Getting a grip on vertigo

While not a diagnosis in itself, vertigo is a symptom of an underlying condition

IF I mention the word vertigo to you, what does it make you think of? Dizziness? Fear of heights? Many of us use the words vertigo and dizziness interchangeably to describe a feeling of light-headedness, but from a medical perspective, vertigo is a very specific problem.

Rather than a general light-headedness, vertigo is typically characterised by a feeling of movement, usually rotation – in other words, a feeling like you have just stepped off a playground roundabout and the world around you is spinning.

Focusing is difficult, and if the vertigo continues, nausea and vomiting often occur. “To give you an idea of how unpleasant it is, many older patients who have vertigo, feel like they are having a stroke. It’s that sense of completely losing control,” says Dr Mel Bates, a spokesman for the Irish College of General Practitioners.

Since dizziness is an extremely common complaint in general practice, GPs must try to get patients to articulate whether they have a general light-headedness or something more specific that might point at vertigo.

According to studies (Yardley, et al), approximately 30 per cent of patients reporting to their GP with “dizziness” have vertigo. The syndrome accounts for 10.7 consultations per 1,000 person years in general practice statistics.

Vertigo is not a diagnosis in itself, according to Dr Karena Hanley, but a symptom of an underlying condition.

Hanley is a GP based in Co Donegal who is recognised as a leading authority on vertigo and co-authored a review article on the subject for the British Journal of General Practice.

She believes that diagnosis of the causes of vertigo is typically not very successful. “In my personal opinion, vertigo is a little bit misunderstood by the medical profession and it is dogged by a lack of clarity about the terminology involved.”

According to Hanley, 80 per cent of cases of vertigo are caused by either benign positional vertigo or acute vestibular neuronitis. “Benign positional vertigo is caused essentially by loose grit in the balance system in the ear while vestibular neuronitis is usually associated with a viral infection. A further 10 per cent of cases are caused by Ménière’s disease and accompanied by hearing loss and tinnitus. Vertigo can also, but less commonly, be a presenting symptom of multiple sclerosis.”

Louise Hawkins is 35 years old and lives in Rush, north Co Dublin. She first experienced vertigo in 2005. Far from the temporary, relatively mild illness that most vertigo sufferers experience, hers has been a long-term debilitating illness.

“It changed my life completely overnight,” she says. “It was very, very sudden. My second child was just a few months old and I was pottering around the house. The floor suddenly started to move as if it was coming up towards me and the walls of our apartment started to spin around. I just about managed to get to the kitchen counter to hang on. It was like being drunk.”

Her doctor diagnosed her with labyrinthitis and put her on prescription medication. “She was reassuring me that everything would be fine in a few weeks but five years on and I still get bouts of vertigo literally daily ranging from a few minutes to half a day. Typically something triggers it – the motion of a car, stimulants like alcohol or coffee, or even the slightest movement around me.”

The fear of an attack of vertigo has more or less confined her to the home in that time, she says. “I am afraid to go anywhere, particularly with the kids, in case I get an attack.”

About a year ago, Hawkins had a particularly bad attack, an event which prompted her to change doctors. “I was in a terrible state of panic with it and I remember saying to my husband when he was going to work, ‘you can’t leave me, I can’t mind the kids by myself’. The new doctor emphasised the fact that vertigo is a symptom of an underlying condition and that we had to find out what that condition was. I had to go through all sorts of tests to rule out more serious conditions which was very scary. But thankfully, they all came up negative. He felt that I didn’t have labyrinthitis at all, but vestibular neuronitis.”

Hanley believes that Hawkins’ experience may be quite common. “I think that she’s in the minority, but not completely unusual, and I would imagine there are cases like this in every town in Ireland. In the vast majority of cases, vertigo settles down itself and doesn’t bother people again, or else they learn to avoid the situation or environment that causes it. I think that we in the medical profession are very good at ruling things out, but there are gaps in the ongoing treatment.”

According to Hanley, only 15 per cent of vertigo cases are referred on to a specialist and she also believes some GPs are prescribing medication to treat long-term, chronic vertigo, which may in fact be unhelpful. “All of the medications, with the exception of betahistadine, are unhelpful and, in fact, detrimental in that case because they dampen down the body’s compensation process. Betahistadine is the only one that helps move that compensation process along.”

An increasingly prominent alternative to medication is a set of simple exercises called vestibular rehabilitation treatment or VRT. “The balance centre in the brain has three inputs in to it. The inner ear, the eyes and the receptors from joints and muscles. All you do with VRT is teach those inputs to work harmoniously together again,” says Hanley.

Hawkins found a physiotherapist who specialised in VRT four months ago. “VRT helps the brain to retrain how to react to dizziness and motion. I’ve been doing exercises twice a day and I am starting to see a considerable improvement.”

Vertigo and driving

While vertigo is clearly an extremely unpleasant prospect for any patient, it can occasionally be dangerous, particularly if it occurs while the sufferer is driving.

Last December a Galway-based GP was acquitted of a charge of dangerous driving causing death, following a five-day trial at Galway Circuit Criminal Court.

Dr Devi Chalikonda (50) had denied a charge of dangerous driving which caused the death of Eileen O’Halloran (67) at Claregalway in 2007.

Martin Giblin SC, defending, said Dr Chalikonda suffered an acute attack of vertigo for the first time that morning while driving to work and could not remember hitting a pedestrian and then driving 2.2km away from the scene. He said her symptoms were so severe she had vomited several times. Eye-witnesses and gardaí who attended the scene variously described her as being drunk, having suffered a stroke or speaking gibberish. A urine sample proved negative for alcohol.

Helpful websites:

www.labyrinthitis.org.uk/

www.vestibular.org/

www.nomorevertigo.com/

• mkelly@irishtimes.com