Vertigo: The dizzying disorder

Vertigo: The dizzying disorder
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First Published: Tue, Oct 13 2009. 12 03 AM IST

Illustration: Jayachandran / Mint
Illustration: Jayachandran / Mint
Updated: Tue, Oct 13 2009. 12 03 AM IST
Ever felt the world spin out of control? It happened with 30-year-old, Bangalore-based housewife Nalini Patil while she was driving. Patil swerved to hit the road divider as she fought off waves of nausea and dizziness. “It was the first time I had experienced such an attack,” she says.
She sought medical advice and after a series of tests, vertigo, brought on by anxiety and depression (Patil had suffered a loss in the family) plus a sinus infection, was diagnosed. Six months and a course of medication later, she hasn’t had a recurrence.
Anurag Shankar, a 62-year-old retired teacher in Noida, suffered her first attack of acute dizziness four years ago. “I couldn’t even move my head while lying down in bed,” she says. The episodes abated after three-four days. The cause: Vertigo due to a compression of nerves by an extra rib (which Shankar was born with). The permanent solution would be surgery, but she is wary of going under the knife and prefers to live with the infrequent attacks, keeping her prescribed medication (Vertin) handy for the dizzy spells.
Illustration: Jayachandran / Mint
Vertigo is among the most common complaints doctors encounter. It’s typically a sensation of spinning or losing balance—simply put, dizziness. And no, contrary to popular belief, it is not always associated with a fear of heights. “Around 60-70% people suffer vertigo at least once in their lifetime,” says Rakesh Agarwal, senior consultant, neurology, Indraprastha Apollo Hospital, New Delhi.
Only a symptom
Like fever, vertigo is a symptom, not a disease. Most of the underlying problems leading to it, such as high blood pressure, can be treated. But Dr Agarwal adds a note of caution, “While all cases are not serious, some are, so it’s important to get checked out.” He advises a four-step preliminary examination: MRI (magnetic resonance imaging) of the brain, X-ray of the neck, ENT (ear, nose and throat) check-up and a routine blood test.
“Typically, it (vertigo) is caused by problems in the neck, eye, ear or the central system or the brain,” says Ish Anand, vice-chairman and senior consultant, neurology, Sir Ganga Ram Hospital, New Delhi. These can range from astigmatism (cylindrical vision), high or low blood pressure and poor posture to an injury to the inner ear or brain, which disrupts the body’s balance mechanisms. More serious possibilities include a cerebral stroke or a viral infection that affects the ear.
However, once infection, injury or other underlying causes are ruled out, doctors typically zero in on a diagnosis of either Ménière’s disease or Benign Paroxysmal Positional Vertigo (BPPV). These two otherwise benign conditions are the leading causes of vertigo, with a fifth of all cases attributed to BPPV.
Both Ménière’s and BPPV result from disorders of the inner ear, which contains the body’s balance mechanism. Their causes are not known (they are not caused by injury or infection), but the disturbances affect the sense of equilibrium (which usually helps make out whether you are upright, lying down or tilted and lets you recover balance when you move). The result: You feel off-balance and get dizzy. “Ménière’s disease can also be accompanied by hearing impairment, (a) buzz in the ear,” adds Chandran Gnanamuthu, neurologist, Wockhardt Hospitals, Bangalore.
Will it go away?
“In 95% of cases (of vertigo), the dizziness can go away,” says Dr Gnanamuthu. The loss of balance rarely persists, if correctly treated. Not all cases call for pills or surgery. So delaying a visit to the doctor because it is “tolerable” can mean needless suffering.
For astigmatism, for instance, special glasses are advised; for an infection, medication may be prescribed; for cervical spondylosis, proper posture and isometric exercises are advised. Alternative therapies are also available. Raman Kapur, who runs an acupuncture clinic at Sir Ganga Ram Hospital, says, “Almost 90% of patients with cervical spondylosis-related vertigo have been successfully treated through acupuncture.”
In Bangalore, the Jindal Nature Cure Hospital has a 10-15-day detoxification and relaxation regimen for cervical spondylosis. Babina Nandkumar, joint chief medical officer, says, “Then patients are also taught asanas (vrikshasana, trikonasana) and pranayama (sheetali, nadishodhana) to control the vertigo and to train muscles in the affected part to relax.”
There are drugs for Ménière’s disease too, says Dr Gnanamuthu. In the case of BPPV, “Certain head and neck manipulations, (such as those called) Semont manoeuvre or Epley manoeuvre, done by a doctor, can alleviate this problem,” says Joy Dev Mukherji, head, neurology, Max Super Speciality Hospital, New Delhi.
Patients are also taught exercises, such as the Brandt-Daroff exercise (see below), to practise at home. Brandt-Daroff exercises are used as follow-up treatment at home, commonly prescribed to vertigo patients.
But if there is no serious underlying problem, what sufferers need most is reassurance, says Dr Gnanamuthu. This is where counselling comes in. Not just for psychological problems (such as anxiety in Patil’s case), but because losing one’s sense of balance is scary. “Typically, after an attack of vertigo, patients tend to be anxious,” says Dr Gnanamuthu. “It is important to ease the anxiety, which is why some amount of psychotherapy and relaxation techniques are needed.”
Taking precautions
Vertigo can be aggravated by awkward neck postures or jerking motions experienced when, for example, travelling or scrambling out of bed quickly. “Travelling can affect this condition,” says Dr Anand, who advises bed rest and decreased neck movements, besides medication, for intense symptoms.
For milder symptoms, simple precautions suffice. Dr Mukherji suggests people with a history of vertigo should ask their doctor for prescription medicine prior to air travel or long-distance journeys. “But such people should not drive on winding roads,” he says.
The important thing, doctors say, is not to be too anxious about vertigo or let fear of a dizzy spell restrict you from normal everyday life and the activities you enjoy. “Almost everyone has a little bit of vertigo,” says Dr Mukherji. “So it is a question of managing it.”
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Brandt-Daroff exercise
Sit on the edge of a bed or a sofa. Lean quickly to the side that causes the worst vertigo. End up lying on your side with your ear down. Remain in this position until either the vertigo goes away or 30 seconds have passed. Then sit up. If this causes vertigo, wait for it to stop before repeating the exercise on the other side. People prescribed this exercise are usually instructed to do sets of 20 repeats at least twice a day.
Expert: Ish Anand, vice-chairman and senior consultant, neurology, Sir Ganga Ram Hospital, New Delhi.
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Chitra Narayanan also contributed to this story.
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First Published: Tue, Oct 13 2009. 12 03 AM IST
More Topics: Vertigo | Health | Dizziness | Vertin | MRI |