Vertigo

Vertigo is classified into either peripheral or central depending on the location of the dysfunction of the vestibular pathway,{{cite journal|last1=Wippold 2nd|first1=FJ|last2=Turski|first2=PA|title=Vertigo and hearing loss|journal=American Journal of Neuroradiology|year=2009|volume=30|issue=8|pages=1623–1625|pmid=19749077|pmc=7051589|url=http://www.ajnr.org/content/30/8/1623.long|url-status=live|archive-url=https://web.archive.org/web/20130205084120/http://www.ajnr.org/content/30/8/1623.long|archive-date=2013-02-05}} although it can also be caused by psychological factors.{{cite web|url=http://www.dartmouth.edu/~dons/part_2/chapter_14.html#chpt_14_evaluation|title=Chapter 14: Evaluation of the Dizzy Patient|access-date=2009-08-06|url-status=live|archive-url=https://web.archive.org/web/20090706143716/http://www.dartmouth.edu/~dons/part_2/chapter_14.html#chpt_14_evaluation|archive-date=2009-07-06}}

Vertigo can also be classified into objective, subjective, and pseudovertigo. Objective vertigo describes when the person has the sensation that stationary objects in the environment are moving.{{cite book|title=The Merck manual of diagnostics and therapy|year=1992|publisher=Merck & Co Inc.|location=Rahway|pages=2844|editor=Berkow R.}} Subjective vertigo refers to when the person feels as if they are moving. The third type is known as pseudovertigo, an intensive sensation of rotation inside the person's head. While this classification appears in textbooks, it is unclear what relation it has to the pathophysiology or treatment of vertigo.{{cite book|last=Ropper|first=AH|title=Adams and Victor's Principles of Neurology|year=2014|location=NY, Chicago, San Francisco|pages=303|edition=tenth|author2=Brown RH }}

Vertigo that is caused by problems with the inner ear or vestibular system, which is composed of the semicircular canals, the vestibule (utricle and saccule), and the vestibular nerve is called "peripheral", "otologic", or "vestibular" vertigo.{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/001432.htm |title=Vertigo-associated disorders |author=U.S. National Library of Medicine |year=2011 |publisher=National Institutes of Health |access-date=2 January 2013 |url-status=live |archive-url=https://web.archive.org/web/20130125053802/http://www.nlm.nih.gov/medlineplus/ency/article/001432.htm |archive-date=25 January 2013 }}{{cite journal|last=Karatas|first=M|title=Central Vertigo and Dizziness|journal=The Neurologist|year=2008|volume=14|issue=6|pages=355–364|doi=10.1097/NRL.0b013e31817533a3|pmid=19008741|s2cid=21444226}} The most common cause is benign paroxysmal positional vertigo (BPPV), which accounts for 32% of all peripheral vertigo. Other causes include Ménière's disease (12%), superior canal dehiscence syndrome, vestibular neuritis, vestibular paroxysmia, and visual vertigo.{{cite journal|title=Visual vertigo: symptom assessment, spatial orientation and postural control|journal=Brain|volume=124|issue=8|pages=1646–1656|year=2001|doi=10.1093/brain/124.8.1646|last1=Guerraz|first1=M.|pmid=11459755|last2=Yardley|first2=L|last3=Bertholon|first3=P|last4=Pollak|first4=L|last5=Rudge|first5=P|last6=Gresty|first6=MA|last7=Bronstein|first7=AM|doi-access=free}} Any cause of inflammation such as common cold, influenza, and bacterial infections may cause transient vertigo if it involves the inner ear, as may chemical insults (e.g., aminoglycosides){{cite journal|last1=Xie|first1=J|last2=Talaska|first2=AE|last3=Schacht|first3=J|title=New developments in aminoglycoside therapy and ototoxicity|journal=Hearing Research |year=2011|volume=281|issue=1–2|pages=28–37|pmid=21640178|doi=10.1016/j.heares.2011.05.008|pmc=3169717}} or physical trauma (e.g., skull fractures). Motion sickness is sometimes classified as a cause of peripheral vertigo.{{citation needed|date=April 2022}}

People with peripheral vertigo typically present with mild to moderate imbalance, nausea, vomiting, hearing loss, tinnitus, fullness, and pain in the ear. In addition, lesions of the internal auditory canal may be associated with facial weakness on the same side. Due to a rapid compensation{{Clarify|date=March 2019}} process, acute vertigo as a result of a peripheral lesion tends to improve in a short period of time (days to weeks).

