Coping with recurring vertigo

Attacks of vertigo can be terrifying, temporarily disabling, and dangerous — increasing the risk of falls and injuries. An attack feels like the world is spinning around you or moving in some way. "It could feel like you are rocking on the deck of a ship, bouncing on a pogo stick, or standing in an elevator that drops a few inches," says Dr. Steven Rauch, medical director of the Balance and Vestibular Center at Harvard-affiliated Massachusetts Eye and Ear.

Vertigo flare-ups can last anywhere from minutes to months, depending on the cause. For many people, attacks of vertigo recur periodically. Fortunately, there are ways to end an episode and reduce suffering, and you may be able to prevent vertigo from coming back.

Why it happens

Recurring vertigo usually is caused by a disorder involving the vestibular (balance) system, which includes several tiny, fluid-filled canals — called the semicircular canals — inside your ears. There are several vestibular disorders.

Benign paroxysmal positional vertigo (BPPV). In this condition, tiny crystals in the inner ear can become dislodged when you do a particular movement, such as putting your head back to use eye drops. The loose crystals then bump around inside the semicircular canals, which normally help the brain sense the position and movement of the head. The loose crystals send confusing signals to the balance center in the brain. "The first day an episode hits, you may be woozy and dizzy all day long," Dr. Rauch says. "Then, within 48 hours, vertigo happens only when you change your position — lie down, sit up, roll over, or move your head up or down. Once you stay in a new position, the crystals land in one place, and the vertigo stops."

Cervical vertigo. Some types of vertigo occur because of problems in the neck (the cervical part of the spine). "Your neck muscles are part of your balance system. They send information to the brain about your alignment and movement," Dr. Rauch says. "Certain problems, such as neck arthritis or a whiplash injury, can affect communication between the neck and brain, and send abnormal signals that create the illusion of motion."

Movements that trigger cervical vertigo are unpredictable. "One time it might happen because you turn your head to the right. The next time it might happen because you look down to the left," Dr. Rauch says.

Meniere's disease. In this condition, another small canal inside the ear becomes swollen, for uncertain reasons. It causes not only attacks of vertigo but also nausea, a sensation of fullness or ringing in the ear, and hearing loss. The attacks typically last longer than the vertigo of BPPV. "The attacks come out of the blue and last anywhere from 20 minutes to 12 hours," Dr. Rauch says.

Vestibular migraine. When you think of migraines, you think of headaches. But pain is just one aspect of migraines. Migraines disturb the way the brain processes sensory information, causing sensitivity to light, touch, sounds, or smells. "And it turns out that about 30% of people with migraines get dizzy spells. We call that vestibular migraine. It doesn't always come with headaches, especially in women who've gone through menopause," Dr. Rauch says. "If every time you get dizzy you also can't stand bright light, or sound is unbearable, that's a migraine."

Treatment

Although it's relatively common to feel momentarily dizzy or unbalanced, sudden attacks of vertigo — where the world around you is moving or spinning — are much less common. When you experience true vertigo for the first time, take it as a warning. If it comes on suddenly and is accompanied by sudden difficulty with speech, weakness on one side of the body, or confusion, go to the emergency room to get checked for a stroke.

Otherwise, see your doctor to rule out temporary causes of vertigo, such as a medication side effect. If vertigo persists, you may need to see an ear, nose, and throat doctor, who can determine if a balance-related disorder is to blame. Getting a vestibular disorder under control with medication may be the first step in treatment.

Physical therapy

Physical therapy tailored for balance disorders is another helpful aspect of treatment. "We teach you to feel comfortable with movement," says Kathy Joy, a Massachusetts Eye and Ear physical therapist. "A typical program can include relaxation and breathing techniques, so you don't panic when vertigo starts; exercises to help you feel more grounded in movement, such as tai chi, in which you slowly shift weight from one side of your body to the other; and soft tissue release — a form of massage — on tight areas in the neck."

The therapist might also show you exercises to retrain the ear to tolerate head movements. Here's one example: "Stand up straight, feel your feet on the ground, and practice slowly turning your head to each side for a few seconds," Joy says. "Repeat this five to 10 times."

Maneuvers for BPPV

When BPPV strikes, a simple maneuver to reposition loose crystals in the ear can reduce or eliminate symptoms. "There are a number of different types of maneuvers, and each one includes a series of positions done while sitting or lying down," Joy says. "Of all of them, the Epley maneuver is the gold standard. Your doctor may give you a diagram to try it at home. But be careful. If you don't do it correctly, the loose crystals may wind up in the wrong place and worsen vertigo. It's best to have a clinician or physical therapist guide you through it the first time."

Once you're comfortable with the maneuver, you can try it at home (if your doctor says it's safe) at the first sign of vertigo. It might be helpful to watch a video about it for guidance (there are many on YouTube). Just make sure the expert in the video is a credentialed physical therapist.

It also helps to avoid positions that trigger BPPV flare-ups, such as yoga positions that turn you upside down or put you flat on your back.

These approaches and others aren't a guarantee that vertigo won't return. "But they may help you avoid an episode," Joy says. "And they'll help restore your equilibrium so you can get back to doing the things you love."

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