Whether getting up in the morning, bending over, or on a long car ride, vertigo is a complex phenomenon that can occur in a wide variety of situations. Often, vertigo is accompanied by accompanying symptoms such as headaches, nausea or ringing in the ears. The duration as well as the type of dizziness – spinning dizziness or staggering dizziness – can sometimes already provide initial clues as to the cause of the complaints. In this interview, Prof. Dr. med. Michael Strupp presents various causes of vertigo in more detail and gives tips on the correct treatment.
What is vertigo?
About ten percent of all patients who visit their family doctor struggle with dizziness. Because dizziness becomes more common with age, the percentage of those who suffer from dizziness more often is relatively high, especially among older people. For example, about 30 percent of people over 65 experience dizziness on a regular basis.
Vertigo is an illusory movement between the environment and one’s own body. One has the feeling that the environment or one’s own body is turning or that the floor is swaying. In fact, however, these movements are based on a disturbed perception of the environment, which can be based on a wide variety of causes.
Dizziness has numerous causes
Dizziness is not a disease in its own right, but an indication that there is a disorder in the narrower or broader area of the vestibular system. What triggers this disturbance varies.
“When it comes to the causes that can be behind dizziness, three major groups can be distinguished,” explains expert Prof. Michael Strupp, MD. “The first group is diseases of the peripheral vestibular organ, the second group is central vertigo and the third group is phobic vertigo.”
If a disease of the vestibular organ in the inner ear is present, Strupp says the following three causes are particularly common for vertigo:
- Benign positional vertigo
- Meniere’s disease
- Inflammation of the vestibular nerve (so-called neuritis vestibularis).
Benign positional vertigo
“Benign positional vertigo is noticeable at night or in the morning when turning over in bed. Acute attacks of rotational vertigo can occur during such movements,” says Strupp. The cause of positional vertigo is small crystals in the ear that irritate the sensory cells in the inner ear during certain movements, triggering the vertigo attacks.
“The good news for all sufferers is that such positional vertigo is 100 percent treatable,” the expert assures. “For treatment, so-called liberation maneuvers are performed, which the patient can perform independently at home after a doctor’s instruction.” Through the exercises, the crystals are transported out of the archways – often patients are symptom-free after only a few days.
Meniere’s disease
Meniere’s disease is a condition that is particularly common in people between the ages of 40 and 60. “In sufferers, the spinning vertigo results from too much fluid being produced in the ear. Regular attacks of vertigo then occur, along with accompanying symptoms such as hearing disorders, a feeling of pressure in the ear, and ringing in the ears,” explains Strupp.
For people suffering from Meniere’s disease, drug therapy is necessary to combat the dizziness. Usually, the active ingredient betahistine is used. “Similar to benign positional vertigo, the chances of cure for Meniere’s disease are very good. About 90 percent of patients are attack-free under treatment,” the expert emphasizes.
Inflammation of the vestibular nerve
Inflammation of the vestibular nerve is also known as neuritis vestibularis. “It is characterized by acute onset of severe spinning vertigo lasting for days,” Strupp says. “The inflammation is triggered by herpes viruses, which are also responsible for the unpleasant herpes blisters on the lip, among other things.”
Strupp recommends treating the inflammation of the nerve in the acute phase with the administration of cortisone. In this way, normal function of the vestibular nerve can be restored in about two-thirds of cases, he said. However, it may take a few days to a few weeks for the symptoms to subside completely.
