 |
 |
|
|
|
|
VERTIGO OVERVIEW
Vertigo (comes from Latin word vertigin-, vertigo, "dizziness," originally "a whirling or spinning movement", from vertere - the Latin term meaning "to turn") is a specific type of dizziness, a major symptom of a balance disorder and is considered a symptom of another condition and not a disease or an illness in itself.
Vertigo is the feeling that you or your environment is moving, swaying or spinning while the body is actually stationary with respect to the surroundings. A person may suffering from vertigo may feel that he or she is sinking or falling and/or the objects in the room are spinning around or the individual may feel that he or she is spinning too. It can be very disorienting for the person. Vertigo is sometimes accompanied by nausea and hearing loss. It occurs as a result of a disturbance in balance (equilibrium). It also may be used to describe feelings of dizziness, lightheadedness, faintness, and unsteadiness. Vertigo differs from dizziness in that vertigo describes an illusion of movement.
When you feel as if you yourself are moving, it is called subjective vertigo, and the perception that your surroundings are moving is called objective vertigo. Unlike non-specific lightheadedness or dizziness, vertigo has relatively few causes. The effects of vertigo may be slight. It can cause nausea and vomiting and, in severe cases, it may give rise to difficulties with standing and walking.
Vertigo usually occurs as a result of a disorder in the vestibular system (i.e., structures of the inner ear, the vestibular nerve, brainstem, and cerebellum). The vestibular system is responsible for integrating sensory stimuli and movement and for keeping objects in visual focus as the body moves. Benign paroxysmal position vertigo (BPPV) is a common cause for dizziness.
When the head moves, signals are transmitted to the labyrinth, which is an apparatus in the inner ear that is made up of three semicircular canals surrounded by fluid. The labyrinth then transmits movement information to the vestibular nerve and the vestibular nerve carries the information to the brainstem and cerebellum (areas of the brain that control balance, posture, and motor coordination). There are a number of different causes for dizzy spells.
INCIDENCE & PREVALENCE
Vertigo is one of the most common health problems in adults. According to the National Institutes of Health (NIH), about 40 percent of people in the United States experience feeling dizzy at least once during their lifetime. Prevalence is slightly higher in women and increases with age.
CAUSES OF DIZZINESS (LIGHTHEADEDNESS VS VERTIGO)
Dizziness is not synonymous with vertigo. Dizziness is a word that is often used to describe two different feelings. It is important to know exactly what you mean when you say "I feel dizzy" because it can help you and your health professional narrow down the list of possible problems. Anyone may occasionally experience a feeling of lightheadedness, dizziness, unsteadiness, or the sensation of feeling faint. Those with low blood pressure may have this feeling upon rising quickly from a sitting position or lying position. In some cases, dizziness can be a warning sign of a heart attack, stroke, concussion, or brain damage.
Although dizziness can occur in people of any age, it is more common among older adults. A fear of dizziness can cause older adults to limit their physical and social activities. Dizziness can also lead to falls and other injuries.
LIGHTHEADEDNESS
Lightheadedness is a feeling that you are about to faint or "pass out." Although you may feel dizzy, you do not feel as though you or your surroundings are moving. Lightheadedness often goes away or improves when you lie down. If lightheadedness gets worse, it can lead to a feeling of almost fainting or a fainting spell (syncope). You may sometimes feel nauseated or vomit when you are lightheaded.
It is common to feel lightheaded from time to time. Lightheadedness usually is not caused by a serious problem. It often is caused by a momentary drop in blood pressure and blood flow to your head that occurs when you get up too quickly from a seated or lying position (orthostatic hypotension).
Lightheadedness has many causes, including:
Allergies.
Illnesses such as the flu or colds. Home treatment of your flu and cold symptoms usually will relieve lightheadedness.
Vomiting, diarrhea, fevers, and other illnesses that cause dehydration.
Very deep or rapid breathing (hyperventilation).
Anxiety and stress.
The use of tobacco, alcohol, or illegal drugs.
A more serious cause of lightheadedness is bleeding. Most of the time, the location of the bleeding and the need to seek medical care are obvious. However, sometimes bleeding is not obvious (occult bleeding). You may have small amounts of bleeding in your digestive tract over days or weeks without noticing the bleeding. When this happens, lightheadedness and fatigue may be the first noticeable symptoms that you are losing blood. Heavy menstrual bleeding also can cause this type of lightheadedness.
An uncommon cause of lightheadedness is an abnormal heart rhythm (arrhythmia), which can cause fainting spells (syncope). Unexplained fainting spells need to be evaluated by a health professional. To check your heart rate, see taking a pulse.
Many prescription and non-prescription medicines can cause lightheadedness or vertigo. The degree of lightheadedness or vertigo that a medicine causes will vary.
VERTIGO
Vertigo is a feeling that you or your surroundings are moving when there is no actual movement. You may feel as though you are spinning, whirling, falling, or tilting. When you have severe vertigo, you may feel very nauseated or vomit. You may have trouble walking or standing, and you may lose your balance and fall.
Vertigo occurs when the central nervous system receives conflicting messages between the signals sent to the brain by various balance and position-sensing systems of the body such as the inner ear, eyes, muscles, and skin pressure receptors. Your brain uses input from four sensory systems to maintain your sense of balance and orientation to your surroundings.
Vision gives you information about your position and motion in relationship to the rest of the world. This is an important part of the balance mechanism and often overrides information from the other balance-sensing systems.
Sensory nerves in your joints allow your brain to keep track of the position of your legs, arms, and torso. Your body is then automatically able to make tiny changes in posture that help you maintain your balance (proprioception). Skin pressure sensation gives you information about your body's position and motion in relationship to gravity.
A portion of the inner ear, called the labyrinth, which includes the semicircular canals, contains specialized cells that detect motion and changes in position. Injury to or diseases of the inner ear can send false signals to the brain indicating that the balance mechanism of the inner ear (labyrinth) detects motion. If these false signals conflict with signals from the other balance and positioning centers of the body, vertigo may occur.
Vertigo is typically classified into one of two categories depending on the location of the damaged vestibular pathway. These are peripheral or central vertigo. Each category has a distinct set of characteristics and associated findings. Vertigo, or dizziness, usually results from a disorder in the peripheral vestibular system (i.e., structures of the inner ear). Dizziness also may occur as a result of a disorder in the central vestibular system (i.e., vestibular nerve, brainstem, and cerebellum).
COMMON CAUSES OF VERTIGO
INNER EAR DISORDERS
Vertigo is usually associated with a problem in the inner ear balance mechanisms (vestibular system). Inner ear disorders, such as benign paroxysmal positional vertigo (BPPV), Meniere's disease, vestibular neuritis, or labyrinthitis.
Benign paroxysmal positional vertigo (BPPV) is the most common peripheral disorder and is characterized by the sensation of motion initiated by sudden head movements or moving the head in a certain direction. It may be accompanied by hearing loss, reduced cognitive function, and facial muscle weakness). BPPV usually affects one of the sensing tubes in the inner ear called the posterior semicircular canal. BPPV occurs when debris made up of calcium carbonate and protein (called otoliths or ear crystals) builds up in and moves around in the posterior semicircular canal. BPPV also can affect the anterior canal or the horizontal canal. When the head is moved in certain ways (e.g., turning in bed, looking up, bending over), the calcium crystals move around and trigger inner ear sensors, causing a brief sensation of spinning. Inner ear degeneration (usually occurs in elderly patients), head trauma, and inner ear infection (e.g., otitis media, labyrinthitis) can cause BPPV. This type of vertigo is rarely serious and can be treated.
COGAN'S SYNDROME
Cogan's syndrome is inflammation of connective tissue in the cornea which results in vertigo, ringing in the ears (tinnitus)], and loss of hearing.
MENIERE'S DISEASE
Meniere's disease is composed of a triad of symptoms such as fluctuating pressure of inner ear fluid (endolymph) which results in severe episodes of vertigo, ringing in the ears (tinnitus), and progressive hearing loss. People have the abrupt onset of severe vertigo, fluctuating hearing loss, as well as periods in which they are symptom-free.
MoonDragon's Health & Wellness: Meniere's Disease
MIGRAINES
Migraine (30-50 percent of patients experience vertigo). Migraine headaches are painful debilitating headaches that often occur with vertigo, nausea, vomiting, and sensitivity to light, noise, and smell. The vertigo is usually followed by a headache. There is often a prior history of similar episodes but no lasting problems.
MULTIPLE SCLEROSIS
Multiple sclerosis (MS) may occur when demyelination affects the brainstem or cerebellum. Vertigo is often the presenting symptom in multiple sclerosis. The onset is usually abrupt, and examination of the eyes may reveal the inability of the eyes to move past the midline toward the nose.
ORTHOSTATIC HYPOTENSION
Orthostatic hypotension (sharp decrease in blood pressure upon rising from a lying or sitting position to a standing position; caused by diabetes, dehydration, and anemia).
TRAUMA FROM INJURIES
Injury to the ear, neck injury or head trauma may also result in vertigo, which usually goes away on its own.
Vertigo can be caused by decreased blood flow to the base of the brain. Bleeding into the back of the brain (cerebellar hemorrhage) is characterized by vertigo, headache, difficulty walking, and inability to look toward the side of the bleed. The result is that the person's eyes gaze away from the side with the problem. Walking is also extremely impaired.
Inadequate or interrupted supply of oxygen to the brain.
SYSTEMIC DISEASES
Systemic diseases such as kidney disease and thyroid disorders.
Allergies.
Diabetes and blood glucose (sugar) problems. If dizziness is accompanied by nausea, sweating, and paleness of complexion with a racing heartbeat, seek medical attention. This can be a sign of a number of health problems including a hypoglycemic (low blood sugar) episode.
Nutritional deficiencies may cause vertigo.