Vertigo that arises from injury to the balance centers of the central nervous system (CNS), often from a lesion in the brainstem or cerebellum, is called "central" vertigo and is generally associated with less prominent movement illusion and nausea than vertigo of peripheral origin.{{cite journal|last=Dieterich|first=Marianne|title=Central vestibular disorders|journal=Journal of Neurology|year=2007|volume=254|pages=559–568|doi=10.1007/s00415-006-0340-7|issue=5|pmid=17417688|s2cid=22647113}} Central vertigo may have accompanying neurologic deficits (such as slurred speech and double vision), and pathologic nystagmus (which is pure vertical/torsional). Central pathology can cause disequilibrium, which is the sensation of being off balance. The balance disorder associated with central lesions causing vertigo is often so severe that many people are unable to stand or walk.

A number of conditions that involve the central nervous system may lead to vertigo including: lesions caused by infarctions or hemorrhage, tumors present in the cerebellopontine angle such as a vestibular schwannoma or cerebellar tumors, epilepsy,{{cite journal|last1=Taylor|first1=J|last2=Goodkin|first2=HP|title=Dizziness and vertigo in the adolescent|journal=Otolaryngologic Clinics of North America|year=2011|volume=44|issue=2|pages=309–321|pmid=21474006|doi=10.1016/j.otc.2011.01.004}} cervical spine disorders such as cervical spondylosis, degenerative ataxia disorders, migraine headaches, lateral medullary syndrome, Chiari malformation, multiple sclerosis, parkinsonism, as well as cerebral dysfunction. Central vertigo may not improve or may do so more slowly than vertigo caused by disturbance to peripheral structures. Alcohol can result in positional alcohol nystagmus (PAN).

Vertigo is a sensation of spinning while stationary.{{cite web |url=http://www.merck.com/mmhe/sec06/ch080/ch080c.html |title=Vertigo: Dizziness and Vertigo: Merck Manual Home Edition |url-status=live |archive-url=https://web.archive.org/web/20100213014133/http://www.merck.com/mmhe/sec06/ch080/ch080c.html |archive-date=2010-02-13 }} It is commonly associated with nausea or vomiting, unsteadiness (postural instability),{{cite journal | last1=Jahn |first1=K|last2=Dieterich|first2=M| title=Recent advances in the diagnosis and treatment of balance disorders| journal=Journal of Neurology |volume=258 |issue=12 |pages=2305–2308|date=December 2011|pmid=22037955|doi=10.1007/s00415-011-6286-4|s2cid=22123074}} falls,{{cite journal | last1=Vieira |first1=ER|last2=Freund-Heritage|first2=R|last3=Da Costa|first3=BR| title=Risk factors for geriatric patient falls in rehabilitation hospital settings: a systematic review| journal=Clinical Rehabilitation |volume=25 |issue=9 |pages=788–799|date=September 2011|pmid=21504956|doi=10.1177/0269215511400639|s2cid=22180203}} changes to a person's thoughts, and difficulties in walking.{{cite journal|last1=Ricci|first1=NA|last2=Aratani|first2=MC|last3=Doná|first3=F|last4=MacEdo|first4=C|last5=Caovilla|first5=HH|last6=Ganança|first6=FF|title=A systematic review about the effects of the vestibular rehabilitation of middle-age and older adults|journal=Revista Brasileira de Fisioterapia|volume=14|issue=5|pages=361–371|year=2010|pmid=21180862|doi=10.1590/S1413-35552010000500003|doi-access=free}} Recurrent episodes in those with vertigo are common and frequently impair the quality of life. Blurred vision, difficulty in speaking, a lowered level of consciousness, and hearing loss may also occur. The signs and symptoms of vertigo can present as a persistent (insidious) onset or an episodic (sudden) onset.{{cite journal | last1= Strupp|first1=M|last2=Thurtell|first2=MJ|last3=Shaikh|first3=AG|last4=Brandt|first4=T|last5=Zee|first5=DS|last6=Leigh|first6=RJ| title=Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus| journal=Journal of Neurology |volume= 258 |issue=7 |pages=1207–1222|date=July 2011|pmid=21461686|doi=10.1007/s00415-011-5999-8 | pmc= 3132281 }}

