Vertigo (Dizziness)
Vertigo is a common and often unsettling symptom that can make the world feel like it is spinning, tilting, or moving when you are standing still. Many patients experience dizziness and vertigo, which are often accompanied by other symptoms and can vary in severity from brief and mild to persistent, disabling, and disruptive to daily life. Understanding what is causing vertigo is the first step toward effective treatment and improved balance.
At Chester Neurology, Dr. Roshni Karnani provides expert neurological evaluation and care for patients experiencing vertigo, dizziness, and balance disorders throughout Westchester, Yonkers, Manhattan, and New York City.
What Is Vertigo?
Vertigo is the sensation of motion when no movement is actually occurring. Many patients describe it as spinning, swaying, or feeling pulled to one side. It is important to understand that vertigo is not a diagnosis itself. Rather, it is a symptom that points to an issue within the inner ear, the balance system, or the nervous system.
The balance system relies on coordination between the inner ear, eyes, muscles, and brain. When any part of this system is disrupted, the brain may receive conflicting signals, leading to vertigo and dizziness. The initial evaluation of vertigo includes assessing the vestibular system and related structures to determine the underlying cause.
Common Types of Vertigo
There are several causes of vertigo, each with different characteristics and treatment approaches.
Benign Paroxysmal Positional Vertigo (BPPV)
Benign paroxysmal positional vertigo (BPPV) is a common cause of peripheral vertigo. It occurs when tiny calcium carbonate crystals move out of their normal position in the semicircular canals of the inner ear, triggering vertigo with changes in head position, such as tipping the head backward or rolling over in bed. Canalith repositioning procedures, like the Epley maneuver, are the primary treatment for BPPV and help move the crystals back to their normal position.
Vestibular Neuritis or Labyrinthitis
Vestibular neuritis or labyrinthitis is caused by inflammation of the inner ear or vestibular nerve, often following a viral infection. Symptoms may include sudden vertigo, nausea, and imbalance.
Ménière’s Disease
Ménière’s disease is an inner ear disorder that involves fluid buildup, leading to vertigo episodes along with hearing loss, tinnitus (ringing in the ears), and aural fullness, or a sensation of pressure or fullness in the ear.
Middle Ear Conditions
Conditions affecting the middle ear, such as otosclerosis (characterized by abnormal bone growth), can also cause vertigo and hearing issues.
Vestibular Migraine
Vestibular migraine is a form of migraine that affects balance. Vertigo may occur with or without a headache and is often associated with light sensitivity or visual disturbances.
Central Vertigo
Central vertigo is less common and originates in the brain rather than the inner ear. It may be linked to neurological conditions such as stroke, multiple sclerosis, or tumors.
Vertigo Symptoms
Vertigo can present differently depending on the underlying cause. The primary symptom is a spinning feeling or sensation, where it may seem as if you or your surroundings are moving or rotating. Common symptoms include a spinning or swaying sensation, balance problems or unsteadiness, nausea or vomiting, lightheadedness, difficulty focusing, or visual disturbances.
Some patients may feel dizzy and also experience other symptoms such as headaches, ear fullness, hearing changes, or ringing in the ears. Symptoms may occur briefly or persist for days or weeks, and their severity can range from mild to debilitating.
When Vertigo is a Concern
While vertigo is often treatable, certain symptoms should prompt immediate medical evaluation. Sudden or severe vertigo may indicate a more serious condition. Vertigo accompanied by weakness, numbness, facial drooping, or speech changes requires urgent attention. If you experience severe vertigo with concerning symptoms such as sudden hearing loss, weakness, or neurological deficits, seek care at the nearest emergency room.
Persistent or worsening symptoms, vertigo following a head injury, or frequent falls and balance loss should also be evaluated by a neurologist to rule out neurological causes.
Causes and Triggers
Vertigo may be caused or triggered by a variety of factors. A common cause is an inner ear problem, such as Meniere’s disease, BPPV, or vestibular neuritis, which disrupts balance signals to the brain. Other contributors include head or neck injuries, infections or inflammation, migraine-related changes, and neurological conditions affecting the brain or nerves. Cardiovascular disease can also be associated with vertigo and dizziness, highlighting the importance of considering comorbid conditions.
Certain medications can also affect balance and trigger dizziness or vertigo. It is important to note that changes in blood pressure can cause dizziness, which is different from vertigo. Identifying the specific cause allows for targeted treatment rather than temporary symptom relief.
Diagnosis and Medical Assessment
At Chester Neurology, efforts to diagnose vertigo begin with a detailed review of your symptoms, including when they started, how long they last, and what triggers them. Your neurologist will perform a comprehensive neurological and balance examination to assess coordination, eye movements, and nerve function. A thorough head, neck, and neurologic examination is essential for diagnosing vertigo.
Positional testing may be used to evaluate inner ear involvement. When necessary, imaging studies or additional tests help identify neurological or structural causes. The goal is to determine the exact source of dizziness so treatment can be both effective and safe. A multidisciplinary team approach, interprofessional collaboration among neurologists, otolaryngologists, and therapists, and effective communication among healthcare professionals are crucial for optimal vertigo management and better patient outcomes.
Treatment Options for Vertigo
Vertigo treatment is highly individualized and based on the underlying cause. For BPPV, specialized repositioning maneuvers can often provide rapid relief. Medications may be used to reduce nausea, dizziness, or inflammation during acute episodes. Some medications, including antihistamines and anti-anxiety medications, can help reduce symptoms of vertigo.
Vestibular rehabilitation therapy helps retrain the brain and improve balance through guided exercises. These exercises are designed to help the brain and body maintain balance during and after vertigo episodes. Vestibular rehabilitation therapy usually involves a range of exercises to improve common vertigo symptoms like dizziness, unstable vision, and balance issues.
When vertigo is related to migraines, neurological conditions, or other medical issues, treatment focuses on managing the root cause. However, there is no guaranteed way to cure vertigo permanently, and most treatments focus on symptom management rather than a definitive cure. Surgery is rarely needed for vertigo, typically only when other treatments don’t work for serious underlying health issues.
Lifestyle adjustments and trigger management may also play an important role in long term symptom control. Patient education is a critical component of vertigo management, helping patients understand their condition and treatment options.
Physical Therapy for Vertigo
Vestibular rehabilitation may also be beneficial for some patients with central vertigo, such as those recovering from a stroke or traumatic brain injury. Your neurologist can refer you to a trusted physical therapist.
Through customized exercises, physical therapists help patients adapt to changes in their balance system, reduce dizziness, and regain confidence in daily activities. Education on avoiding certain head movements that may trigger vertigo, as well as strategies to manage symptoms, are also key components of therapy. By working closely with a physical therapist, many patients experience fewer vertigo attacks and improved quality of life.
When to Reach Out
If you are experiencing ongoing dizziness, balance problems, or vertigo that interferes with daily life, it is important to seek evaluation. Early diagnosis can prevent complications, reduce fall risk, and improve quality of life.
Dr. Roshni Karnani and the team at Chester Neurology are experienced in diagnosing and treating vertigo and balance disorders for patients in Westchester and New York City.
Call us today at (914) 816-1941 or email info@chesterneurology.com to schedule an appointment.
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