CARDIAC & CNS DISORDERS
High (hypertension) or low (hypotension) blood pressure. Hypotension, or a sudden drop in blood pressure, can cause sudden dizziness, especially after meals.
Cardiovascular disorders such as bradycardia (slowed heart rate) or tachycardia (rapid heart rate). If dizziness is accompanied by nausea, sweating, and paleness of complexion with a racing heartbeat, seek medical attention. This can be a sign of a number of health problems including a heart attack.
Decreased blood flow (poor cerebral circulation) through the arteries that supply blood to the base of the brain (vertebrobasilar insufficiency) may cause dizziness and the inability to maintain balance. This may be due to either the narrowing of the blood vessels that supply the brain (arteriosclerosis), pinched blood vessels in the neck (cervical osteoarthritis), or a disorder of diabetes or anemia.
Central nervous system (CNS) disorders, such as stroke (brain attack) or brain hemorrhage. Immediate medical attention is needed if vertigo occurs suddenly with loss of function. Vertigo that occurs with loss of function in one area of the body can mean a problem in the brain, such as a stroke or transient ischemic attack (TIA). If you feel dizzy and find it difficult to speak, swallow, or think clearly, seek medical attention. These may be symptoms of a stroke. Numbness and tingling or loss of vision accompanied by dizziness also can be signs of a stroke.
Neurological disease and psychological stress may cause vertigo.
INFECTIONS
Vertigo can be caused by inflammation of the inner ear due to the common cold, influenza, and bacterial infections.
Vertigo may be caused by a fever.
Vertigo-like symptoms may also appear as paraneoplastic syndrome (PNS) in the form of opsoclonus myoclonus syndrome, a multi-faceted neurological disorder associated with many forms of incipient cancer lesions or viruses.
Vestibular neuritis is inflammation of vestibular nerve cells which may be caused by viral infection.
Vertigo may also be caused by inflammation within the inner ear (labyrinthitis), which is characterized by the sudden onset of vertigo and may be associated with hearing loss. The most common cause of labyrinthitis is a viral or bacterial infection.
TUMORS
A non-cancerous growth in the space behind the eardrum (cholesteatoma).
Tumors that affect the central vestibular system, such as acoustic neuroma. Acoustic neuroma is a type of tumor that can cause vertigo. Symptoms include vertigo with one-sided ringing in the ear and hearing loss.
Brain tumors and cancer that has traveled from another part of the body (metastatic).
ALCOHOL & DRUGS
Alcohol and many prescription and non-prescription medicines can cause lightheadedness or vertigo. These problems may develop from:
- Consumption of alcohol, even in small quantities in some people, can also cause vertigo.
- Taking too much of a medicine (over medicating).
- Alcohol and medicine interactions. This is a problem, especially for older adults, who may take many medicines at the same time.
- Misusing or abusing a medicine or alcohol.
- Drug intoxication or the effects of withdrawal.
Ototoxicity (i.e., ear poisoning). Some medications and environmental chemicals (e.g., lead, mercury, tin) can cause ototoxicity, which may result in damage to the inner ear or the 8th cranial nerve (acoustic nerve) and cause vertigo. The damage can be permanent or temporary. Long-term use or high doses of certain antibiotics (e.g., aminoglycosides [streptomycin, gentamicin]) and antineoplastics (e.g., cisplatin, carboplatin) can cause permanent ototoxicity. Medications that may cause temporary ototoxicity include the following:
- Anticonvulsants (e.g., phenytoin, carbamazepine).
- Antidepressants (e.g., clomipramine, amoxapine).
- Antihypertensives (e.g., labetalol, enalapril).
- Loop diuretics (e.g., bumetanide, furosemide).
- Pain relievers (e.g., aspirin).
- Prescription and over-the-counter cold medicines.
- Quinine (e.g., chloroquine, quinidine)
OTHER CAUSES OF VERTIGO
Blockage of the ear canal or eustachian tube due to middle ear infections, or excess wax in the ear can cause vertigo.
Vertigo can occur after long flights or boat (sailing) journeys where the mind gets used to turbulence, resulting in a person's feeling as if he is moving up and down (sometimes referred to by sailors as "land sickness"). This usually subsides after a few days. Certain activities, such as taking amusement park rides, watching action movies, or playing video games may bring on vertigo or dizziness. In such cases, symptoms diminish soon after the activity ceases.
Changes in atmospheric pressure can cause vertigo.
Air contains less oxygen at altitudes high above sea level. Lower oxygen levels can cause mild, temporary dizziness or lightheadedness.
Another source of vertigo is through exposure to high levels of sound pressure, rattling the inner ear and causing a loss of balance.
There are at least 100 different syndromes that can include vertigo. In some cases, the cause of vertigo is unknown.
TYPES OF VERTIGO
There are also different types of vertigo. Among the most common are the following:
- Chronic Vertigo: Can occur as a result of hypertension or atherosclerosis. This type of vertigo either does not go away completely or recurs frequently.
- Senile Vertigo: Can be cased by atherosclerosis, chronic eye disease, or the benign paroxysmal positional vertigo (BPPV) syndrome. However, it is worth checking to see if side effects or interactions might be causing the problem.
- Juvenile Vertigo: Is usually caused by anxiety or hyperventilation.
- Positional Vertigo: Is, as it states, an attack of vertigo that occurs when you assume a particular position. BPPV is an example of positional vertigo. It is thought to be caused by damage to the body's balance mechanisms in the inner ear. The structures in the middle ear might be dislodged by injury or infection, or as a result of old age, causing all the symptoms of vertigo when you move your head.
- Sudden-Onset Vertigo: Is, as the name implies, vertigo that strikes suddenly and may last for minutes or hours. It can be caused by motion sickness, Meniere's disease, or insufficient oxygen supply to the brain. Low blood sugar can also cause dizziness similar to vertigo.
VERTIGO & AGING
Because of the effects of aging on the body, older people are more prone than others to vertigo. The body maintains a sense of balance through a complex mechanism involving both the inner ears and visual input. Within the canals of the inner ears and visual input. Within the canals of the inner ears, there are structures called otoliths, which are minute calcium carbonate crystals that press upon the hair-like cells that line the inner membranes. Gravity acts on the otoliths so that they shift in response to head movements. This bends the fiber cells, which, in turn, transmit signals to the brain. The brain then uses these signals to calculate the positioning of the head. As people age, tiny bits of debris may accumulate in the inner ears and press against the hair cells, resulting in false signals being sent to the brain. This can interfere with a sense of balance and result in vertigo. In addition, with increasing age, nerve impulses require more time to travel from the eyes to the brain and spinal cord. This can cause dizziness and loss of balance upon sudden movement.
VERTIGO NEUROCHEMISTRY
The neurochemistry of vertigo includes 6 primary neurotransmitters that have been identified between the 3-neuron arc that drives the vestibulo-ocular reflex (VOR). Many others play more minor roles.
Three neurotransmitters that work peripherally and centrally include glutamate, acetylcholine, and GABA.
- Glutamate maintains the resting discharge of the central vestibular neurons, and may modulate synaptic transmission in all 3 neurons of the VOR arc.
- Acetylcholine appears to function as an excitatory neurotransmitter in both the peripheral and central synapses.
- GABA is thought to be inhibitory for the commissures of the medial vestibular nucleus, the connections between the cerebellar Purkinje cells and the lateral vestibular nucleus, and the vertical VOR.
Three other neurotransmitters work centrally.
- Dopamine may accelerate vestibular compensation.
- Norepinephrine modulates the intensity of central reactions to vestibular stimulation and facilitates compensation.
- Histamine is present only centrally, but its role is unclear. It is known that centrally acting antihistamines modulate the symptoms of motion sickness.
The neurochemistry of emesis overlaps with the neurochemistry of motion sickness and vertigo. Acetylcholine, histamine, and dopamine are excitatory neurotransmitters, working centrally on the control of emesis. GABA inhibits central emesis reflexes. Serotonin is involved in central and peripheral control of emesis but has little influence on vertigo and motion sickness.
SIGNS & SYMPTOMS
Vertigo, or dizziness, refers to the sensation of spinning (subjective vertigo) or the perception that surrounding objects are moving or spinning (objective vertigo). Some patients describe a feeling of being pulled toward the floor or toward one side of the room. Moving the head, changing position, and turning while lying down often worsen vertigo.
The sudden onset of vertigo usually indicates a peripheral vestibular disorder (inner ear disturbance such as BPPV, Meniere's disease, vestibular neuritis).
Symptoms of benign paroxysmal positional vertigo (BPPV) usually last a few seconds to a few minutes and are intermittent (i.e., come and go). They also may include lightheadedness, imbalance, and nausea, usually as a result of a change in position (e.g., rolling over in bed, getting out of bed).
Symptoms of Meniere's disease and vestibular neuritis include vertigo, hearing loss, ringing in the ears (tinnitus), and ear pressure that often lasts hours to days.
VERTIGO SYMPTOMS ACCORDING TO TYPE OF DISORDERS
Vertigo implies that there is a sensation of motion either of the person or the environment. This should not be confused with symptoms of lightheadedness or fainting. If true vertigo exists, there is a sensation of disorientation or motion.
Peripheral vestibular disorders also may cause the following symptoms:
- Blurred vision.
- Fatigue and reduced stamina.
- Headache.
- Heart palpitations (rapid fluttering of the heart).
- Imbalance.
- Inability to concentrate.
- Increased risk for motion sickness.
- Muscle ache (especially of the neck and back).
- Nausea and vomiting.
- Reduced cognitive function (i.e., thinking and memory).
- Sensitivity to bright lights and noise.
- Sweating.
Vertigo caused by a central vestibular disorder usually develops gradually. In addition to vertigo, central vestibular disorders (such as a stroke [brain attack], migraine) may cause the following symptoms:
- Double vision (diplopia) and other visual disturbances.
- Headache (may be severe).
