As kids, many of us loved spinning in circles until we collapsed on the ground, laughing as the world kept whirling around us. That kind of self-induced dizziness was fun then, a harmless game of testing our balance. But decades later, when the same spinning sensation comes uninvited, it's called vertigo, and it's not a laughing matter anymore.
Vertigo, which originated from the Latin word vertere ("to turn"), doesn't always appear as a full-blown spin. As per Harvard Health Publishing, it can also manifest as unsteadiness, lightheadedness, or the sensation of moving when you are standing still. Some people even endure nausea and vomiting alongside it. While vertigo itself is rarely life-threatening, it can provoke falls, a leading cause of injury-related deaths among adults 65 and older.
A symptom, not a condition
Vertigo isn't a diagnosis in itself, but rather a symptom signalling something deeper. That's why it's important not to dismiss it, explains Dr. James Naples, an otolaryngologist at the Beth Israel Deaconess Medical Centre Dizziness Clinic, affiliated with Harvard Medical School.
"Telling your doctor you have vertigo is like saying you have a stomachache," Dr Naples notes. "It doesn't mean you have a solution, it means you have to look for a cause."
Where vertigo begins
Many vertigo cases originate in the inner ear, which houses the body's vestibular system, regulating balance and spatial orientation. Others stem from the way the brain interprets motion.
Minor, short-lived dizziness can also result from everyday factors: dehydration, stress, fatigue, alcohol use, or hormonal changes during perimenopause. But persistent vertigo usually points to an underlying condition. The most common culprits include:
- Benign paroxysmal positional vertigo (BPPV): The leading cause in older adults, triggered when tiny crystals (canaliths) in the inner ear shift out of place, causing intense dizziness with certain head movements.
- Vestibular migraines: A migraine variant that can cause vertigo without the hallmark headache.
- Vestibular neuritis (acute labyrinthitis): Often viral in origin, this is an inflammation of the inner ear's balance apparatus.
- Ménière's disease: Characterised by vertigo, ringing in the ears, and hearing loss, this condition stems from changes in inner-ear fluid volume.
When to seek help
If vertigo occurs with sudden vision or hearing changes, speech difficulties, or numbness on one side of the body, it's an emergency. Stroke or other neurological conditions must be ruled out quickly.
Even without alarming symptoms, Dr Naples stresses that a first episode of vertigo should always prompt a doctor's visit. Physicians may check for nystagmus (involuntary eye movements) and order hearing tests or brain scans to pinpoint the cause.
Treatment approaches
The right treatment depends on the diagnosis. Strategies include:
- Medication: Helps reduce dizziness and nausea but doesn't cure the underlying condition.
- Epley manoeuvre: A head-positioning technique to move misplaced inner-ear crystals in BPPV.
- Vestibular therapy: A tailored form of physical therapy to retrain balance and manage dizziness.
- Cognitive behavioural therapy (CBT): To help cope with the emotional toll vertigo often brings.
Regardless of treatment, one of the most important takeaways is to resist becoming sedentary. "It causes more harm than good to sit and wait for the next vertigo episode," says Dr. Naples. "Simply staying active is going to help."
The bottom line
Vertigo may feel like the world is spinning out of control, but it's often manageable with proper diagnosis and treatment. If it strikes, don't shrug it off—seek medical guidance. The earlier you identify the cause, the sooner you can regain stability in your world.
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