Vertigo

What is vertigo?

Vertigo is a type of dizziness that can last just for a short period of time (minutes) or that can last for hours or even days. People who have dizziness and vertigo have a false feeling of their surroundings moving or spinning caused by a fullness in the ear. This is usually accompanied by a feeling of sickness (nausea) and balance problems, which can interfere with daily activities

Central vertigo can also cause someone with the condition to be sick (vomit). Vertigo is a symptom and not a condition in itself. In most cases there is a medical condition that causes vertigo such as head injury and ear problems. However, sometimes the cause is unknown.

Who does vertigo affect?

Vertigo can affect people of any age, and of either sex.

What causes vertigo?

The most common cause of vertigo is a problem with the inner part of the ear - for example, an infection or inflammation. When we move our head, the inner part of the ear is a balance organ and tells us where our head is. If there are problems with the inner part of the ear then this causes us to feel sick (nausea) and feel dizzy. Ringing in the ear (tinnitus) or hearing loss is not common with most causes of vertigo and should be investigated in its own right.

Other conditions that can affect the inner ear and cause an episode of vertigo include:

• Ménière's disease.

• Motion sickness.

• Toxicity of the ear caused by medicines.

A common cause of vertigo in older people is benign paroxysmal positional vertigo. This causes intense dizziness (short episodes of vertigo) in head movements when you move your head in certain directions. It it thought to be caused by tiny particles in the inner ear which have got 'stuck' and cannot move as they usually do.

Less commonly, vertigo may be caused by conditions that make changes to certain parts of the brain - for example:

• A stroke.

• Migraine.

• Multiple sclerosis.

• A growth in the brain (acoustic neuroma).

• Double vision (diplopia).

• Drinking too much alcohol.

See the separate feature Can stress cause vertigo?

How to tell which ear is causing vertigo

An examination by a doctor can sometimes tell which side the vertigo is coming from, but this cannot be worked out from symptoms alone.

Vertigo treatment

The treatment for vertigo depends on what has caused it - the treatment may just be rest, it may be tablets or it may be special exercises to do. The rest of this leaflet only discusses medicines that help to ease the symptoms of dizziness and nausea caused by vertigo.

There are separate leaflets for different types of vertigo called Benign Paroxysmal Positional Vertigo (BPPV), Ménière's Disease, Vestibular Neuritis and Labyrinthitis, Dizziness and Migraine.

Note: vertigo is sometimes referred to as a 'fear of heights' - this is not correct. The right term for the fear of heights is acrophobia.

Medication for vertigo

A number of medicines can be prescribed to help with the symptoms of vertigo. They include prochlorperazine or antihistamines such as cinnarizine, cyclizine or promethazine. These medicines are the same ones that are used to help treat any feeling of sickness (nausea) and motion sickness. They work by blocking certain chemicals in the brain. Prochlorperazine blocks a chemical called dopamine; this helps with severe sickness.

Antihistamines block histamine, which helps with mild sickness and being sick (vomiting) as well as vertigo. Betahistine is an antihistamine that may be prescribed for patients with Ménière's disease, to prevent attacks from occurring. It is thought that this medicine improves the blood flow around the ear.

These medicines come in various brand names and are available as tablets, capsules, liquids and injections. Some are available as tablets that dissolve between the upper gum and lip (sublingual tablets).

How well do vertigo medicines work?

There are no good studies that tell us how well these medicines work. However, they have been prescribed to treat vertigo for many years.

What medicine is prescribed for vertigo?

The choice of medicine depends on what is causing your vertigo and how severe your symptoms are. If you have a severe feeling of sickness (nausea), your doctor may prescribe prochlorperazine. The advantage of this medicine is that it is available as an injection or as a tablet to dissolve between the upper gum and lip (a sublingual tablet). It may be more suitable for people who are very sick and being sick (vomiting).

If you have mild nausea, your doctor may prescribe an antihistamine such as cinnarizine, cyclizine or promethazine. These will also help to treat dizziness.

What is the usual length of vertigo treatment?

Medicines to treat vertigo and sickness are usually only taken for a short time - normally from 3 to 14 days. If you have vertigo frequently and long term, your doctor may prescribe a short supply of these medicines to keep at home, to use when you have another attack.

Side-effects of vertigo treatment

It is not possible to list all the possible side-effects of each of these medicines in this leaflet. However, as with all medicines, there are a number of side-effects that have been reported. If you want more information specific to your medicine, see the information leaflet that came with your medicine.

Most side-effects of vertigo treatment are not serious and each person may react differently to these medicines. Common side-effects include drowsiness, constipation, headaches, tiredness, trouble with sleeping (insomnia) and indigestion. Prochlorperazine can cause muscle twitching of the shoulders, face and neck. This usually goes away once this medicine is stopped.

Who cannot take medication for vertigo?

There are very few people who cannot take a medicine for vertigo. If for some reason one medicine has caused a side-effect or there is a reason you cannot take one, your doctor can choose a different type of medicine that will suit you.

Can vertigo medication be bought over the counter?

You can buy cinnarizine from your pharmacy but the pharmacist can only sell it to people who have motion sickness.

Self-help tips to ease vertigo

For benign positional vertigo, Brandt-Daroff exercises may be given to use at home - it is important that these are done regularly.