Persistent onset vertigo is characterized by symptoms lasting for longer than one day and is caused by degenerative changes that affect balance as people age. Nerve conduction slows with aging, and a decreased vibratory sensation is common as a result.{{cite journal | last1= Kaneko|first1=A|last2=Asai|first2=N|last3=Kanda|first3=T|title=The influence of age on pressure perception of static and moving two-point discrimination in normal subjects| journal=Journal of Hand Therapy|volume= 18 |issue=4 |pages=421–424|year= 2005 |pmid=16271689 |doi=10.1197/j.jht.2005.09.010}} Additionally, there is a degeneration of the ampulla and otolith organs with an increase in age.{{cite journal | last1= Kutz|first1=JW Jr.| title=The dizzy patient| journal=Medical Clinics of North America |volume= 94 |issue=5 |pages=989–1002|date=September 2010|pmid=20736108|doi=10.1016/j.mcna.2010.05.011}} Persistent onset is commonly paired with central vertigo signs and symptoms.

The characteristics of an episodic onset vertigo are indicated by symptoms lasting for a smaller, more memorable amount of time, typically lasting for only seconds to minutes.

A large meta-analysis of genome-wide association study (GWAS) associated six genes with vertigo and implicated the proteins they encode in the biology of the inner ear .{{Cite journal|last=Skuladottir|first=Astros Th|date=2021-10-07|title=A genome-wide meta-analysis uncovers six sequence variants conferring risk of vertigo|journal=Communications Biology|volume=4|issue=1|page=1148|doi=10.1038/s42003-021-02673-2|pmid=34620984|pmc=8497462|bibcode=2021NatCB...4.1148S|language=en}}

The neurochemistry of vertigo includes six primary neurotransmitters that have been identified between the three-neuron arc{{cite journal|last1=Angelaki|first1=DE|title=Eyes on target: what neurons must do for the vestibuloocular reflex during linear motion|journal=Journal of Neurophysiology|volume=92|issue=1|pages=20–35|date=July 2004|pmid=15212435|doi=10.1152/jn.00047.2004|s2cid=15755814}} that drives the vestibulo-ocular reflex (VOR). Glutamate maintains the resting discharge of the central vestibular neurons and may modulate synaptic transmission in all three neurons of the VOR arc. Acetylcholine appears to function as an excitatory neurotransmitter in both the peripheral and central synapses. Gamma-Aminobutyric acid (GABA) is thought to be inhibitory for the commissures of the medial vestibular nucleus, the connections among the cerebellar Purkinje cells, the lateral vestibular nucleus, and the vertical VOR.

Three other neurotransmitters work centrally. Dopamine may accelerate vestibular compensation. Norepinephrine modulates the intensity of central reactions to vestibular stimulation and facilitates compensation. Histamine is present only centrally, but its role is unclear. Dopamine, histamine, serotonin, and acetylcholine are neurotransmitters thought to produce vomiting. It is known that centrally acting antihistamines modulate the symptoms of acute symptomatic vertigo.{{cite journal|url=http://www.racgp.org.au/afpbackissues/2008/200806/200806kuo.pdf|last1=Kuo|first1=CH|last2=Pang|first2=L|last3=Chang|first3=R|title=Vertigo-part 2-management in general practice|journal=Australian Family Physician|volume=37|issue=6|pages=409–413|date=June 2008|pmid=18523693|url-status=live|archive-url=https://web.archive.org/web/20131019153639/http://www.racgp.org.au/afpbackissues/2008/200806/200806kuo.pdf|archive-date=2013-10-19}}

Tests for vertigo often attempt to elicit nystagmus and to differentiate vertigo from other causes of dizziness such as presyncope, hyperventilation syndrome, disequilibrium, or psychiatric causes of lightheadedness. Tests of vestibular system (balance) function include electronystagmography (ENG), Dix-Hallpike maneuver, rotation tests, head-thrust test, caloric reflex test,{{cite web|url=http://www.bcm.edu/oto/studs/vertigo.html |title=Core Curriculum: Inner Ear Disease —Vertigo |publisher=Baylor College of Medicine |date=23 January 2006|access-date=19 September 2007|archive-url =https://web.archive.org/web/20070630173414/http://www.bcm.edu/oto/studs/vertigo.html |archive-date = 2007-06-30}} and computerized dynamic posturography (CDP).{{cite web |url=http://vestibular.org/understanding-vestibular-disorder/diagnosis |title=Diagnosis: How are vestibular disorders diagnosed? |year=2013 |publisher=Vestibular Disorders Association |access-date=9 January 2013 |url-status=live |archive-url=https://web.archive.org/web/20130122002724/http://vestibular.org/understanding-vestibular-disorder/diagnosis |archive-date=22 January 2013 }}

