Vertigo is classified mainly as Central Vertigo and Peripheral Vertigo.
– Central Vertigo ( is associated with disorders of the brain or cerebellum (stroke, tumour etc.)
– Peripheral Vertigo is caused by the disease of the vestibular system in the inner ear (vestibular neuritis, Meniere’s disease, antibodies etc).
Both headache and vertigo can occur together in a special type of migraine known as vestibular migraine. Another special type of vertigo which is associated with change in head position is called BPPV (Benign Positional Paroxysmal Vertigo). Its predisposing factors are head trauma, vitamin D deficiency, autoimmune disorders and osteoporosis. It is treated with CRT (a set of physical maneuvers done by experts) rather than medications. There are different maneuvers for different canal/ cupola BPPV, hence the need for expertise, experience and equipments. A wrongly performed CRT can aggravate the vertigo.
When to seek help:
One should seek urgent help if one has vertigo associated with severe nausea and vomiting, sudden onset severe vertigo, and vertigo which is associated with severe imbalance, weakness, difficulty speaking or swallowing or other neurological symptoms. The latter could indicate a serious problem like brain stroke or tumour and therefore might require urgent medical attention and timely intervention.
Making a diagnosis:
Clinical Assessment is primarily essential for diagnosis of Vertigo. Very often the doctors perform tests of the ear and balancing system of brain, using computerized testing and/or brain MRI to accurately diagnose the cause of vertigo.
Types of treatment:
Vertigo/ imbalance is most commonly treated with anti-vertigo medicines, which might hamper brain’s balancing and adaptive ability. Vestibular rehabilitation exercises should be performed under the guidance of an expert therapist to help improve the compensation by brain. In BPPV, Canalith Repositioning Therapy (CRT), physical exercise based repositioning and not medicines are the treatment.
Implications of not seeking medical help: Not seeking timely treatment may lead to increased symptoms of giddiness and imbalance, often reducing the chances of complete cure. Occasionally one might miss out a dangerous condition like brain stroke or tumor.
A 76 yr old woman was experiencing repeated spells of giddiness every 2-3 weeks, often lasting a few days at a time, for the past 3 months. During these spells, she developed spinning sensation for a few seconds to minute, especially while turning in bed or getting up from a sleeping position. She had been visiting doctors, both GPs and specialists, but no relief could be obtained despite medications and physiotherapy. She decided to visit the Headache and Vertigo clinic to seek an opinion from a specialist doctor. She was diagnosed to have a rare form of BPPV causing vertigo. She reported vertigo in the side lying position and could not be treated by routine bedside CRT maneuvers. After a series of repositioning maneuvers (Guffoni, modified Guffoni and Semont’s) under VNG guidance, she became completely free of vertigo. She could be discharged the very next day.