What is Vertigo?
Vertigo is a false sensation of movement, which occurs due to reasons like inner ear problems, problems in the vestibular system, or even problems in the brain, like stroke and infection. Symptoms may be mild, with little or no dizziness, or they may be severe and cause a disorienting episode that makes it difficult to stand, walk or do everyday things. Dizziness can come on suddenly and last from seconds to days. In severe cases, the symptoms may be constant and interfere greatly with daily living.
What are the Types of Vertigo?
Vertigo is broadly classified into two main types based on the origin of the underlying problem: the inner ear or the brain. Here is an overview of the main types:
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Peripheral Vertigo
This kind of vertigo happens when there is an issue with the inner ear or the vestibular nerve, both of which play a vital role in keeping balance. There are different types of vestibular disorders. Benign Paroxysmal Positional Vertigo ( BPPV ) is caused by certain head movements. Labyrinthitis is an inner ear inflammation. Vestibular neuritis also affects the vestibular nerve. Ménière 's disease is an inner ear disorder that may also cause hearing loss and tinnitus.
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Central Vertigo
This type of vertigo occurs due to a problem in the brain, such as an infection, stroke, or traumatic brain injury. It is more severe compared to peripheral vertigo. The patient may have considerable difficulty walking and maintaining balance. Central vertigo generally requires prompt medical attention because it stems from a brain condition.
How Common is Vertigo in India?
Vertigo is very prevalent in India, with around 70 million people experiencing it. It is most common in people aged between 55 and 64 years, with 15% to 20% of them experiencing it each year. In fact, according to a survey, around one-fourth of vertigo patients experience an attack once a month. Despite the high number of cases, the condition is often misdiagnosed or dismissed as minor discomfort in the country. The condition also puts a major burden on daily life. Many patients change their routines to manage symptoms, for example, not travelling in vehicles and reducing screen time. Misconceptions about vertigo are common; however, 21% of patients believe it only affects the elderly, and 15% mistakenly believe it is untreatable or contagious.
What Causes Vertigo?
Most cases of vertigo are caused by problems in the inner ear, but it can also be caused by conditions affecting the brain or other parts of the body. Here are some of the most common causes:
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Benign Paroxysmal Positional Vertigo (BPPV): BPPV is one of the most common causes of vertigo and occurs when small calcium particles get dislodged in the inner ear and interfere with the signals sent to the brain about movement and balance. It may come about for no apparent reason and tends to get worse with age.
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Ménière's Disease: It is an inner ear condition caused by fluid buildup and changing pressure, which can lead to episodes of vertigo, tinnitus, and hearing loss.
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Vestibular Neuritis or Labyrinthitis: This is an inner ear infection, usually from a viral infection such as chickenpox, measles, or hepatitis, leading to inflammation of the nerves that control balance.
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Migraines: In some cases, migraine headaches can also cause an episode of vertigo.
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Head or Neck Injury: Trauma to the head or neck can disrupt the systems that control balance and spatial orientation.
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Stroke or Brain Tumour: Conditions affecting the brain can interfere with the central processing of balance signals.
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Stress and Anxiety: Stress can cause dizziness and is also a risk factor for labyrinthitis, making it an indirect contributor to vertigo.
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Certain Medications: Some types of antibiotics, cardiovascular drugs, and anti-inflammatory medicines can cause ear damage. Vertigo could be the side effect of that.
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Other Causes: Additional causes include ear infections, acoustic neuroma, dehydration, low blood pressure, irregular heart rhythms, multiple sclerosis, diabetes, and abnormal bone growth in the middle ear.
What are the Complications of Vertigo?
While vertigo is not life-threatening in most cases, it can lead to complications that affect both physical safety and quality of life. These include:
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Falls and Injuries: The loss of balance associated with vertigo can increase the risk of falls, which may result in fractures or other injuries, particularly in older adults.
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Effect on Daily Life: If vertigo episodes happen often, your ability to do routine activities, go to work, or maintain an active lifestyle is impacted.
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Difficulty Driving: Vertigo can impair spatial awareness and reaction time, making driving unsafe for those experiencing episodes.
When Should I See My Healthcare Provider?
If you experience severe or frequent episodes of vertigo, it is important to see a healthcare provider, as an underlying condition may be causing the symptoms. In fact, if you experience any of the following symptoms with vertigo, you must immediately seek emergency medical help:
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Chest pain or heart palpitations
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A sudden, severe headache
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Difficulty walking or loss of coordination
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Vision changes
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Weakness in one arm or leg
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A fever above 38°C
How is Vertigo Diagnosed?
Vertigo is generally diagnosed by an ear-nose-throat (ENT) specialist or a physician based on physical examination, a review of symptoms, and a series of specialised tests.