- Impaired or decreased level of consciousness.
- Inability to speak (difficulty speaking) due to muscle impairment (dysarthria).
- Lack of coordination, difficulty walking.
- Nausea and vomiting.
- Weakness.
Other symptoms may include:The duration of symptoms can be from minutes to hours, and symptoms can be constant or episodic. The onset may be due to a movement or change in position. It is important to tell the health care provider about any recent head trauma or whiplash injury as well as any new medications the patient is taking.
- Abnormal eye movements.
- The patient may have hearing loss and a ringing sensation in the ears.
COMPLICATIONS
Severe vertigo can be disabling and may result in complications such as irritability, loss of self-esteem, depression, and injuries from falls. Falls are the leading cause of serious injury in people over the age of 65.
If you have any of the following symptoms, evaluate those symptoms first and contact your health care provider if necessary.
- Chest pain.
- Change in your heart rate.
- Severe headache.
- Thoughts of suicide or harming yourself.
- Hyperventilation.
PREPARING FOR YOUR APPOINTMENT WITH YOUR HEALTH CARE PROVIDER
You can help your health professional diagnose and treat your condition by being prepared to answer the following questions:
- What is your major symptom, lightheadedness or vertigo?
- How long have you had your symptoms? Do they come and go, or are they always present?
- What were you doing when your symptoms started?
- How often do you experience dizziness?
- What makes your symptoms better or worse?
- Do you have other symptoms that may be related to your major symptom? Symptoms may include:
- Changes in vision, such as blurred or double vision, halos, or spots.
- Chest pain.
- Confusion.
- Fainting or falling.
- Heart palpitations, irregular heartbeat, or an unusually slow or fast heart rate.
- Nausea or vomiting.
- Numbness or tingling.
- Weakness or changes in your ability to stand or walk.
- Ringing in the ears (tinnitus) or loss of hearing.
- Shortness of breath or a feeling of suffocation.
- What medicines do you take? Make a list of both prescription and non-prescription medicines you use as well as any dietary supplements and herbal therapies.
- Do you have any health risks?
Before seeing your health professional, it may be helpful to keep track of your symptoms. Keeping a health diary may help to pinpoint problem causes, times and situations. Include dietary and exercise information along with a time, place and activity associated with your symptoms.
QUESTIONS TO ASK YOUR HEALTH CARE PROVIDER
Vertigo, or dizziness, is one of the most common health problems in adults. Anyone who has experienced vertigo knows just how difficult it can be to cope with this condition. Vertigo usually results from a disorder or disturbance in the vestibular system, which is comprised of the inner ear, the vestibular nerve, the brainstem, and the cerebellum, and is responsible for maintaining balance and equilibrium. In addition to dizziness, vertigo can produce the sensation of spinning (called subjective vertigo) or that surrounding objects are spinning (called objective vertigo), lightheadedness, unsteadiness, and nausea. Common causes for dizziness include benign paroxysmal position vertigo (BPPV), inner ear damage or infection, head trauma, medications (such as aspirin, cold medicines, antibiotics, chemotherapy drugs), and diseases (such as multiple sclerosis [MS], kidney disease, thyroid disorders, Meniere's disease).
Here are some questions to ask your health care provider or neurologist about vertigo. Take the list with your to your health care provider's appointment. The more knowledge you have about your condition, the easier it is to make important decisions about your medical care.
- What do you suspect is causing my vertigo? Why do you suspect this cause?
- What kinds of activities may trigger or worsen my vertigo symptoms?
- Is there anything I should do or avoid doing to help reduce the severity and frequency of symptoms?
- What types of examinations, evaluations, and/or diagnostic tests will be performed to determine if an underlying condition is causing my dizziness?
- How do I prepare for these exams and tests?
- Do you recommend that I see a specialist or visit a hospital or medical center that specializes in vertigo for my condition? Why or why not?
- What is the usual prognosis for people with this type of vertigo?
- In addition to dizziness, what other symptoms and complications related to this type of vertigo may develop?
- What should I do if I experience new symptoms or serious complications?
- Can the underlying cause for my vertigo usually be successfully treated? If so, do you expect treatment to resolve my dizziness and other vertigo symptoms?
- What is the recommended treatment for my vertigo? Why do you recommend this treatment?
- If this treatment is unsuccessful, what other treatment options might you recommend?
- Will I undergo vestibular rehabilitation therapy to treat my vertigo? If so, how often will I have therapy and how long will therapy last?
- What is the canalith repositioning procedure, also called the Epley maneuver? Might this technique be used to treat my vertigo?
- Will medication(s) be used to treat my vertigo? If so, which medications?
- What are the most common side effects of the medication(s)?
- What types of severe side effects may occur?
- What should I do if I experience severe side effects?
- Might surgery be required to treat my condition? Why or why not?
- If I do require surgery, what type of surgery may be performed and how do I prepare for the procedure?
- What can I expect following surgery to treat vertigo?
- What should I do if I experience complications after surgery?
- Do you recommend that I participate in a vertigo clinical trial or explore newer treatment options?
- Can you recommend a local or online support group for patients with vertigo?
VERTIGO DIAGNOSIS
It is important to diagnose the cause of vertigo, or dizziness, as quickly as possible to rule out serious conditions such as cardiovascular disease, stroke, hemorrhage, or tumor. Diagnosis includes clinical history, physical and neurological examination, blood tests, and imaging tests such as a CT scan or an MRI scan.
Important considerations include the following:
- What triggers the vertigo?
- What other symptoms occur?
- How long does the dizziness last?
- What improves or worsens symptoms?
MEDICAL HISTORY
The history is comprised of four basic areas.
- The health care provider may want to know if the patient feels any sensation of motion, which may indicate that true vertigo exists. Report any nausea, vomiting, sweating, and abnormal eye movements.
- The health care provider may ask how long the patient has symptoms and whether they are constant or come and go. Do the symptoms occur when moving or changing positions? Is the patient currently taking any new medications? Has there been any recent head trauma or whiplash injury?
- Are there any other hearing symptoms? Specifically, report any ringing in the ears or hearing loss.
- Does the patient have weakness, visual disturbances, altered level of consciousness, difficulty walking, abnormal eye movements, or difficulty speaking?
PHYSICAL EXAMINATION
Physical examination includes measuring blood pressure and heart rate.
NEUROLOGICAL EXAMINATION
Neurological examination includes testing facial and vestibular nerves and muscles, strength, coordination, balance, and walking (gait).
The positional vertigo test is used to help distinguish peripheral from central vestibular disorders. In this test, the patient sits on a table with the head turned to the side. The physician then supports the head and lowers it gently below the table while the patient lies back. The patient reports symptoms of vertigo while the physician looks for circular movement of the eyes (called nystagmus).
A delay between the onset of nystagmus and the sensation of vertigo usually indicates a peripheral vestibular disorder. Lack of a delay may indicate a central vestibular disorder. The test is repeated with the head turned in the opposite direction.
Electronystagmography (ENG) is a neurological test used to evaluate the vestibular system. It involves testing hearing in both ears (audiometry tests), testing eye movements, and evaluating responses to changes in posture and position.
BLOOD TESTS
Blood tests include a complete blood count (CBC) to check for anemia and infections, glucose testing to check blood sugar levels, and kidney and thyroid panels to rule out systemic diseases (such as kidney disease, hypothyroidism). If the patient is taking medication, drug levels are obtained.
IMAGING TESTS
Imaging tests may be used to detect brain abnormalities (such as a stroke, tumor). Computed tomography (CT scan) produces x-ray images of the brain and magnetic resonance imaging (MRI scan) uses a magnetic field to produce detailed images of brain tissue and arteries in the neck and brain.
Gadolinium-enhanced MRI if findings suggest CNS lesion. Diagnosis is based on characteristic symptoms, on nystagmus as determined by the Dix-Hallpike maneuver (a provocative test for positional nystagmus), and on absence of other abnormalities on neurologic examination. Such patients require no further testing. Patients with nystagmus suggesting a CNS lesion undergo gadolinium-enhanced MRI. Unlike the positional nystagmus of BPPV, the positional nystagmus of CNS lesions lacks latency, fatigability, and severe subjective sensation and may continue for as long as the position is maintained. Nystagmus caused by a CNS lesion may be vertical or change direction and, if rotary, is likely to be in the unexpected direction.
The practitioner may perform tests such as a CT scan if a brain injury is suspected to be the cause of vertigo.
CARDIAC TESTS
The use of an electrocardiogram (ECG) to look at heart rhythm may also be helpful.
VERTIGO SELF-CARE AT HOME
Home therapy should only be undertaken if you have already been diagnosed with vertigo and are under the supervision of a health care provider.
Lightheadedness usually is not a cause for concern unless it is severe, does not go away, or occurs with other symptoms such as an irregular heartbeat or fainting. Lightheadedness can lead to falls and other injuries. Protect yourself from injury if you feel lightheaded:
- Lie down for a minute or two. This will allow more blood to flow to your brain. After lying down, sit up slowly and remain sitting for 1 to 2 minutes before slowly standing up.
- Rest. It is not unusual to develop lightheadedness during some viral illnesses, such as a cold or the flu. Resting will help prevent attacks of lightheadedness.
- Do not drive a motor vehicle, operate equipment, or climb on a ladder while you are dizzy.
- Do not use substances that can affect your circulation, including caffeine, tobacco, alcohol, and illegal drugs.
- Do not get dehydrated, which can cause or increase lightheadedness, when you have an illness that causes diarrhea, vomiting, or a fever. Drink more fluids, especially water. Other fluids are also helpful, such as fruit juice mixed to half-strength with water, rehydration drinks, weak tea with sugar, clear broth, and gelatin dessert. If you have another medical condition, such as kidney disease or heart disease, that limits the amount of fluids you are allowed to have, do not drink more than this amount without first talking to your health care provider.