The HINTS test, which is a combination of three physical examination tests that may be performed by physicians at the bedside, has been deemed helpful in differentiating between central and peripheral causes of vertigo.{{Cite web|url=https://collections.lib.utah.edu/ark:/87278/s6zs6jsb|title=Demonstration of HINTS examination in a normal subject|last=Gold|first=Daniel|website=Neuro-Ophthalmology Virtual Education Library (NOVEL): Daniel Gold Collection. Spencer S. Eccles Health Sciences Library.|access-date=20 November 2019}} The HINTS test involves the horizontal head impulse test, observation of nystagmus on primary gaze, and the test of skew.{{Cite journal|title = Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome|journal = Canadian Medical Association Journal|date = 2011-06-14|issn = 0820-3946|pmc = 3114934|pmid = 21576300|pages = E571–E592|volume = 183|issue = 9|doi = 10.1503/cmaj.100174|first1 = Alexander A.|last1 = Tarnutzer|first2 = Aaron L.|last2 = Berkowitz|first3 = Karen A.|last3 = Robinson|first4 = Yu-Hsiang|last4 = Hsieh|first5 = David E.|last5 = Newman-Toker}} CT scans or MRIs are sometimes used by physicians when diagnosing vertigo.

Tests of auditory system (hearing) function include pure tone audiometry, speech audiometry, acoustic reflex, electrocochleography (ECoG), otoacoustic emissions (OAE), and the auditory brainstem response test.

A number of specific conditions can cause vertigo. In the elderly, however, the condition is often multifactorial.

A recent history of underwater diving can indicate a possibility of barotrauma or decompression sickness involvement, but does not exclude all other possibilities. The dive profile (which is frequently recorded by dive computer) can be useful to assess a probability for decompression sickness, which can be confirmed by therapeutic recompression.{{cite journal|last1=Nachum|first1=Z|last2=Shupak|first2=A|last3=Spitzer|first3=O|last4=Sharoni|first4=Z|last5=Doweck|first5=I|last6=Gordon|first6=C.R.|title=Inner ear decompression sickness in sport compressed-air diving.|journal=The Laryngoscope|date=May 2001|volume=111|issue=5|pages=851–6|doi=10.1097/00005537-200105000-00018|pmid=11359165|s2cid=3143075}}

Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder and occurs when loose calcium carbonate debris has broken off of the otoconial membrane and enters a semicircular canal thereby creating the sensation of motion. People with BPPV may experience brief periods of vertigo, usually under a minute, which occur with change in the position.{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/001420.htm |title=Benign positional vertigo |author=MedlinePlus |year=2011 |publisher=U.S. National Institutes of Health |access-date=2 January 2013 |url-status=live |archive-url=https://web.archive.org/web/20130125002721/http://www.nlm.nih.gov/medlineplus/ency/article/001420.htm |archive-date=25 January 2013 }}

This is the most common cause of vertigo. It occurs in 0.6% of the population yearly with 10% having an attack during their lifetime. It is believed to be due to a mechanical malfunction of the inner ear. BPPV may be diagnosed with the Dix-Hallpike test and can be effectively treated with repositioning movements such as the Epley maneuver.{{cite journal|last1=Alvarenga|first1=GA|last2=Barbosa|first2=MA|last3=Porto|first3=CC|title=Benign paroxysmal positional vertigo without nystagmus: diagnosis and treatment|journal=Brazilian Journal of Otorhinolaryngology|year=2011|volume=77|issue=6|pages=799–804|pmid=22183288|doi=10.1590/S1808-86942011000600018|pmc=9443834 |doi-access=free}}{{cite journal|url=http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=13153812&pident_usuario=0&pcontactid=&pident_revista=495&ty=150&accion=L&origen=elsevier&web=www.elsevier.es&lan=en&fichero=295v25n05a13153812pdf001_2.pdf|last1=Prim-Espada|first1=MP|last2=De Diego-Sastre|first2=JI|last3=Pérez-Fernández|first3=E|title=[Meta-analysis on the efficacy of Epley's manoeuvre in benign paroxysmal positional vertigo]|journal=Neurologia|volume=25|issue=5|pages=295–299|date=June 2010|pmid=20643039|doi=10.1016/j.nrl.2010.01.004|url-status=live|archive-url=https://web.archive.org/web/20130219194204/http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=13153812&pident_usuario=0&pcontactid=&pident_revista=495&ty=150&accion=L&origen=elsevier&web=www.elsevier.es&lan=en&fichero=295v25n05a13153812pdf001_2.pdf|archive-date=2013-02-19|doi-access=free}}

