Understanding of vertigo and its management

Understanding of vertigo and Symptoms

The word vertigo originated from the Latin word “Vertere” which means “to turn” or “whirling”. It can be described as a rotator or spinning sensation in the head, often experienced during a sudden change in posture.  Most commonly, vertigo is a result of diseases of the inner ear, but it can be a due to disturbances of the vestibular centers or pathways in central nervous system.

Risk factors or causes

Vestibular system, component of inner ear, is responsible for our sense of balancing. Hence,  inner ear diseases like benign paroxysmal positional  vertigo, Meniere’s disease, vestibular neuritis or labyrinthitis and inner ear infections  are the most common cause of vertigo. Although vertigo can be experienced in head and neck injury, stroke and migraines.


Medications and vestibular rehabilitation exercises are the base for treatment of vertigo. Vestibular suppressant medications easily alleviate the symptoms, but in case of diseases like  BPPV or stroke, utility of medications is limited. Vestibular rehabilitation exercises like Epley maneuvers recondition the brain to visual and proprioreceptive signals

Apart from the symptomatic treatment, the underlying etiology should be taken care of. As in case of ear infections like labyrinthitis etc., proper antibiotics along with vestibular suppressant should be given. In BPPV patients, vertigo improves with head rotation maneuvers like Epley. Epley maneuvers  consist of having the patient sit on the edge of a table and lie down on one side till the vertigo resolves followed by sitting up and lying down on the other side, again until the vertigo ceases. Patients suffering from meniere’s disease, need  low salt diet and medication to increase urine output is needed. Vertigo that takes place due to migraine or vertiginious migraine may respond better to migraine treatments than to other interventions. Acute vertigo caused by a cerebellar or brainstem stroke  should be treated with vestibular suppressant medication and minimal head movement should be there for the very first day. After that, medication should be tapered as soon as possible, and vestibular rehabilitation exercises should be started.

Self care

Various physical exercises can be performed by the patient at home. Epley maneuvers, Cawthorne head exercises and Brandt-Daroff Home Exercise  are some of them. Epley maneuver as described above repeatedly reposition the head. It is most effective in BPPV patients, as symptoms are due to displaced calcium crystals in inner ear. Epley maneuver moves the crystals  in a way that they either re-adhere, dissolve , broken up or move to some other place.  Brandt  daroff exercise is effective in both BPPV patients and labyrinthitis patients. Patient is seated, and then lied on one side with nose pointing up. Patient is made to stay in that position for 30 seconds or till the vertigo ceases, then move back to the seated position and then same procedure on other side. Cawthorne exercises are used to reinforce the associations between your balance mechanism and your eyes. It includes eye exercises, head exercises, sitting, standing and moving.


Acute phase of vertigo can be treated by vestibular suppressants like antihistamine-anticholinergics e.g. meclizine and benzodiazepines e.g. lorazepam and diazepam. If a middle ear infection is present, treatment medications include antiviral drugs, antibiotics and steroids. Other groups of drug used in treatment of vertigo (according to etiology) include anti-inflammatory, antimigrainous, anticonvulsant, anti-migrainous, antidepressants and antiemetics.

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