If you have vertigo:
- Do not lie flat on your back. Prop yourself up slightly to relieve the spinning sensation.
- Move slowly to avoid the risk of falling.
SYMPTOMS TO WATCH FOR DURING HOME TREATMENT
Evaluate your symptoms if any of the following occur during home treatment:
- Nausea or vomiting develops or increases.
- Moderate to severe dehydration develops.
- Fainting occurs.
- Your symptoms do not improve in 1 week with the use of home treatment.
- Your symptoms become more severe or frequent.
CONVENTIONAL MEDICAL TREATMENT FOR VERTIGO
Vertigo is triggered when the patient's head moves (eg, when rolling over in bed or bending over to pick up something). Acute vertigo lasts only a few seconds to minutes; episodes tend to peak in the morning and abate throughout the day. Nausea and vomiting may occur, but hearing loss and tinnitus do not.
TREATMENTS
The choice of treatment will depend on the diagnosis. Treatment for vertigo, or dizziness, depends on identifying and eliminating the underlying cause. If a particular medication is responsible for the condition, lowering the dosage or discontinuing the drug may eliminate vertigo.
Vertigo can be treated with medicine taken by mouth, through medicine placed on the skin (a patch), or drugs given through an IV.
Specific types of vertigo may require additional treatment and referral:
- Bacterial infection of the middle ear requires antibiotics.
- For Meniere's disease, in addition to symptomatic treatment, people might be placed on a low salt diet and may require medication used to increase urine output.
- A hole in the inner ear causing recurrent infection may require referral to an ear, nose, and throat (ENT) specialist for surgery.
- In addition to the drugs used for benign paroxysmal positional vertigo, several physical maneuvers can be used to treat the condition.
VESTIBULAR REHABILITATION THERAPY
Vestibular rehabilitation therapy (VRT) is a type of physical therapy used to treat vertigo. The goal of treatment is to minimize dizziness, improve balance, and prevent falls by restoring normal function of the vestibular system. In VRT, the patient performs exercises designed to allow the brain to adapt to and compensate for whatever is causing the vertigo. The success of this treatment depends on several factors including the following:
- Age of the patient.
- Cognitive function (such as memory, ability to follow directions in order).
- Coordination and motor skills.
- Overall health of the patient (including the central nervous system).
- Physical strength.
Vestibular rehabilitation therapy is designed by a physical therapist under the direction of a physician. In most cases, patients visit the therapist on a limited basis and perform custom-designed exercises at home, several times a day. As the patient progresses, difficulty of the exercises increases until the highest level of balance is attained during head movement, eye movement (tracking with the eyes), and walking.
In benign paroxysmal positional vertigo, short (less than 60 seconds) episodes of vertigo occur with certain head positions. Nausea and nystagmus develop. Diagnosis is clinical. Treatment involves canalith repositioning maneuvers. Drugs and surgery are rarely, if ever, indicated.
Benign paroxysmal positional vertigo (BPPV) is the most common cause of relapsing otogenic vertigo. It affects people increasingly as they age and can severely affect balance in the elderly, leading to potentially injurious falls.
According to the American Academy of Neurology, the most effective treatment for benign paroxysmal positional vertigo (BPPV) caused by ear crystals in the posterior semicircular canal, is a technique called the canalith repositioning procedure, or the Epley maneuver.
In this procedure, a health care provider or physical therapist assists the patient in performing a series of head and body movements, which move the calcium crystals out from the posterior semicircular canal and into another inner ear canal, where it is absorbed by the body. Another technique (called the Semont maneuver) also may be effective, but additional studies are needed.
Vestibular rehabilitation exercises consist of having the patient sit on the edge of a table and lie down to one side until the vertigo resolves followed by sitting up and lying down on the other side, again until the vertigo ceases. This is repeated until the vertigo no longer occurs.
Particle repositioning maneuver is a treatment based on the idea that the condition is caused by displacement of small stones in the balance center (vestibular system) of the inner ear. The head is repositioned to move the stones to their normal position. This maneuver is repeated until the abnormal eye movements are no longer visible.
ETIOLOGY
The condition is thought to be caused by displacement of otoconial crystals (calcium carbonate crystals normally embedded in the saccule and utricle). This displaced material stimulates hair cells in the posterior semicircular canal, creating the illusion of motion. Etiologic factors include spontaneous degeneration of the utricular otolithic membranes, labyrinthine concussion, otitis media, ear surgery, recent viral infection (such as viral neuronitis), head trauma, prolonged anesthesia or bed rest, previous vestibular disorders (such as Meniere's disease), and occlusion of the anterior vestibular artery.
BPPV usually subsides spontaneously in several weeks or months but may continue for months or years. Because the condition can be long-lasting, drug treatment (like that used in Meniere's disease) is not recommended. Often, the adverse effects of drugs worsen dysequilibrium.
Because BPPV is fatigable, one therapy is to have the patient perform provocative maneuvers early in the day in a safe environment. Symptoms are then minimal for the rest of the day.
CANALITH REPOSITIONING MANEUVERS
Canalith repositioning maneuvers such as the Epley maneuver and Semont maneuver involve moving the head through a series of specific positions intended to return the errant canalith to the utricle. After performing these maneuvers, the patient should remain erect or semi-erect for 1 to 2 days. Both maneuvers can be repeated as necessary.
THE EPLEY MANEUVER
This maneuver is used to treat benign positional vertigo by returning displaced otoliths to the utricle. If vertigo occurs during any of the positions, that position is held until the vertigo subsides.
THE SEMONT MANEUVER
For the Semont maneuver, the patient is seated upright in the middle of a stretcher. The patient's head is rotated toward the unaffected ear; this rotation is maintained throughout the maneuver. Next, the torso is lowered laterally onto the stretcher so that the patient is lying on the side of the affected ear with the nose pointed up. After 3 minutes in this position, the patient is quickly moved through the upright position without straightening the head and is lowered laterally to the other side now with the nose pointed down. After 3 minutes in this position, the patient is slowly returned to the upright position, and the head is rotated back to normal.
VERTIGO MEDICATION TREATMENT
Treatment is specific for underlying disorder of vertigo:
- Vestibular rehabilitation (see above).
- Benign paroxysmal positional vertigo (BPPV), a special kind of vertigo, is treated with the Epley maneuver performed by a health practitioner or physical therapist, or with a BPPV maneuver at home.
- Anticholinergics.
- Antihistamines.
- Benzodiazepines.
- Calcium channel antagonists, specifically Verapamil and Nimodipine.
- GABA modulators, specifically gabapentin and baclofen.
- Neurotransmitter reuptake inhibitors such as SSRI's, SNRI's and tricyclics.
- Antibiotics if the underlying cause is inflammation of the inner ear due to bacterial infection.
Ear infections, such as otitis media and labyrinthitis, caused by bacteria may be treated using antibiotics (amoxicillin, ceftriaxone). Myringotomy is a surgical procedure that may be used to treat chronic ear infections. In this procedure, which is performed under anesthesia, an incision is made in the eardrum and a small tube is placed in the opening to prevent fluid and bacteria from building up inside the ear.
BPPV that does not respond to canalith repositioning may be treated with meclizine (Antivert®), an oral antiemetic that can be taken up to 3 times a day, or only as needed. Meclizine may cause drowsiness, dry mouth, and blurred vision.
If meclizine is ineffective, benzodiazepines such as clonazepam (Klonopin®) or antihistamines such as promethazine (Phenergan®) may be prescribed. Side effects of clonazepam include drowsiness, lack of coordination (ataxia), and confusion. Promethazine may cause drowsiness, fatigue, insomnia, and tremors.
Meniere's disease may be treated by reducing sodium (salt) intake and with diuretic medications. A short, tapered course of corticosteroids (prednisone) may be prescribed early in the disease to reduce inflammation and stabilize hearing. Antibiotics (gentamicin) may be administered into the middle ear (called intratympanic perfusion) to treat severe vertigo caused by Meniere disease.
Vertigo caused by migraine can often be treated with medication.
Cerebrovascular disease (stroke), tumors, and multiple sclerosis may require treatment with medication, radiation, or surgery.
MEDICATIONS COMMONLY PRESCRIBED FOR VERTIGO
Meclizine Hydrochloride (Antivert) Generic Name: Meclizine Brand Names: Antivert, Bonine, Meni-D, Antrizine Drug Class & Mechanism: Meclizine is an antihistamine with antiemetic (anti-nausea) and antispasmodic (anti-muscle spasm) activity. It also suppresses the nervous system by blocking the action of the neurotransmitter acetylcholine. (Neurotransmitters are chemicals that nerves use for communicating with each other.) Meclizine prevents nausea and vomiting by reducing the activity of the center in the brain that controls nausea. It also prevents motion sickness by reducing excitability of neurons in the motion and balance center (vestibular region) of the brain. Prescription: Yes; no (Dramamine less drowsy formula). Generic Available: Yes. Preparations: Tablets: 12.5, 25, and 50 mg. Capsule: 25 mg. Storage: Meclizine tablets should be stored between 15-30°C (59-86°F). Capsules should be stored below 30°C (86°F). Prescribed For: Meclizine is used for the treatment of nausea, vomiting, and dizziness associated with motion sickness. Meclizine possibly is effective in the treatment of vertigo (balance disorder) caused by diseases of the body's balance (vestibular) system. Dosing: When used for treating symptoms of motion sickness, meclizine 25-50 mg should be taken one hour prior to travel and then every 24 hours for the duration of the journey. The dosing should not exceed 2 tablets in 24 hours. Vertigo is treated with 25-100 mg daily in divided doses. Drug Interactions: Alcohol, sedatives, and tranquilizers can increase drowsiness caused by meclizine. Pregnancy: Meclizine has been used to control nausea during pregnancy. Available evidence does not suggest that use of meclizine during pregnancy is harmful. However, meclizine should be used in pregnancy only if it is clearly needed and under the supervision of a health care provider. Nursing Mothers: Available information suggests that the risk of harm to the baby is minimal when meclizine is used while nursing. Side Effects: Meclizine can cause drowsiness. Other side effects include nausea, dry mouth, blurred vision, rash constipation, diarrhea and urinary retention (inability or difficulty urinating). Meclizine also has been associated with hypotension (low blood pressure) and heart palpitations.
