Benign Paroxysmal Positional Vertigo (BPPV)
Benign Positional Paroxysmal Vertigo is the most diagnosed cause of peripheral vertigo in Brisbane, making up between 17-42% of all vertigo cases. It is characterised by periods of vertigo and dizziness, brought on by head movements. The severe nature of the symptoms, and the ease of which they are brought on, makes it a very debilitating condition for sufferers.
Physical tests and a subjective history are generally all that is needed in order to identify BPPV as the cause of your vertigo. These tests are designed to assess structures in the inner-ear, which, along with the vestibular nerve, is known to be the underlying cause and mechanism of BPPV. This differs from other types of vertigo such as central vertigo, which is due to a dysfunction in the central nervous system.
In cases where these tests are unable to identify the true cause, or if conventional BPPV vertigo treatment isn’t effective, there is another option to treating vertigo.
Hypertension Headache
Headache is a commonly described symptom of hypertension, or high blood pressure, but the link between the two has not been accurately established. GP guidelines still encourage a headache history to be used as an assessment tool for hypertension, even though it has only been confirmed that headaches are commonly present in patients who reach ‘hypertensive crisis’ (Assarzadegan, Asadollahi, Hesami, Aryani, Mansouri, & Beladi moghadam, 2013).
Blood pressure readings of 140-160/90-99 mmHg indicate a diagnosis of ‘mild hypertension’ and there has been a reported link to headache symptoms in this population (Hannson, Smith, & Reeves, 2000). 10% of the Brisbane population have hypertension, with more prevalence in people aged over 75 (Statistics, 2018).
Vertigo Cervical Headache
Vertigo Cervical Headaches, commonly known as Vestibular Migraine headaches, are often overlooked as a cause of dizziness, loss of balance and vertigo. Patients who experience these symptoms are often mis-diagnosed with BPPV, however when treatment is ineffective, Vertigo Cervical Headache is a likely diagnosis. As well as dizziness and vertigo symptoms, patients may experience the classic migraine symptoms.
Soreness or stiffness in the neck is commonly described by patients and can be an indicator of more severe vertigo symptoms. Vestibular migraine attacks are often triggered by changes in visual inputs, like; bright lights, flickering lights, or visual disturbances.
As opposed to the secondary causes of vertigo symptoms, like BPPV or Meniere’s disease, vertigo cervical headaches are thought to be caused by sensitivities in the brainstem.
Vestibular Migraine Treatment
Treatment for vestibular migraines can involve lifestyle changes, medications for acute attacks, and preventive therapy. Lifestyle adjustments include avoiding triggers like stress and certain foods. Medications such as triptans and anti-nausea drugs can be prescribed to relieve symptoms during attacks. Preventive medications like beta-blockers or antidepressants may be prescribed for frequent migraines.
Vestibular physiotherapy, with exercises tailored by a vestibular physiotherapist, can improve balance and reduce dizziness. Cognitive behavioural therapy may help manage stress while alternative therapies like acupuncture may also provide relief. Working closely with healthcare providers is crucial to tailor treatment and improve quality of life.
What Triggers Vertigo Attacks?
Vertigo attacks can be triggered by various factors, depending on the underlying cause of the vertigo. Some common triggers for vertigo attacks include:
Changes in Position:
Certain head movements, such as looking up, bending over, or rolling over in bed, can trigger vertigo attacks, especially in cases of benign paroxysmal positional vertigo (BPPV).
Stress and Anxiety:
Emotional stress and anxiety can exacerbate symptoms of vertigo or trigger vertigo attacks in some individuals. Stress management techniques may help reduce the frequency and severity of attacks.
Motion:
Activities such as riding in a car, flying, or being on a boat can trigger vertigo attacks, particularly in individuals with motion sickness or vestibular disorders.
Fatigue and Lack of Sleep:
Fatigue and inadequate sleep can worsen symptoms of vertigo and increase the likelihood of experiencing vertigo attacks.
Certain Medications:
Some medications, including certain antibiotics, anticonvulsants, sedatives, and antidepressants, may have side effects that can trigger or worsen vertigo.
Dehydration:
Dehydration can affect the balance of fluids and electrolytes in the inner ear, leading to vertigo attacks. Staying hydrated is important, especially in hot weather or during physical activity.
Caffeine and Alcohol:
Excessive consumption of caffeine or alcohol can disrupt the vestibular system and trigger vertigo attacks in some individuals.
Meniere’s Disease Triggers:
For individuals with Meniere’s disease, specific triggers such as dietary factors (e.g. high salt intake), stress, changes in weather or barometric pressure, and exposure to loud noises may precipitate vertigo attacks.
Inner Ear Infections:
Infections of the inner ear, such as labyrinthitis or vestibular neuritis, can cause vertigo attacks, often accompanied by symptoms such as ear pain, hearing loss, or tinnitus.
Migraines:
Vertigo attacks can be a symptom of vestibular migraine – a type of migraine headache that affects the vestibular system. Certain migraine triggers such as stress, hormonal changes, or specific foods may provoke vertigo attacks in susceptible individuals.
It’s important for sufferers of vertigo attacks to identify and avoid their specific triggers whenever possible and to seek medical evaluation and management to address the underlying cause of their vertigo.