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Physical Examination
Doctors will ask about your symptoms, like the duration of episodes, frequency, and any triggers. They will also check your inner ear and watch your eye movements to help find the cause.
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Balance and Movement Tests
Several simple physical tests may be performed to assess balance and detect problems with the inner ear or nervous system:
- Fukuda-Unterberger Test: The patient marches in place for 30 seconds with eyes closed. Leaning or turning to one side may indicate an inner ear problem.
- Romberg's Test: The patient stands still with feet together and eyes closed. Unsteadiness may point to a problem with the brain or spinal cord.
- Head Impulse Test: The doctor moves the patient's head from side to side while the patient focuses on a fixed point, helping detect problems with the balance system in the inner ear.
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Specialised Ear and Nerve Tests
- Hearing Tests: These tests assess whether there is a problem with the inner ear nerve.
- Caloric Testing: Warm or cold air is introduced into the ear to stimulate the inner ear and check for damage to the acoustic nerve.
- Electronystagmography: This test measures eye movements to evaluate how well the vestibular nerve and other inner-ear and brain nerves function.
- Vestibular Test Battery: A series of tests that check for problems specifically within the vestibular system of the inner ear.
How is Vertigo Treated?
There is no single cure for vertigo. The treatment is based on the underlying cause. Here are the main treatment options:
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Repositioning Manoeuvres: For BPPV-induced vertigo, repositioning procedures such as the Epley manoeuvre are commonly used. These are a series of specific head manoeuvres designed to move the displaced calcium crystals back to their proper place in the inner ear.
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Medicines: Doctors often give motion sickness medicines, antihistamines, steroids, antibiotics, and diuretics to treat vertigo. The main goal of the medicines is to reduce dizziness, nausea, and other symptoms.
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Vestibular Rehabilitation Therapy: This specialised form of physical therapy trains the brain and other senses to compensate for inner-ear changes. It involves exercises targeting balance, eye movement control, dizziness, and stability, tailored to each patient's specific needs.
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Surgery: Surgery is rarely required but may be recommended when vertigo is caused by a serious underlying condition such as a brain tumour, acoustic neuroma, or neck injury, particularly when other treatments have not been effective.
Can Vertigo Be Prevented?
Since vertigo can be induced by multiple underlying causes, it cannot be prevented. However, you can do some things to prevent a vertigo episode or ease its symptoms:
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If you begin to feel dizzy, always sit down immediately, rather than continuing with what you were doing.
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When picking something up off the floor, squat instead of bending at the waist.
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Sleep with your head slightly elevated on two pillows to help reduce the chances of episodes during the night.
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Have a light on if you have to get up at night to reduce disorientation.
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If you think you might fall during an episode, use a walking stick for support.
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If you have an episode, you may find relief from the spinning sensation by lying down in a dark, quiet room.
What is the Prognosis of Vertigo?
Vertigo is not a disease but a symptom of a cause. Therefore, the prognosis depends on the underlying cause and how soon and how well it is treated. The prognosis is generally better for peripheral vertigo. Central vertigo is associated with brain diseases and has a less predictable course.
Does Health Insurance Cover Vertigo?
Health insurance policies cover treatment for vertigo if they include coverage for the underlying cause and the type of treatment. If the condition requires hospitalisation for at least 24 consecutive hours, the related expenses are generally covered under a standard health insurance policy. Many insurers may also cover pre- and post-hospitalisation expenses, such as follow-up consultations, prescribed medications, and diagnostic tests, subject to policy terms and limits.
However, if vertigo is managed through home remedies, regular medications, outpatient consultations, or day-care procedures, coverage may not apply unless the policy specifically includes OPD or day-care benefits. Therefore, it is important to carefully review the policy documents to understand the inclusions, exclusions, waiting periods, and other applicable conditions.
How Much Health Insurance is Needed for Vertigo Treatment?
The cost of vertigo treatment can vary widely. While mild cases can be treated with medicines, serious underlying causes can require hospitalisation. A health insurance cover of around ₹5 to ₹10 lakh is highly recommended for sufficient financial protection against treatment expenses.
FAQs
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Q1. How to stop a vertigo attack?
Ans: To ease a vertigo attack, sit or lie down immediately in a dark, quiet room. This may help lessen the spinning feeling of a vertigo attack. It also helps if you move slowly and avoid sudden head movements. -
Q2. Can vertigo be cured completely?
Ans: Whether vertigo can be completely cured or not depends on its underlying condition. For example, positional vertigo (BPPV) or vertigo from certain medications can be completely cured. But diseases like Meniere’s cannot be cured. -
Q3. What is the cause of vertigo?
Ans: The most common causes of vertigo are inner ear problems such as BPPV, Meniere’s disease or vestibular neuritis. Other causes include brain conditions such as stroke, tumours or head injury, migraines, certain medications and other underlying health conditions.