Diphenhydramine Hydrochloride Generic Name: Diphenhydramine Brand Names: Benadryl
Numerous other generic products also exist. Basic medication information for Benadryl (NDA #006146) is as follows: FDA original approval was March 6, 1947.Drug Class & Mechanism: Benadryl (Parke Davis) is a non-prescription (over-the-counter) antihistamine used to treat hay fever and allergies. It is an older antihistamine and inhibits type 1 histamine receptors, as well as other, unrelated receptors, in both the brain (central nervous system) and throughout the body, thereby increasing the incidence of sedation. Because of its strong sedative effect, it is rarely used for daily treatment of allergies. Antihistamines compete with histamine for histamine receptor sites. By occupying the histamine receptor sites, they prevent histamine from its actions. Prescription: No. Generic Available: Yes. Preparations: Injection, oral capsule, tablets, or elixir in dosage strengths of 50 mg/mL injection, 25 and 50 mg capsules/tablets, 12.5 mg/5 mL elixir. Prescribed For: Benadryl is indicated for adults and children 2 years or older to temporarily relieve symptoms caused by hay fever and allergies (runny nose, sneezing, itchy/watery eyes, scratchy nose or throat). It is available in a variety of forms, including tablets, and syrup. Benadryl may also be administered as an injection for serious allergic reactions. Drug Interactions: Combination with a decongestant (such as Claritin D), may cause insomnia or anxiety. Individuals who are allergic to Benadryl or any of its ingredients should not take it. Pregnancy: Individuals who are pregnant, think they may be pregnant, or are planning to become pregnant should not take Benadryl. Nursing Mothers: Individuals who are breastfeeding should not take Benadryl. Side Effects: This is NOT a complete list of side effects reported with Benadryl. The health care practitioner or pharmacist can discuss a more complete list of side effects. Antihistamines are typically well tolerated, and serious side effects are rare. The more common side effects are usually mild and may go away. Older antihistamines, such as Benadryl, are more likely to cause dizziness, excessive sedation, lightheadedness, and low blood pressure, particularly in elderly individuals. Urine retention, constipation, dry mouth, headache, or blurred vision may occur.
Scopolamine Transdermal Patch (Transderm-Scop) Generic Name: Scopolamine Brand Names: Transderm-Scop Drug Class & Mechanism: Scopolamine is an oral, intravenous, ophthalmic or topical drug with many uses including the prevention of motion sickness. Transderm-Scop is scopolamine administered topically (through the skin or transdermal) via a special delivery system that gradually releases scopolamine onto the skin over a period of three days. The scopolamine is absorbed into the body through the skin. It is not clear how scopolamine prevents nausea and vomiting due to motion sickness. The vestibular part of the ear is very important for balance. When a person becomes disoriented due to motion, the vestibule sends a signal through nerves to the vomiting center in the brain, and vomiting occurs. Acetylcholine is a chemical that nerves use to transmit messages to each other. Scientists believe that scopolamine prevents communication between the nerves of the vestibule and the vomiting center in the brain by blocking the action of acetylcholine. Scopolamine also may work directly on the vomiting center. Scopolamine must be taken before the onset of motion sickness to be effective. Prescription: Yes. Generic Available: No. Preparations: Disc (Patch): 1.5 mg. Storage: Store at room temperature 15-30°C (59-86°F). Prescribed For: Transderm-Scop is used for the prevention of nausea and vomiting resulting from motion sickness. Dosing: The recommended adult dose is one disc every three days. The disc is applied to the hairless area behind the ear at least 4 hours before the effects are desired. If therapy is needed for more than three days, the first disc is discarded, and a second disc is applied behind the opposite ear. To prevent contact with eyes, the hands should be washed with soap and water after handling the patch. Drug Interactions: Alcohol and other drugs that cause drowsiness may worsen the drowsiness caused by scopolamine. Pregnancy: Use in pregnant women has not been adequately evaluated. Nursing Mothers: It is not known whether scopolamine is excreted in breast milk. Side Effects: The most common side effects are drowsiness, dry mouth, blurred vision and dilation of pupils. Scopolamine may worsen narrow angle glaucoma, cause difficulty urinating and lead to dry, itchy eyes.
Promethazine Hydrochloride (Phenergan) Generic Name: Promethazine Brand Names: Phenergan, Phenadoz, Promethegan Drug Class & Mechanism: Promethazine is a phenothiazine in the same drug class as chlorpromazine (Thorazine) and trifluoperazine (Stelazine). However, unlike the other drugs in this class, promethazine is not used as an anti-psychotic. It used as an anti-histamine, sedative, and antiemetic (anti-nausea). The body releases histamine during several types of allergic reactions. When histamine binds to its receptors on cells, it stimulates changes within the cells that lead to sneezing, itching, and increased mucus production. Antihistamines such as promethazine compete with histamine for one of the receptors for histamine (the H1 receptor) on cells. However, when the antihistamines bind to the receptors they do not stimulate the cells. Instead, they prevent histamine from binding and stimulating the cells. Promethazine also blocks the action of acetylcholine (anticholinergic effect), and this may explain its benefit in reducing the nausea of motion sickness. It is used as a sedative because it causes drowsiness as a side effect. The FDA approved promethazine in 1951. Prescription: Yes. Generic Available: Yes. Preparations: Tablets: 12.5, 25, and 50 mg; Suppositories: 12.5, 25, and 50 mg; Syrup: 6.25 mg/5 ml; Injection: 25 and 50 mg/ml. Storage: Tablets, syrup and injection should be stored at room temperature between 15-25°C (68-77deg;F). Suppositories should be stored at 2-8°C (36-46°F). Prescribed For: Promethazine is prescribed for treating nausea or vomiting, motion sickness, and allergic reactions and for sedation. Dosing: Allergic reactions are treated with 6.25-25 mg 3 times daily. A single 25 mg dose administered at bedtime also may suffice. Nausea and vomiting may be managed with 12.5-25 mg administered every 4-6 hours as needed. Doses of 12.5-50 mg at bedtime are used for sedation. For prevention of motion sickness, 25 mg is used 30 to 60 minutes before the motion begins and then every 8 to 12 hours as needed. Oral, rectal and injectable doses are similar. Promethazine injections are used when the oral route is not possible (for example, with severe vomiting). Tablets may be taken with or without food. Suppositories are unwrapped and moistened with water before insertion into the rectum. If the suppository is too soft from being stored in a warm place, it may be chilled in the refrigerator for 20 to 30 minutes or placed in cold water before the wrapper is removed. Drug Interactions: Promethazine should not be taken with any of the MAO (mono-amine oxidase) inhibitor-class of antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane), because of the increased risk of extrapyramidal symptoms (EPS) - uncontrollable movement disorders. Excessive anti-cholinergic effects can occur when promethazine is used with other antihistamines, for example, diphenhydramine (Benadryl); some phenothiazines, for example, thioridazine (Mellaril); some tricyclic antidepressants, for example, amitriptyline (Elavil); clozapine (Clozaril), cyclobenzaprine (Flexeril), and disopyramide (Norpace). Excessive sedation may occur when promethazine is combined with other medications that depress the central nervous system (brain) and cause sedation. Such drugs include ethanol, barbiturates, anti-anxiety medications, sedatives, other phenothiazines, and narcotic pain medications. There may be an increase in the risk of certain neurologic reactions that affect movement of muscles when promethazine is combined with medicines that also cause EPS. Such drugs include antipsychotics, metoclopramide (Reglan), and amoxapine (Asendin). Promethazine should not be used with propylthiouracil (PTU) due to the increased risk of low white blood cell counts and increased risk of infections. The reason for this interaction is not known. Concurrent use of promethazine with the dye used for myelography (x-rays of the spinal cord) can lower the threshold for seizures and thus increase the risk of seizures. Promethazine should be stopped at least 48 hours before myelography and not restarted until at least 24 hours after myelography. Pregnancy: There are no adequate studies of promethazine in pregnant women. Administration of promethazine within 2 weeks of delivery may affect platelet function in the newborn. Nursing Mothers: It is not known whether promethazine is excreted in breast-milk. Side Effects: Promethazine often causes sedation. In children less than two it can depress respiration and lead to death. Therefore, it should not be used in children less than two years old. Dizziness may also occur. Ironically, promethazine sometimes stimulates patients, particularly children. Such stimulation may be manifest by restlessness, inability to sleep, heart palpitations or even seizures. Promethazine also causes anticholinergic side effects such as blurred vision, dry mouth, dilated pupils, nausea, urinary retention (inability to urinate), impotence, and constipation. EPS may occur. EPS are categorized as dystonic reactions (alterations in muscle tone), sharp, involuntary muscle movements (often limited to one muscle or muscle group), akathisia (subjective restlessness), and Parkinsonism. Parkinsonian symptoms are more common in older persons whereas children more often develop involuntary muscle movement reactions. Dystonic reactions are most commonly seen during the first week of treatment. Restlessness and Parkinsonian symptoms usually develop days to weeks after starting therapy. A complex called neuroleptic malignant syndrome (NMS) can occur in patients receiving phenothiazines. NMS consists of high body temperature, severe EPS, changes in consciousness and mental status, and increased heart rate with low or high blood pressure. NMS occurs more frequently in young men and in persons who are dehydrated. Rarely, blood cell disorders can occur; low white cell counts can lead to severe infections. Phenothiazines such as promethazine can cause skin hyperpigmentation (darkening) but usually only after prolonged use. The effect usually is restricted to areas of the body exposed to sunlight. Thus, people who need long-term treatment with promethazine should either keep out of the sun or use effective sunscreens. Phenothiazines can cause blurred vision, difficulty with nighttime vision, or changes in color vision. Liver damage has been reported rarely with phenothiazines. Jaundice is possible. Jaundice also may occur in newborns of mothers who receive phenothiazines during pregnancy. Phenothiazines such as promethazine block dopamine receptors. This effect can lead to increases in blood levels of prolactin, a hormone involved in lactation (formation of breast milk). As a result, phenothiazines can cause the breast to produce fluid ("milk") even when a woman is not pregnant. Additionally, phenothiazines can cause missed menstrual periods, breast enlargement or tenderness, loss of sexual drive, impotence, inability to ejaculate, and priapism. Weight gain also may occur.
