If you are feeling dizzy, the most common cause is vertigo, the sensation often reported is "my head is spinning". You may also feel other symptoms as well.
In the clinic, the majority of patients who reported feeling dizzy were experiencing a type of vertigo called BPPV (Benign paroxysmal positional vertigo).
Dizziness is a general term we use when we feel off balance. To help understand the cause of dizziness it is good to break it down into its different types[ii].
- Vertigo” it feels like my head or the room is spinning around”
- Disequilibrium, “I feel unsteady on my feet”,
- Presyncope, “I feel like I am about to faint”
- Light headedness “my head feels light like it's not getting enough blood”.
If you have vertigo you will feel that either, the room is spinning or you are spinning. Sometimes people will also report other symptoms like :- headaches, nausea, vomiting, sounds in your ears, unusual eye movements, or altered focusing. A vertigo episode starts when you move your head in a particular way and typically only lasts a short time until the next time you move your head through the same position again. It is possible to have other types of dizziness occurring at the same time as vertigo[v].
Some tips when you are living with vertigo.
* Move slow, it allows your vestibular system to keep up with your movements
* Try to avoid fast-moving images till your feeling better. This includes Tv pictures, looking out a car window.
* try to determine what movement starts the vertigo, try to avoid that movement
ie if turning right causes vertigo to start, try to turn left more, and when you have to turn right do it slowly
The vestibular system maintains our balance with input from our eyes, ears muscles, and joints. The most common causes of vertigo are due to inner ear issues. The major input for the vestibular system is called the labyrinth, we have one located in each inner ear. It comprises 3 semicircular canals, each canal is orientated in a different plane. Combining the information from each canal the vestibular system knows where our head is in space, like a set of X,Y,Z coordinates or GPS system. Also part of the labyrinth is the cochlea, its function is sensing the sound coming into the ear. The cochlea is not part of the balance system but due to its proximity to the semicircular canals, some conditions can affect both.
An old saying "A person with one watch always knows what time it is; a person with two watches is never sure which of the two is correct."
When the vestibular system gets the same information from both labyrinths, all is good. However, if there is a difference between the left and right labyrinths the vestibular system becomes uncertain which is correct and will also check other inputs from the body, such as eyes and joints. Sometimes the body can’t resolve the exact position of our body and you start to feel your body is spinning.
The most common form of vertigo seen in the clinic is Benign Paroxysmal Positional Vertigo (BPPV).
Benign paroxysmal positional vertigo (BPPV)
BPPV is the most common cause of vertigo[v], Prevalence of BPV is more frequent in the age group 50 years to 70 years often. Often BPPV has a sudden onset for no apparent reason it can occur at other ages in life and it may be linked to a minor trauma of the head, an ear condition, or tight muscles in the neck pulling around the ear. Typically, the dizziness episodes are triggered by the movement of the head and last minutes until it is triggered again. The particular head movement will vary depending on which canal is affected, it can be turning to the left or the right or looking up. Normally BPPV is resolved over a period of days to weeks, it is very rare cases it can last 6 months or a year[iii].
What you feel: Vertigo often occurs with simple movements, like rolling over in bed, looking up to see the top shelf or just turning the head left or right. People feel quite dizzy at first, then over a period of minutes, it settles down. Many patients that experience BPPV report they feel fatigued.
What is happening: The cause of the BPPV is thought to be loose calcium carbonate crystals (otoconia) in the semicircular canals in each inner ear[i]. These crystals are present normally but become dislodged and disturb the vestibular system.
How we might treat this. Cranial osteopathic techniques can work to improve the normal movement of the bone structure in the head and the spine[iv]. Soft tissue work on the muscles to the upper neck and head. If appropriate you get some home exercises to help retrain your vestibular system.
Menuires disease is a condition that affects the function of Labyrinth which can impact both the hearing and the balance functions. People most affected by this disease are in their 40s and 50s. The episodes can last can 10 minutes to hours, then normally resolves until the next episode occurs[v]. The episodes reoccur and there are surgical options if symptoms are too severe. It is also common for Meniere's to go into remission after a period of years [vi].
What you feel: The episode may be proceeded with hearing changes either ringing or changes in the quality of the hearing. During the episode associated with vertigo you could be nauseous, need to vomit, sweating You may also feel a fullness in the ear The duration can be minutes to hours.
What is happening: It is not fully understood why Meniere's occurs but during an episode there is an increase of fluid in the canals of the inner ear. Fluid in the cochlear impedes the hearing function, while extra flid in the semi auricular canals disrupt the balance function.
How we might treat this. Cranial osteopathic techniques can work to improve the normal movement of the bone structure in the head and the spine [iv]. Soft tissue work on the muscles to the upper neck and head. If appropriate you get some home exercises to help retrain your vestibular system.
The Labyrinth structure is involved in both hearing and balance functions. It transfers both messages to the brain via two nerve pathways. If both parts of the nerve are affected there will be a change to the hearing and balance. When the nerve for hearing is unaffected but the balance is affected it is called neuritis. The inflammation can come from an untreated infected ear where it spreads to the labyrinth or a virus in the body that resides in the labyrinth. When a labyrinthitis episode starts it can last one or two months.
What you feel: Depending on the severity of the episode vertigo can be slight or severe. The other symptoms may also be vomiting, nausea, unsteadiness on your feet, and tinnitus. The hearing will also be affected in labyrinthitis.
What is happening: The inflammation can be bacterial or viral that disrupts the nerve signals with hearing and balance information going to the brain.
How we might treat this. The primary treatment is with your GP to address the infection. The osteopathic treatment can supplement the treatment by improving the movement of the bone structure [iv] and help drainage of the region.