{{Further|Ménière's disease}}

Ménière's disease is an inner ear disorder of unknown origin, but is thought to be caused by an increase in the amount of endolymphatic fluid present in the inner ear (endolymphatic hydrops). However, this idea has not been directly confirmed with histopathologic studies, but electrophysiologic studies have been suggestive of this mechanism. Ménière's disease frequently presents with recurrent, spontaneous attacks of severe vertigo in combination with ringing in the ears (tinnitus), a feeling of pressure or fullness in the ear (aural fullness), severe nausea or vomiting, imbalance, and hearing loss.{{cite journal| last1= Semaan|first1=MT|last2=Megerian|first2=CA|title=Ménière's disease: a challenging and relentless disorder| journal=Otolaryngologic Clinics of North America |volume= 44 |issue=2 |pages=383–403|date=April 2011|pmid=21474013|doi=10.1016/j.otc.2011.01.010}} As the disease worsens, hearing loss will progress.

Vestibular neuritis presents with severe vertigo with associated nausea, vomiting, and generalized imbalance and is believed to be caused by a viral infection of the inner ear, although several theories have been put forward and the cause remains uncertain.{{cite journal| last1=Goddard |first1=JC|last2=Fayad|first2=JN| title=Vestibular Neuritis| journal=Otolaryngologic Clinics of North America |volume=44 |issue=2 |pages=361–365|year=2011 |pmid=21474010|doi=10.1016/j.otc.2011.01.007|s2cid=36332043 }} Individuals with vestibular neuritis do not typically have auditory symptoms, but may experience a sensation of aural fullness or tinnitus. Persisting balance problems may remain in 30% of people affected.

Vestibular migraine is the association of vertigo and migraines and is one of the most common causes of recurrent, spontaneous episodes of vertigo. The cause of vestibular migraines is currently unclear;{{Cite web|last=Kramer, MD|first=Jeffrey|title=Vestibular Migraine|url=https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/vestibular-migraine/|website=Vestibular Disorders Association}} however, one hypothesized cause is that the stimulation of the trigeminal nerve leads to nystagmus in individuals with migraines. Approximately 40% of all migraine patients will have an accompanying vestibular syndrome, such as vertigo, dizziness, or disruption of the balance system.

Other suggested causes of vestibular migraines include the following: unilateral neuronal instability of the vestibular nerve, idiopathic asymmetric activation of the vestibular nuclei in the brainstem, and vasospasm of the blood vessels supplying the labyrinth or central vestibular pathways resulting in ischemia to these structures. Vestibular migraines are estimated to affect 1–3% of the general population and may affect 10% of people with migraine . Additionally, vestibular migraines tend to occur more often in women and rarely affect individuals after the sixth decade of life.

Motion sickness is common and is related to vestibular migraine. It is nausea and vomiting in response to motion and is typically worse if the journey is on a winding road or involves many stops and starts, or if the person is reading in a moving car. It is caused by a mismatch between visual input and vestibular sensation. For example, the person is reading a book that is stationary in relation to the body, but the vestibular system senses that the car, and thus the body, is moving.

{{Main|Alternobaric vertigo}}

Alternobaric vertigo is caused by a pressure difference between the middle ear cavities, usually due to blockage or partial blockage of one eustachian tube, usually when flying or diving underwater. It is most pronounced when the diver is in the vertical position; the spinning is toward the ear with the higher pressure and tends to develop when the pressures differ by 60 cm of water or more.{{cite book | last = Powell | first = Mark | year = 2008 | title = Deco for Divers | publisher = Aquapress | location = Southend-on-Sea | isbn = 978-1-905492-07-7 |page=70 }}{{cite journal |last=Ross |first=HE |title=The direction of apparent movement during transient pressure vertigo |journal=Undersea Biomedical Research |volume=3 |issue=4 |pages=403–10 |date=December 1976 |pmid=10897867 |url=http://archive.rubicon-foundation.org/2442 |access-date=2 June 2017 |url-status=usurped |archive-url=https://web.archive.org/web/20100709042055/http://archive.rubicon-foundation.org/2442 |archive-date=9 July 2010 }}

{{Further|Decompression sickness}}

Vertigo is recorded as a symptom of decompression sickness in 5.3% of cases by the U.S. Navy as reported by Powell, 2008 including isobaric decompression sickness.