Diazepam (Valium) Generic Name: Diazepam Brand Names: Valium, Diastat Drug Class & Mechanism: Diazepam is an anti-anxiety medication in the benzodiazepine family, the same family that includes alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan), flurazepam (Dalmane), and others. Diazepam and other benzodiazepines act by enhancing the effects of gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter (a chemical that nerve cells use to communicate with each other) that inhibits activity in the brain. It is believed that excessive activity in the brain may lead to anxiety or other psychiatric disorders. Prescription: Yes. Generic Available: Yes. Preparations: Tablets: 2, 5, and 10 mg. Solution: 5 mg/ml. Injection: 5 mg/ml. Rectal Gel: 2.5, 10, and 20 mg. Storage: Diazepam should be stored at room temperature, 15-30°C (59-86°F). Prescribed For: Diazepam is used for the treatment of anxiety disorders. Diazepam also is used for the treatment of agitation, tremors, delirium, seizures, and hallucinations resulting from alcohol withdrawal. It is used for the treatment of seizures and relief of muscle spasms in some neurological diseases. Dosing: Diazepam may be taken with or without food. Diazepam is metabolized by the liver and excreted mainly by the kidney. Dosages of diazepam may need to be lowered in patients with abnormal kidney function. The usual oral diazepam dose is 2-10 mg given 2-4 times daily. The usual rectal dose is 0.2-0.5 mg/kg and depends on the age of the patient. Drug Interactions: Alcohol or medications that cause sedation may add to the sedative effects of diazepam. Patients taking benzodiazepines should avoid such combinations. Cimetidine (Tagamet), ketoconazole (Nizoral), omeprazole (Prilosec, Rapinex), fluvoxamine (Luvox), and fluoxetine (Prozac) may prolong the effects of diazepam by inhibiting liver enzymes that break down diazepam. Dosages may need to be decreased when these drugs are used with diazepam. Pregnancy: Benzodiazepines, such as diazepam, can cause fetal abnormalities and should not be used during pregnancy. Nursing Mothers: Diazepam is excreted in breast milk and can affect nursing infants. Therefore, diazepam should not be used by women who are nursing. Side Effects: The most frequent side effects of diazepam are drowsiness, fatigue, and ataxia (loss of balance). Rarely, diazepam causes a paradoxical reaction with excitability, muscle spasm, lack of sleep, and rage. Confusion, depression, speech problems, and double vision are also rare side effects of diazepam. Diazepam can lead to addiction (dependency), especially when higher dosages are used over prolonged periods of time. In patients addicted to diazepam or after prolonged use, abrupt discontinuation of the medicine may cause symptoms of withdrawal (insomnia, headaches, nausea, vomiting, lightheadedness, sweating, anxiety, and fatigue). Seizures can occur in more severe cases of withdrawal. Therefore, after extended use, diazepam should be slowly tapered under a health care provider's supervision rather than abruptly stopping the medication.
These medications should be taken only as directed and under the supervision of a health care provider.
FOLLOW-UP
Anyone with a new diagnosis of vertigo should follow-up with his or her health care provider or be referred directly to a neurologist or ENT specialist.
PREVENTION OF LIGHTHEADEDNESS & VERTIGO
People whose balance is affected by vertigo should take precautions to prevent injuries from falls.
Those with risk factors for stroke should control their high blood pressure and high cholesterol and stop smoking.
Patient's with Meniere's disease should limit salt in their diet.
You may be able to prevent lightheadedness caused by orthostatic hypotension by taking your time.
- Get up slowly from your bed or chair.
- Sit on the edge of the bed for a few minutes before standing.
- Sit up or stand up slowly to avoid sudden changes in blood flow to your head that can make you feel lightheaded.
In most cases, vertigo cannot be prevented. However, some cases of vertigo are caused by head injuries. Taking the following safety measures can help lower your risk of getting a head injury that might lead to vertigo.
- Wear your seat belt when you are traveling in a motor vehicle. Secure young children in age-appropriate child car seats.
- Do not use alcohol or other drugs before playing sports or when operating an automobile or other equipment.
- Wear a helmet and other protective clothing whenever you are biking, motorcycling, skating, kayaking, horseback riding, skiing, snowboarding, rock climbing, or participating in any high-speed or impact sport.
- Wear a hard hat if you work in a construction job or in an industrial area.
- Do not dive into shallow or unfamiliar water.
- Do not keep firearms in your home. If you must keep firearms, lock them up and store them unloaded and uncocked. Lock ammunition in a separate area.
When you are dizzy, your risk of falling increases. You can make changes in your home to reduce your risk of falls.
- Remove raised doorway thresholds, throw rugs, and clutter.
- Repair loose carpet or raised areas in the floor that may cause you to trip.
- Rearrange furniture and electrical cords to keep them out of walking paths.
- Use non-skid floor wax and wipe up spills immediately, especially on ceramic tile floors.
- Keep stairways, porches, and outside walkways well lit. Use night lights in hallways and bathrooms.
- Install sturdy handrails on stairways and grab handles and nonskid mats inside and outside your shower or tub and near the toilet.
- Use shower chairs and bath benches.
- Add extra light switches if needed or use remote switches (such as clap-on switches) or timers on lights by doors and near your bed so that you will not have to get up quickly to turn on lights or walk across the room in the dark.
- Put things within easy reach so you do not need to reach overhead for them.
- Keep a cordless phone and a flashlight with new batteries by your bed.
PROGNOSIS
The prognosis (outlook) depends on the source of the vertigo. Vertigo caused by problems in the inner ear, while usually self-limited, in some cases can become completely incapacitating. The use of drugs and rehabilitation exercise is mainstay of treatment. Most commonly this will make the symptoms completely go away or make the condition tolerable.
The prognosis of vertigo from a brain lesion depends on the amount of damage done to the central nervous system. Vertigo caused by a brain lesion may need emergency evaluation by a neurologist and neurosurgeon.
CURRENT RESEARCH ABOUT VERTIGO
Because vertigo usually occurs as a result of a disorder in the vestibular system (i.e., the inner ear, vestibular nerve, brainstem, and cerebellum), the focus of ongoing research is to determine the precise connection between the structures of the inner ear and the brain. The relationship between vertigo, eye movements, and body position is being studied to provide a better understanding of balance disorders and improve methods of diagnosis using computer-controlled testing systems, treatment using certain exercises, and rehabilitation. According to the National Institute on Deafness and Other Communication Disorders (NIDCD), recent studies suggest that the vestibular system may play a significant role in regulating blood pressure. This research may provide important information about how to manage low blood pressure that occurs as the result of a change in position (condition called orthostatic hypotension) and also improve the understanding of balance disorders. Other studies are focused on determining how the vestibular system is able to differentiate between types of movement (such as downward movement, side-to-side movement). Genetic studies also are being conducted to determine how certain genes affect vestibular system function and how inherited neurological conditions and hearing loss affect balance.
Benign paroxysmal positional vertigo (BPPV) is a common type of vertigo caused by the accumulation of tiny particles in fluid in the semicircular canals of the inner ear. These three canals are used by the brain to detect head movement and help maintain balance and equilibrium. Patients with BPPV experience dizziness during certain movements. A new treatment for BPPV, called the Comprehensive Positional Management (CPM) system, is being studied in research and clinical settings. In this procedure, the exact location of the particles is determined and the patient is positioned manually to help move the particles out of the semicircular canal.
HOLISTIC RECOMMENDATIONS
NUTRITIONAL RECOMMENDATIONS
Limit your total sodium intake to less than 2,000 milligrams per day. Too much sodium can disrupt the workings of the inner ear.
Avoid alcohol, caffeine, nicotine, and all fried foods.
LIFESTYLE RECOMMENDATIONS
Avoid making rapid or extreme movements and rapid changes in body position.
To subdue dizziness, sit in a chair with your feet flat on the floor and stare at a fixed object for a few minutes.
If vertigo is a recurring problem, consult with your health care provider. It may be a sign of an underlying problem that requires treatment.
HERBS
Black Cohosh lowers blood pressure. Caution: Do not use this herb during pregnancy.
Herbal Remedies: Black Cohosh Extract, Standardized, Nature's Way, 40 mg, 60 Tabs
Herbal Remedies: Black Cohosh Extract, Standardized, Nature's Way, 40 mg, 120 VCaps
Herbal Remedies: Black Cohosh Root, Nature's Way, 540 mg, 180 Caps
Herbal Remedies: Black Cohosh Powder (Cimicifuga Racemosa), 4 oz. Bulk
Herbal Remedies: Black Cohosh Supplement Tincture, 2 fl. oz.
Herbal Remedies: Black Cohosh Supplements & Products
Butcher's Broom and Cayenne (Capsicum) help improve circulation.
Herbal Remedies: Butcher's Broom Tincture, 2 fl. oz.
