is driving or operating machinery while Finally, attempt to describe in detail your underlying causes of dizziness and vertigo taking these types of products. Finally, it is exact experience of dizziness or vertigo. For such as anxiety, infection, stroke and heart important to contact a physician if dizziness instance, specifically explain whether you problems must be managed by the physician. felt you were spinning or if objects around If dizziness appears to be an adverse effect you were turning. Having this information of medication, patients should consult their prepared in advance will greatly assist your physician or pharmacist. It may be necessary physician in determining the cause of your to reduce the dose or prescribe a new symptoms. medication.
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A publication of: Mylan School of Pharmacy Center for Pharmacy Care Pharmaceutical Information Center (PIC) Additional information on newsletter topics: Pharmaceutical Information Center 412-396-4600 pic@duq.edu Questions about screenings or programs: Christine O’Neil, Pharm.D, B.C.P.S. 412-396-6417
Newsletter Contributors John G. Lech, Pharm.D Emily J. Lunz, Pharm.D. Candidate Meghan T. Lardin, Pharm.D. Candidate
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Treatment and Management The treatment options for dizziness and vertigo are dependent on the physician’s diagnosis of your condition. BPPV is commonly and successfully treated with a painless procedure known as canalith repositioning. It is performed by an Ear, Nose & Throat specialist in the physician’s office and frequently results in a significant
Many individuals will have occasional bouts of dizziness or lightheadedness; however, more frequent and severe episodes may be indicators of serious underlying disease. These patients must be evaluated by a physician and treated appropriately. Although most cases are responsive to treatment, dizziness and vertigo may have a significant impact on a patient’s quality of life and, on occasion, result in job loss and incapacitation.
For more information regarding Dizziness and Vertigo, please visit the following Web sites: • http://mayoclinic.com/
• http://vestibular.org/
• http://www.nidcd.nih.gov/
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