Decompression sickness can also be caused at a constant ambient pressure when switching between gas mixtures containing different proportions of different inert gases. This is known as isobaric counterdiffusion, and presents a problem for very deep dives.{{cite book | last1 = Hamilton | first1 = Robert W | last2 = Thalmann | first2 = Edward D | author2-link = Edward D. Thalmann | year = 2003 | chapter = 10.2: Decompression Practice | editor1-last = Brubakk | editor1-first = Alf O | editor2-last = Neuman | editor2-first = Tom S | title = Bennett and Elliott's physiology and medicine of diving | edition = 5th Revised | publisher = Saunders | location = United States | oclc = 51607923 | isbn = 978-0-7020-2571-6 |page=477 }} For example, after using a very helium-rich trimix at the deepest part of the dive, a diver will switch to mixtures containing progressively less helium and more oxygen and nitrogen during the ascent. Nitrogen diffuses into tissues 2.65 times slower than helium, but is about 4.5 times more soluble. Switching between gas mixtures that have very different fractions of nitrogen and helium can result in "fast" tissues (those tissues that have a good blood supply) increasing their total inert gas loading. This is often found to provoke inner ear decompression sickness, as the ear seems particularly sensitive to this effect.{{cite web | last = Burton | first = Steve | title = Isobaric Counter Diffusion | publisher = ScubaEngineer | date = December 2004 | url = http://www.scubaengineer.com/isobaric_counter_diffusion.htm | access-date = 10 January 2010 | url-status = live | archive-url = https://web.archive.org/web/20090310021040/http://www.scubaengineer.com/isobaric_counter_diffusion.htm | archive-date = 10 March 2009 }}

A stroke (either ischemic or hemorrhagic) involving the posterior fossa is a cause of central vertigo. Risk factors for a stroke as a cause of vertigo include increasing age and known vascular risk factors. Presentation may more often involve headache or neck pain, additionally, those who have had multiple episodes of dizziness in the months leading up to presentation are suggestive of stroke with prodromal TIAs. The HINTS exam as well as imaging studies of the brain (CT, CT angiogram, MRI) are helpful in diagnosis of posterior fossa stroke.

Vertebrobasilar insufficiency, notably Bow Hunter's syndrome, is a rare cause of positional vertigo, especially when vertigo is triggered by rotation of the head.{{cite journal| author=Zaidi HA, Albuquerque FC, Chowdhry SA, Zabramski JM, Ducruet AF, Spetzler RF| title=Diagnosis and management of bow hunter's syndrome: 15-year experience at barrow neurological institute. | journal=World Neurosurg | year= 2014 | volume= 82 | issue= 5 | pages= 733–8 | pmid=24549025 | doi=10.1016/j.wneu.2014.02.027 | pmc= | url=https://pubmed.ncbi.nlm.nih.gov/24549025 }}{{cite journal| author=Go G, Hwang SH, Park IS, Park H| title=Rotational Vertebral Artery Compression : Bow Hunter's Syndrome. | journal=J Korean Neurosurg Soc | year= 2013 | volume= 54 | issue= 3 | pages= 243–5 | pmid=24278656 | doi=10.3340/jkns.2013.54.3.243 | pmc=3836934 }}

Definitive treatment depends on the underlying cause of vertigo. People with Ménière's disease have a variety of treatment options to consider when receiving treatment for vertigo and tinnitus including: a low-salt diet and intratympanic injections of the antibiotic gentamicin or surgical measures such as a shunt or ablation of the labyrinth in refractory cases.{{cite journal| last1= Huon|first1=LK|last2=Fang|first2=TY|last3=Wang|first3=PC| title=Outcomes of intratympanic gentamicin injection to treat Ménière's disease| journal= Otology & Neurotology |volume= 33 |issue=5 |pages=706–714|date=July 2012|pmid=22699980|doi=10.1097/MAO.0b013e318259b3b1|s2cid=32209105}}

