Vertigo
Have you ever experienced the sensation that you are spinning when in fact you’re standing still? Or perhaps you’ve felt as though the world is spinning around you? If you have, then you’ve experienced the symptom of vertigo.
Vertigo and dizziness are often confused. Dizziness is a term used to describe a range of sensations, including feeling faint, woozy, weak or unsteady. For a symptom to be considered vertigo one must experience the sensation of spinning, either themselves or the environment around them. Dizziness and vertigo often have different underlying causes, some of which are known whilst others are less clear.
Dizziness and vertigo are very common, having been shown to affect between 15-20% of adults each year. The prevalence of vertigo also rises with age and affects three times as many women as men (Neauhauser, 2016).
Those who have experienced vertigo will know that it can be very unpleasant. Vertigo is often accompanied by nausea/vomiting and a loss of balance or feeling of unsteadiness. These can have serious implications from a falls perspective, but can also provide a significant barrier to exercise or engaging in activities of daily living.
Causes of vertigo
Vertigo is a symptom which can be caused by a number of conditions. These conditions are often categorised into those stemming from peripheral or central causes.
Peripheral causes of vertigo are the most common, accounting for over 90% of diagnosed vertigo (Lui et al, 2017). Peripheral vertigo occurs as a result of a problem in the inner ear or vestibular system. The vestibular system is responsible for providing the brain information regarding spatial orientation, motion and head position with respect to gravity.
Central vertigo accounts for less than 10% of diagnosed vertigo and is caused by a problem within the central nervous system, including the brain or cranial nerves.
Peripheral vertigo: Benign Paroxysmal Positional Vertigo (BPPV)
The most common cause of peripheral vertigo is Benign Paroxysmal Positional Vertigo or BPPV. BPPV has been shown to account for over 50% of vestibular related vertigo (Figtree et al, 2021).
What causes BPPV?
The inner ear contains an organ called the vestibular labyrinth which contains three semicircular canals. These canals contain hairlike sensors and fluid which are responsible for monitoring the head's rotation. Also in the inner ear are otolith organs (the utricle and saccule). These organs contain little crystals which give the brain information regarding the head's position relative to gravity. BPPV is caused when these crystals are dislodged and enter the semicircular canals, thereby increasing one's sensitivity to change in position, resulting in a sensation of spinning. 
Picture reference: Mayo clinic (2022)
The most common symptom of BPPV is vertigo which is caused by a change in head movement. Within minutes of maintaining the new head position, the crystals will settle with respect to gravity and vertigo symptoms often diminish.
BPPV can often be treated with a positioning manoeuvre, called an Epley manoeuvre. This manoeuvre is designed to reposition these crystals back into the otolith organs. The Epley manoeuvre can be performed by a vestibular physiotherapist or trained healthcare professional.
Peripheral vertigo: other causes
Vertigo can be caused by anything else that affects either the vestibular system itself or the messaging from the vestibular system to the brain. Other common causes of peripheral vertigo include:
- Labyrinthitis or vestibular neuritis. These are inner ear infections affecting either the labyrinth or the vestibular nerve. These often result in intense, constant symptoms of vertigo which occur irrespective of head position.
- Meniere’s disease. A disease characterised by a buildup of fluid in the vestibular labyrinth. This often leads to sudden episodes of vertigo which can last for several hours.
- Traumatic head or neck injury which may have caused damage to the vestibular system.
Central vertigo
Central causes of vertigo are typically more serious than peripheral vertigo and often require urgent medical attention. Central causes include stroke, brain tumour, traumatic brain injury and multiple sclerosis.
Vertigo of a central origin is often of a more gradual onset than peripheral vertigo. Central vertigo is typically constant but with milder symptoms and is often not related to head position. Central vertigo may also be associated with loss of coordination, motor function, sensation and gait instability.
What to do?
Should your symptoms be suggestive of central vertigo then you should seek urgent medical attention.
However, often the symptoms of central and peripheral vertigo overlap. We, therefore, recommend that you seek the opinion of a healthcare professional should you experience any vertigo which affects your ability to engage in your activities of daily living. A general practitioner or vestibular physiotherapist will assist in determining the cause of your vertigo and the best course of action.
Exercising with vertigo?
Should you experience vertigo or dizzy spells, exercise is commonly one of the first things you avoid due to your symptoms. Exercise is often particularly troublesome for those who suffer from BPPV as a change in head position typically triggers the onset of symptoms.
Luckily, for many of the causes of vertigo (such as BPPV), the continuation of a regular exercise program is encouraged in conjunction with any additional treatments you may receive.
Some adjustments may need to be made to your exercises to avoid provoking your symptoms. Ultimately the appropriateness of a particular exercise should be guided by your symptoms. To avoid the onset of symptoms, here are some general recommendations:
1. Start with low intensity exercise.
If you’ve taken some time off from exercise due to vertigo or you’ve just started experiencing symptoms, often it’s wise to begin exercise at a lower intensity than previously. This may mean reducing the load or shortening your workouts by performing fewer exercises.
2. Avoid tilting your head, lying down or rapid head movement.
The particular exercises which you perform may also need to be adjusted. Exercises which involve tilting of the head, lying down or rapid head movements often exacerbate symptoms of positional vertigo.
To assist in avoiding excessive head movement when exercising try to visually focus on a stationary marker at roughly eye level. This may be a spot on the wall or a piece of exercise equipment in front of you. This should help to keep your head in the same position with respect to gravity.
3. Focus on strength and balance training
Strength and balance training are beneficial in combating the deleterious effects of vertigo and are often well tolerated with respect to bringing on symptoms.
- Balance training can help to retrain your brain against the confusing signals of vertigo as well as safeguarding against future losses of balance (vertigo related or otherwise).
- Strength training is incredibly time-effective, can be easily regressed in accordance with your symptoms or fitness levels and avoids rapid head movement. Exercises can also often be performed whilst avoiding tilting your head with respect to gravity.
References
Figtree, W., Menant, J. C., Chau, A. T., Hübner, P. P., Lord, S. R., & Migliaccio, A. A. (2021). Prevalence of Vestibular Disorders in Independent People Over 50 That Experience Dizziness. Frontiers in neurology, 12, 658053. https://doi.org/10.3389/fneur.2021.658053
Lui, F., Foris, L. A., Willner, K., & Tadi, P. (2017). Central vertigo.
Mayo Clinic (2022). Benign Paroxysmal Positional Vertigo (BPPV). https://www.mayoclinic.org/diseases-conditions/vertigo/symptoms-causes/syc-20370055
Neuhauser H. K. (2016). The epidemiology of dizziness and vertigo. Handbook of clinical neurology, 137, 67–82. https://doi.org/10.1016/B978-0-444-63437-5.00005-4
