dizziness or vertigo?

Many of us have felt dizzy in our lifetime, but for some people this feeling can be severe and significantly limit their activities.

People explain the sensation of being dizzy in several different ways. The dizzy sensation can range from feeling woozy, unsteady or light-headed, to experiencing a sense that the room is spinning or the ground is moving below your feet.

This latter form of dizziness is called vertigo. Severe vertigo often leads to disorientation, nausea, anxiety and, ultimately, mild to severe activity limitations.

There are numerous reasons why someone might feel dizzy. A light-headed dizziness, especially upon moving from a reclined or seated position to a standing position, can be the result of a drop in blood pressure called postural hypotension. This blood pressure change can be caused by a number of issues, including dehydration, medication effects, low blood sugar or heart problems. Dizziness also can accompany viral infections, sinus irritation or infection, pregnancy, anxiety and some neurological conditions.

Vertigo symptoms often are more severe and distressing than other forms of dizziness.

Vertigo is caused by an imbalance within the vestibular system. The vestibular system is responsible for detecting the movement of our head in space and allows us to move around while staying oriented to our environment. When this system is compromised, a person has a harder time maintaining environmental orientation and may feel that they or their surroundings are moving even when they are sitting still. A person with a compromised vestibular system also may experience involuntary eye movements called nystagmus.

One specific type of vertigo is known as benign paroxysimal positional vertigo. It is one of the most common causes of vertigo. BPPV is characterized by brief episodes of vertigo in response to changes in head position. Most people with BPPV report a sudden onset of mild to severe vertigo that started after they rolled over in bed or bent down to look under a piece of furniture. BPPV is caused when calcium carbonate crystals migrate from one part of the vestibular of the inner ear to one or more of the three semicircular canals of the vestibular apparatus.   These crystals cause the brain to receive conflicting information from your ears, causing a spinning sensation with certain head movements that make the crystals roll through the canal(s) they are in.  This vertigo can be limited to one occurrence or can recur on a regular basis.  

Physical therapists trained in vestibular rehabilitation are able to discern whether or not vertigo symptoms are caused by BPPV. There are multiple potential diagnoses for BPPV depending on which part, or parts, of the vestibular system are affected.  Infrared video goggles, like those used at mainstay physical therapy, significantly improve the ability for a therapist to detect the exact type, or types, of BPPV someone is experiencing.  This, in turn, drastically improves the therapist's ability to accurately treat each patient's specific BPPV.  Symptom improvement in individuals after physical therapy treatment is often immediate, especially with the use of goggles, but it can take several visits before optimal improvement is achieved.

Any concerning feelings of dizziness or vertigo should be discussed with your primary care provider. You and your provider can then decide if a referral for vestibular rehabilitation would be beneficial.