Herbal Remedies: Butcher's Broom Root, Nature's Way, 470 mg, 100 Caps
Herbal Remedies: Cayenne Extra Hot Formula Supplement, Nature's Way, 450 mg, 100,000 HU, 100 Caps
Herbal Remedies: CapsiCool Cayenne Supplement, Nature's way, 390 mg, 100 Caps
Herbal Remedies: Cayenne & Garlic Supplement, Nature's Way, 100 Caps
Herbal Remedies: Cayenne Pepper Supplement, Nature's Way, 450 mg, 180 Caps
Herbal Remedies: Cayenne Pepper Oil, 2 fl. oz.
Herbal Remedies: Cayenne Supplement Tincture, 2 fl. oz.
Herbal Remedies: Cayenne & Ginger Supplement, Nature's Way, 465 mg, 100 Caps
Herbal Remedies: Cayenne Supplements & Products
Dandelion tea or extract is very good for high blood pressure.
Herbal Remedies: Dandelion Root Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Dandelion Tea, NOW Foods, Organic, 30 Tea Bags
Herbal Remedies: Dandelion Root, Vegetarian, Nature's Way, 540 mg, 180 VCaps
Herbal Remedies: Dandelion Root Powder (Taraxacum Officinal), 4 oz. Bulk
Herbal Remedies: Organic Roasted Dandelion Root Tea, Kosher, Traditional Medicinals, 16 Tea Bags
Ginger relieves dizziness and nausea.
Herbal Remedies: Ginger Supplements & Products
Ginkgo Biloba improves circulation and improves brain function by increasing the supply of oxygen to the brain. Take 120 mg of ginkgo biloba extract daily.
Herbal Remedies: Ginkgo Leaf Powder (Ginkgo Biloba), 4 oz. Bulk
Herbal Remedies: Ginkgold, Ginkgo Biloba Extract, Standardized, Nature's Way, Vegetarian, 60 mg, 150 Tabs
Backed by over 35 years of extensive research, including over 400 published scientific and clinical studies, Nature's Way Ginkgold ginkgo biloba extract has been proven to support healthy circulation to the brain as well as the extremities.
Herbal Remedies: Ginkgold MAX, Ginkgo Biloba Extract, Nature's Way, Vegetarian, 120 mg, 60 Tabs
Backed by over 35 years of extensive research, including over 400 published scientific and clinical studies, Nature's Way Ginkgold ginkgo biloba extract has been proven to support healthy circulation to the brain as well as the extremities.
Herbal Remedies: Ginkgo Biloba Extract, Standardized, Nature's Way, Vegetarian, 60 mg, 120 VCaps
Nature's Way Ginkgo biloba extract is a technically and scientifically advanced herbal extract standardized to 24% Ginkgo flavone glycosides and 6% terpene lactones, supported by whole Gotu Kola herb. Ginkgo biloba extract is the most frequently prescribed herbal extract by both doctors and pharmacists worldwide and is the best selling natural healthcare product in Europe.
Herbal Remedies: Ginkgo Supplements & Products
NUTRITIONAL SUPPLEMENTS
Unless otherwise specified, the following recommended doses are for adults over the age of 18. For a child between 12 and 17 years, reduce the dose to 3/4 the recommended dose. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended dose.
VERTIGO SUPPLEMENTS & PRODUCTS
Supplements and products for vertigo, the feeling of dizziness, lightheadedness or faintness resulting from a disturbance in balance and equilibrium. Included are supplements and products for blocked ear canals and ear infections, which may cause or contribute to vertigo.
AHCC (Active Hexose Correlated Compound), NOW Foods, Vegetarian, 500 mg, 60 VCaps
NOW Foods AHCC is a rich source of polysaccharides such as beta glucan 1,3 and activated hemicellulose produced by enzymatic modification of organic medicinal mushrooms, including shiitake.Antibiotic, Natural, Support Tincture, 100% Organic, 2 fl. oz.
Use this natural antibiotic to support the immune system.Bio Defender, Antibacterial, Antiviral, and Antifungal Formula, Balanceuticals, 56 Caps
This unique antibacterial, antiviral and antifungal formula is a clinical nutritionist response to bio terrorism such as anthrax.Blood Circulator, 100% Natural, Jingul Huayu, 450 mg, 60 Caps
This time-honored formula is used in Chinese medicine to promote micro-circulation, increase blood flow to heart muscles, open and clear arteries, inhibit intestinal adhesion, soothe the liver, remove stasis and maintain healthy blood circulation and regular menses.Cayenne Pepper Supplement, Nature's Way, 450 mg, 180 Caps
Cayenne Pepper Supplement is a blood warming herb that has an invigorating effect on several body systems.Clear Head & Neck Comfort, TCM Formula, Toufengning, 100% Natural, 60 Caps
Clear Head & Neck Comfort formula is made of snidium, angelica root, notopterygium rhizome and root, asarum, siler, wild mint, schizonepeta and licorice, herbs for headache.Colloidal Silver, Liquid Silver Homeopathic Formula, SilvaSolution Advanced Immune System Activator for Colds and Flu, 8 fl. oz.
TriMedica SilvaSolution Advanced Liquid Silver Homeopathic Formula integrates the basic principles of homeopathy and is a profound healing system designed to increase the body's ability to respond to immune challenges and restore optimal health.Colloidal Silver Pump Spray, SilvaSolution, 2 fl. oz.
Colloidal Silver Spray works great to promote throat health, as well as provide immune system support.Dandelion Tea, NOW Foods, Organic, 30 Tea Bags
NOW Foods organic Dandelion tea is warm and soothing, and acts as a blood cleanser and gentle diuretic.Earache Relief Earache Drops, Homeopathic For Children, 5 Single Use Droppers
Gentle enough for children but strong enough for adults, Earache Relief Earache Drops may be used alone or in conjunction with other OTC pain relievers or prescription antibiotics.Earache Relief Ear Drops, Homeopathic, 0.33 fl. oz.
This pharmacist-recommended Active Response Formula promptly stimulates the body's natural ability to relieve ear pain.Ear Candling Deluxe Kit
Contains everything included in the Starter Kit plus additional supplies and accessories for a more complete and effective ear candling experience.Ear Candling Mini Pack
All the basics needed for an ear candling session.Ear Candling Pillow
Ear Pillows can be treated for a more relaxing candling experience. They are shaped perfectly for an ear candling session.Ear Candling Starter Kit
Contains all the basic supplies you need for several ear candling sessions.Ear Clear Oil, 100% Organic, 2 fl. oz.
Adults and children may use this Ear Oil for ear aches, infections and for ear wax buildup.Ear Oil, All Natural Herbal Ear Drops, White Egret, 2 fl. oz.
Can be used in the ear canal to soothe the ear and prevent infection. Also used to soften ear wax.Ear Soothies For Ear Candling, 1 Pair
Slips on ears to help with ear discomfort.Ear Soothe Wellness Oil, 2 fl. oz.
This oil is formulated to address swimmer's ear, earaches, ear infections, and ringing in the ear.Echinacea Angustifolia Root Powder, 4 oz. Bulk
Echinacea is an excellent herb for all kinds of viral & bacterial infections, strengthens the immune system against pathogenic infection by stimulating phagocytosis & T-Cell formation, blood cleansing properties, acne, bronchitis, colds & flu, congestion, psoriasis, tonsillitis, wounds, ear infections and stimulates the immune system.Echinacea Herb, Nature's Way, 400 mg, 180 Caps
Echinacea herb supports the immune system and promotes general well-being in cold and flu season.Echinacea Root Tincture, 100% Organic, 2 fl. oz.
Echinacea Root is also known as Purple Coneflower and considered very valuable by North American Indians.Echinacea Tincture For Children, Orange Flavor, Alcohol Free, 100% Organic, 1 fl. oz.
ChildLife's great tasting Echinacea can provide extra support at the first sign of colds, flues, sore throats, upper respiratory symptoms, sinusitis, and ear infections. Periodic use, especially during the winter months, may increase the overall strength of your child's natural defense system.Enzyme Phytonutrient (EPN) Ionic Supplement, Fully Absorbable, 16 fl. oz.
WaterOz Ionic EPN is a pure liquid enzyme supplement. EPN complex is a patent-pending enzyme phytonutrient from a plant source that provides enzyme and saccharides necessary for optimal cellular communication. No combination of vitamins, minerals, amino acids or herbals can replace the necessary saccharides found in EPN.Feverfew Extract (Natural Headache Remedy), Standardized, Nature's Way, 325 mg, 60 Caps
Nature's Way Feverfew extract, a natural headache remedy, offers the benefits of a standardized extract and full spectrum of the whole herb.Feverfew Leaves, Nature's Way, 380 mg, 180 Caps
Feverfew leaves helps maintain normal blood vessel tone and Feverfew leaves are best used for long-term treatment and prevention of migraine headaches.First Defense Homeopathic Formula For Children, 4 fl. oz.
A complete and effective natural broad spectrum anti-infective formula available for infants and children. Completely safe and non-toxic for infants and children of all ages. A homeopathic Formula.Gentle Digest, Natural Probiotic For Pets, 60 Caps
Gentle Digest® provides human grade lactobacillus sporogenes (Lactospore®) which produce L+ form of lactic acid that promote growth of friendly bacteria to pet's digestive tract.Ginger Root Tincture, 100% Organic, 2 fl. oz.
Ginger root has also been recommended as a treatment for atherosclerosis, migraine headaches, rheumatoid arthritis, high cholesterol, burns, ulcers, depression, impotence, and liver toxicity.Ginkgo Biloba Extract, Standardized, Nature's Way, 60 mg, 120 VCaps
Nature's Way Ginkgo biloba extract is a technically and scientifically advanced herbal extract standardized to 24% Ginkgo flavone glycosides and 6% terpene lactones, supported by whole Gotu Kola herb.Gotu Kola, Nature's Way, 475 mg, 180 Caps
Gotu Kola (Centella asiatica) is used in India similar to how the Chinese use Ginseng, for longevity and vitality. Although its name is similar to cola nut, Gotu Kola does not contain caffeine.Grapefruit Seed Extract (GSE) Liquid Concentrate, 1 Gallon
Grapefruit Seed Extract may be used topically as an antiseptic wound cleaner and to treat infections of the skin. Internally, the concentrate is useful as a supportive treatment for a wide variety of ailments.Grapefruit Seed Extract Liquid Concentrate, 2 fl oz.