Common drug treatment options for vertigo may include the following:{{cite journal| last1= Huppert|first1=D|last2=Strupp|first2=M|last3=Mückter|first3=H|last4=Brandt|first4=T| title=Which medication do I need to manage dizzy patients?| journal= Acta Oto-Laryngologica |volume= 131 |issue=3 |pages=228–241|date=March 2011|pmid=21142898|doi=10.3109/00016489.2010.531052|s2cid=32591311}}

• Anticholinergics such as hyoscine hydrobromide (scopolamine){{cite book|author=Fauci, Anthony S.|author2=Daniel L. Kasper |author3=Dan L. Longo |author4=Eugene Braunwald |author5=Stephen L. Hauser |author6=J. Larry Jameson |title=Chapter 22. Dizziness and Vertigo Harrison's Principles of Internal Medicine|year=2008|publisher=McGraw-Hill|location=New York|isbn=978-0-07-147691-1|edition=17th}}
• Anticonvulsants such as topiramate or valproic acid for vestibular migraines
• Antihistamines such as betahistine, dimenhydrinate, or meclizine, which may have antiemetic properties{{citation needed|date=January 2021}}
• Beta blockers such as metoprolol for vestibular migraine
• Corticosteroids such as methylprednisolone for inflammatory conditions such as vestibular neuritis or dexamethasone as a second-line agent for Ménière's disease

All cases of decompression sickness should be treated initially with 100% oxygen until hyperbaric oxygen therapy (100% oxygen delivered in a high-pressure chamber) can be provided.{{cite book | last = Marx | first = John | year = 2010 | title = Rosen's emergency medicine: concepts and clinical practice | url = https://archive.org/details/rosensemergencym00mdjo | url-access = limited | edition = 7th | publisher = Mosby/Elsevier | location = Philadelphia, PA | isbn = 978-0-323-05472-0 |page=[https://archive.org/details/rosensemergencym00mdjo/page/n1833 1813] }} Several treatments may be necessary, and treatment will generally be repeated until either all symptoms resolve, or no further improvement is apparent.

Vertigo is from the Latin word, vertō, which means "a whirling or spinning movement".{{cite web |url=http://www.m-w.com/dictionary/vertigo |title=Definition of vertigo |publisher=Merriam-Webster Online Dictionary |access-date=2007-09-19 |url-status=live |archive-url=https://web.archive.org/web/20071007024206/http://www.m-w.com/dictionary/vertigo |archive-date=2007-10-07 }}

{{Div col}}

• {{Annotated link|Acrophobia}}
• {{Annotated link|Broken escalator phenomenon}}
• {{Annotated link|Chronic subjective dizziness}}
• {{Annotated link|Fear of falling}}
• Head for heights
• {{Annotated link|Ideomotor phenomenon}}
• {{Annotated link|Illusions of self-motion}}
• {{Annotated link|Proprioception}}
• {{Annotated link|Motion sickness}}
• {{Annotated link|Sense of balance|aka=Equilibrioception}}
• {{Annotated link|Spatial disorientation}}

{{div col end}}

{{Clear}}

{{Reflist}}

{{Spoken Wikipedia|Vertigo.ogg|date=2019-09-25}}

• {{cite web | url = https://medlineplus.gov/dizzinessandvertigo.html | publisher = U.S. National Library of Medicine | work = MedlinePlus | title = Dizziness and Vertigo }}

{{Medical condition classification and resources

| DiseasesDB = 29286

| ICD10 = {{ICD10|H|81||h|81}}, {{ICD10|R|42||r|42}}

| ICD9 = {{ICD9|438.85}}, {{ICD9|780.4}}

| ICDO =

| OMIM =

| MedlinePlus =

| eMedicineSubj = article

| eMedicineTopic = 1159385

| MeshID = D014717

}}

{{wiktionary|vertigo}}

{{Portal bar|Medicine}}

{{Ear symptoms and signs}}

{{Diseases of the ear and mastoid process}}

{{Authority control}}

{{DEFAULTSORT:Vertigo (Medical)}}

Category:Symptoms and signs of mental disorders

Category:Neurological disorders

Category:Diseases of inner ear

Category:Illusions

Category:Phenomena

Category:Wikipedia medicine articles ready to translate

Category:Wikipedia emergency medicine articles ready to translate