Narayana Health Care

Giddiness is one of the most commonly seen conditions. It is a means by which the body is trying to communicate to us how healthy or unhealthy it is. It is an indication or symptom of an ailment. Giddiness is age agnostic and the severity can vary from person to person and condition to condition.

Vertigo is an illusion of motion, feeling of spinning, either you or the surroundings. Vertigo is not a disease in itself, but a symptom that directs us towards the disease. Vertigo is a very common symptom that affects all, irrespective of age, gender, geography, and social status. Everyone would have experienced at least some form of giddiness/vertigo in their lifetime once. The studies show the lifetime adult prevalence to be 7.4%. In fact, it is more common in the elderly.

Though vertigo is so common, it is often under-diagnosed and under-treated. This leads to a lot of confusion, frustration, anxiety, and helplessness among people who suffer from it. The 3 most common diseases which present with vertigo are:

• BPPV (Benign Paroxysmal Positional Vertigo)
• Vestibular Migraine
• Meniere’s disease

Benign Paroxysmal Positional Vertigo (BPPV)

It is one of the most causes of vertigo. Usually, the first episode will be seen while getting up from the bed. In Benign Paroxysmal Positional Vertigo, the patient feels a violent spinning sensation on getting up from bed, which may throw him back to bed along with severe vomiting and sweating. The sensation usually lasts for less than 1 minute but the whole cluster may last for 3-4 days. It is positional and is brought on by a change in head positions.

Vestibular Migraine

Migraine is more common in females, between 20-40 yrs. It is characterized by severe throbbing one-sided headache. It usually increases with increased physical activity or restricts physical activity. This may be associated with sensitivity to light and sound along with nausea or vomiting. Vestibular migraine may also present with intolerance to head movements, loss of balance, neck pain, tingling and numbness in limbs. The condition is also quite commonly associated with anxiety, panic symptoms, and palpitation. Balance problems may occur before, during or after headaches or may be completely independent of migraines.

Some of the commonly seen triggers for Vestibular Migraine are:

• Food Triggers – Cheese, paneer, noodles, coffee, tea, ice cream, chocolates, alcohol, etc.
• Environmental triggers – Sunlight, sound, crowded places, and AC
• Others – Irregular sleep, Dehydration, Hunger, lack of physical exercises

The most effective way to manage Vestibular Migraine is to adopt a healthy lifestyle and avoid substances or situations or aspects that trigger and make the condition worse.

Meniere’s disease

This is another common inner ear disorder that presents with vertigo. In this condition, along with vertigo, the patient also develops difficulty in hearing and ringing in the ear. Here vertigo usually lasts for 2-3 hrs along with severe vomiting and sweating. This disease is usually episodic, seen once in 3-4 months. The patient needs to see a vertigo specialist for the management of the disease. It can be managed effectively with medications and lifestyle modifications.

The management of various balance disorders depends on the type of disease present, which is identified by history and examination. Once the diagnosis is made, the following are some of the treatment approaches adopted.

• Positioning maneuvers – In this mode of treatment, the patient is made to follow certain body postures and movements. The change in the positioning of the head helps in moving the calcium deposits which are dislocated, to its position.
• Vestibular Rehabilitation therapy – These are a set of balance exercises designed to reduce the symptoms of gaze instability, imbalance, falls, and head motion intolerance
• Medications – To prevent acute attacks and also to prevent further attacks
• Diet, Lifestyle changes, Exercises – Good sleep, adequate water intake, regular meals, regular exercise
• Counselling and Reassurance – Be it Benign Paroxysmal Positional Vertigo, Vestibular Migraine or Meniere’s disease, they all present huge emotional stress on the patient. Apart from medication, counselling plays a key role in ensuring faster recovery of the patient

Vertigo can be managed effectively. There is no need to be scared or feel helpless about it. The need of the hour is to be aware of it and be empathetic towards those who suffer from it.

Dr. Tejaswini Patel, Neurology, Mazumdar Shaw Medical Center, Bommasandra, Bangalore