Used Grapefruit Seed Extract topically as an antiseptic wound cleaner and to treat infections of the skin.Grapefruit Seed Extract Liquid Concentrate, 4 fl oz.
Grapefruit Seed Extract may be used topically as an antiseptic wound cleaner and to treat infections of the skin. Internally, the concentrate is useful as a supportive treatment for a wide variety of ailments.Hyland's Earache Homeopathic Formula For Children, 40 Tabs
The medicines in Hyland's Earache Tablets have been clinically shown to reduce earache symptoms during the first 48 hours of the episode.Hyssop Throat Comforts, Natural Herb Comforts, 61 Lozenges
Throat Soothers with natural Hyssop can be used to comfort the throat while undergoing ear candling treatments.Iron Ionic Mineral Supplement, Fully Absorbable, 20 +/- ppm, 16 fl. oz.
WaterOz Ionic Iron is a pure liquid Iron supplement. Iron is called the "energy giver." It attracts oxygen and builds blood.Lucid Head, PCK Technologies / MagiHerbs, 500 mg, 60 Caps
This 100% natural herbal formula is based on Chinese decoctions proven effective to relieve, in the early stage, symptoms of nervous system and vascular disorders in the head, including pain, dizziness, blurredness, forgetfulness.Manganese Ionic Mineral Supplement, Fully Absorbable, 30 +/- ppm, 16 fl. oz.
WaterOz Ionic Manganese is a pure liquid Manganese supplement. Manganese, also called the "brain mineral," is important in the utilization of all mental facilities/functions.Mental Clarity, Promotes Memory & Intelligence, Banyan Botanicals, 90 Tabs
The herbs in Mental Clarity have traditionally been used to enhance all aspects of mental performance, including intelligence, concentration, awareness, perception and learning capacity. This effective blend sharpens the mind and is useful for those prone to forgetfulness, confusion or indecisiveness. Mental Clarity is an ideal supplement for anyone with a mentally demanding workload, students, and those experiencing loss of memory.Nature's Antiseptics Tea Tree Oil & Grapefruit Seed Extract, CJ Puotinen, Paperback
Nature's Warfare, this book covers tea tree oil and grapefruit see extract use in safely destroying viruses, bacteria, molds, yeasts and parasites that want to live in us and on us.Nutribiotic Ear Drops, With Grapefruit Seed Extract, 3 fl. oz.
NutriBiotic Ear Drops are an excellent topical treatment for ear aches, swimmer's ear and over-production of wax.Olive Leaf Extract Tincture, 100% Organic, 2 fl. oz.
Olive Leaf extract is used internally, as a laxative and disperser of acids, and is often used in enemas. Olive Leaf extract is also used in a poultice, Olive Leaf relieves pruritis and the effects of stings or burns.Otoscope, Illuminating Ear Scope With 3 Tips
The illuminating Otoscope is the finest, most affordable otoscope available. It is used to view the inside of the ear canal.Plate Guard For Ear Candling
A protective aid to shield ear candle user from any flame or debris caused during the ear candling session.Scissors, Folding For Ear Candling
Small, Folding Scissors to use for cutting a hole in the plate guard.Silver Biotics Liquid, Silver Supplement, 8 fl. oz.
Silver Biotics was tested by researchers and was found to kill every strain of bacteria that it was tested against and that these bacteria, many of which have become resistant to antibiotics, cause many human ailments.Travel or Home First Aid Kit
The Travel or Home First Aid Kit has all the internal and topical products from Nutribiotic you will need for your travel or home first aid needs.Vertigo Support Wellness Oil, Nature's Inventory, 2 fl. oz.
The essential oils in this blend can help to dramatically reduce the effects of Vertigo just by smelling these oils. Apply this oil to any area of your skin where you can smell it, sit down and relax and allow the oils to work with your body's system.Vitamin B-12 Complex Liquid, NOW Foods, 2 fl. oz.
Vitamin B-12 Helps to maintain a healthy nervous system, and helps in the prevention of pernicious anemia. Folic Acid should be taken by all females of child bearing age to help prevent neuro-tube birth defects. Folic acid is also linked to heart health.Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps
Nature's Way Vitamin C With Bioflavonoids provides antioxidant provides antioxidant protection for many of the body's important enzyme systems.Vitamin C Liquid For Baby & Children, 4 fl. oz.
Vitamin C is known as a principal anti-oxidant, the need for which is greatly increased in infants and children due to today's elevated environmental stresses and pollution.Vitamin E, Natural D-Alpha-Tocopherol, 400 IU, 100 Softgels
Vitamin E has potent antioxidant activity, supplies oxygen to the blood, aids in strengthening capillary walls, and plays a beneficial role in cancer and cardiovascular disease prevention, anti-aging benefits, circulation, wound-healing, immune function, nervous system function, PMS, hot flushes, diabetes, vascular disease, eye health, tissue repair, athletic performance, leg cramps, skin and hair health, and alleviating fatigue.Xylitol Plus Natural Sugar Substitute, NOW Foods, 20 Packets, 4.4 oz.
Xylitol Plus Natural Sugar Substitute is derived from fruit, such as strawberries, pears and plums, or trees, specifically birchwood.Zinc Lozenges With Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges
Nature's Way Zinc lozenge boosts cold season defense with zinc, widely recognized as an important nutritional support during the cold season, and echinacea pupurea, clinically shown to support the immune system, and Vitamin C, a vitally important vitamin for general health maintenance.
Herbal Remedies: Vertigo Information
Herbal Remedies: Vertigo Supplements & Products
Herbal Remedies: Ear Infection / Ear Ache Information
Herbal Remedies: Ear Infection / Ear Ache Supplements & Products
Herbal Remedies: Ear, Nose & Throat For Children Supplements & Products
Herbal Remedies: Cold / Common Cold / Head Cold, Chest Cold Supplements & Products
Herbal Remedies: Meniere's Disease Information
Herbal Remedies: Meniere's Disease Supplements & Products
Herbal Remedies: Motion Sickness Information
Herbal Remedies: Motion Sickness Supplements & Products
NOTIFY YOUR HEALTH CARE PROVIDER IF...
Any signs and symptoms of vertigo warrant an evaluation by a health care provider. The majority of cases of vertigo are harmless. Although vertigo can be debilitating, most causes are easily treated with prescription medication. Have a practitioner check any new signs and symptoms of vertigo to rule out potentially serious or life-threatening causes.
Certain signs and symptoms of vertigo may require evaluation in a hospital's emergency department:
- Double vision.
- Headache.
- Weakness.
- Difficulty speaking.
- Abnormal eye movements.
- Altered level of consciousness, not acting appropriately, or difficulty arousing.
- Difficulty walking or controlling the arms and legs.
If you have any of the following symptoms that require emergency treatment, call 9-1-1 or other emergency services immediately.
- Loss of consciousness and inability to rouse the person.
- Signs of shock in adults or children.
- Seizure (convulsion).
- Sudden, severe vertigo with nausea or vomiting and the inability to walk or stand.
- Persistent loss of function, such as:
- Partial or complete inability to move (paralysis) a part or all of one side of the body (face, arm, and leg), or persistent numbness.
- Loss of vision in one or both eyes.
- Confusion or altered behavior, such as unusual aggressive or combative behavior.
- Inability to speak, difficulty speaking, or difficulty understanding speech.
- Sudden, severe headache and is the worst headache you have ever had.
- Chest pain that is crushing or squeezing, increases in intensity, or occurs with any other symptoms of a heart attack.
- Sudden change in your normal heart rate (pulse rate less than 50 or more than 150 beats per minute). Know how to check your heart rate by taking a pulse.
- Heart palpitations with any of the following symptoms:
- Chest pain.
- Shortness of breath.
- Decreased alertness.
- Vision changes.
If you have any of the above symptoms that indicate you need emergency care, call 9-1-1 or other emergency services immediately.
RELATED INFORMATION
For a full list of available products from Mountain Rose Herbs, click on banner below:
HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
If you see a suggested Amazon product "not there" as indicated by an orange box with the Amazon logo, this only means the specific product link has been changed by Amazon.com. Use the "click here" icon on the orange box and it will bring you to Amazon.com and you can do a search for a specific product using keywords and a new list of available products and prices will show. Their product and resource links are constantly changing and being upgraded. Many times there are more than one link to a specific product. Prices will vary between product distributors so it pays to shop around and do price comparisons.
Educational materials and health products are available through Amazon.com. Use the search box provided below to search for a particular item.
HERBS, OILS, & SUPPLIES
Mountain Rose Bulk Herbs
Mountain Rose Aromatherapy Oils
Click Here To Visit Herbal Remedies Product Page
A Source For Medicinal & Ritual Herbs & Supplies
Aphrodisiacs Aromatherapy Bath & Body Care Bulk Herbs By The Pound Capsules, Tablets & Extracts Chinese Herbals Electronics Extracts First Aid Products Food Products, Mixes, Seeds, Snacks & More! Hair Care Products & Supplies Herbs & Oils, Kilo & Ton Hydroponics & Gardening Kava Products Kitchen & Housewares Mushrooms Musical Instruments Oral Care & Dental Products PC & IT - Computer Supplies & Assessories Skin Care, Cosmetics, & Gift Sets Smokes, Seeds, Cacti Spices, Salts, Sweeteners, & Seasonings Sports, Toys & Games Sweets, Candy, Chips & Snacks Stimulants Sedatives Teas & Coffees
Shaman Shop Home Page
