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Vertigo Educational Guide

Dizziness and lightheadedness

Symptoms of dizziness may indicate different health issues. Lightheadedness is a feeling that you are about to faint or “pass out,” not necessarily feeling that you or your surroundings are moving. Lightheadedness often goes away or improves after you lie down. You may sometimes feel nauseated or vomit when you are lightheaded.

Vertigo

Dizziness caused by vertigo is different than lightheadedness. The term vertigo comes from the Latin verto, “a whirling or spinning movement.” Vertigo is the feeling that you or your surroundings are moving when you are actually stationary. It is often accompanied by dizziness and a sensation of whirling or spinning. Vertigo can cause symptoms ranging from nausea and vomiting to difficulties with standing or walking. Vertigo is caused by a conflict between the signals sent to the brain by various balance and position-sensing systems in the body. It occurs because of a dysfunction of the vestibular system, a complex sensory apparatus located in the inner ear that controls how the body senses motion and body position. The brain actually uses input from four different sensory systems to maintain a sense of balance and orientation. When these systems are impaired or send conflicting signals, the brain can become confused.

The four sensory systems:

These are the four sensory systems that can be affected:

• Vision gives you information about your position and motion in relationship to the rest of the world. This is an important part of the balance mechanism and often overrides information from the other balance-sensing systems.

• Sensory nerves in your joints allow the brain to keep track of the position of the legs, arms and torso. The body is then automatically able to make tiny changes in posture that help maintain balance.

• Skin pressure sensation provides you with information about your body’s position and motion relative to the effects of gravity.

• The vestibular system is comprised of portions of the inner ear, including the semicircular canals and the cochlea. This area, called the labyrinth, contains specialized cells that detect motion and changes in position. When the inner ear is injured or damaged, it can send false signals to the brain. If these false signals conflict with signals from the other balance and positioning centers, vertigo may occur.

Common causes of vertigo:

• Inner ear disorders, such as benign paroxysmal positional vertigo (BPPV), in which vertigo is triggered by changes in head position or by lying down, turning over or sitting up in bed; Ménière’s disease, a disorder of inner ear that often causes tinnitus (a ringing, roaring or swishing noise in the ear) and progressive hearing loss in addition to vertigo; vestibular neuritis (attacks of vertigo caused by inflammation of the nerve that connects the inner ear to the brain); or labyrinthitis (an inflammation of the inner ear)

• Injury to the ear or head

• Migraine headaches (painful, debilitating headaches that often occur with vertigo, nausea, vomiting and sensitivity to light, noise and smell)

• Decreased blood flow through the arteries that supply blood to the base of the brain Depending on the location of the dysfunction, vertigo is classified as either peripheral or central. Peripheral vertigo (also called “otologic” or “vestibular” vertigo) is caused by problems with the vestibular system. The most common cause is BPPV, but other causes include Ménière’s disease, superior canal dehiscence syndrome (a thinning of the bone that overlies the part of the ear that detects head movement), labyrinthitis and visual vertigo (a type of vertigo induced by specific visual environments like driving or being at a supermarket). Any cause of inflammation, such as the common cold, influenza or bacterial infections may cause transient (temporary) vertigo if the inner ear becomes inflamed. Chemical insults (e.g., aminoglycosides, a type of antibiotic medication used to treat certain infections) or physical trauma (e.g., skull fractures) can also cause  transient vertigo.

Central vertigo arises from the balance centers of the brain. It is usually milder, and has accompanying neurologic deficits, such as slurred speech, double vision or involuntary eye movement. Brain pathology can cause a sensation of disequilibrium, which is an off-balance sensation.

Motion sickness

Motion sickness (also called kinetosis or travel sickness) results when the brain senses movement from signals it gets from the vestibular system, muscles and joints. When your brain receives signals from the eyes that do not match the signals sent by other systems, motion sickness may result. For example, when standing below the waterline of a boat, the inner ear senses motion, but the eyes cannot see any movement. It is a common problem for people traveling in cars, trains, planes and especially boats. Depending on its cause, motion sickness can also be called seasickness, car sickness, simulation sickness, airsickness or space sickness. A person’s relative location within these modes of transport can make a difference. The front seat of a car, forward cars of a train, upper deck on a boat or wing seats in a plane may lead to a more comfortable ride. Looking out into the distance

— instead of trying to read or look at something in the vehicle

— may also help reduce symptoms.

The symptoms of motion sickness

Symptoms of motion sickness can include dizziness, sweating, a general feeling of discomfort, nausea or vomiting. Motion sickness can start suddenly, with a queasy feeling and cold sweats. It can then lead to nausea, dizziness and vomiting.

About 33 percent of people are susceptible to motion sickness even in mild conditions such as being on a boat in calm water, although nearly 66 percent of people are susceptible in more severe circumstances. Even  astronauts are not immune — approximately 50 percent of US astronauts have suffered from space sickness.

The most common hypothesis for the cause of motion sickness is that it functions as a defense mechanism against neurotoxins. The area postrema in the brain is responsible for resolving conflicts between vision and balance. It also controls vomiting. When the body detects toxins, the area postrema induces vomiting to get rid of the toxins. When your body senses motion but does not perceive it visually, the inner ear transmits to the brain that it senses motion, but the eyes tell the brain that everything is still. The brain may think this discordance is occurring because of a toxin and the body may respond by vomiting, to clear the perceived toxin.

Who is most at risk?

• Children between two to 12 years of age are especially susceptible to motion sickness, while infants and toddlers seem relatively immune. 

• Women, especially when pregnant, are more likely to have motion sickness.

• People who suffer from migraines are more prone to motion sickness and commonly suffer both conditions concurrently.

Lifestyle suggestions for dealing with Vertigo and Motion Sickness

If you find that you are prone to experience the effects of vertigo or motion sickness, there are a few actions that you can take to help minimize the effects. On a ship: choose a cabin toward the middle of the craft and near the waterline. While on board, visit an outside deck and focus on the horizon.

In an airplane: Request a window seat and look out the window. A seat over the front edge of the wing is best (the degree of motion is lowest there). Direct the air vent to blow cool air on your face.

On a train: Always face in the same direction that the train is moving and sit near a window. In a vehicle: Sit in the front seat. If you are a passenger, look at the scenery in the distance. For some people, driving the vehicle is an instant remedy.

Other lifestyle suggestions would include:

• If you are prone to motion sickness, do not read in moving vehicles.

• While traveling in trains, planes or automobiles, avoid moving your head quickly when changing your gaze from directly around yourself to outside the vehicle.

• Get a good night’s sleep the night before traveling. Being overtired makes some people more susceptible to motion sickness.

• If you can, stand up when you feel queasy. Look out over the horizon. Sitting or lying down may actually make you feel worse. 

• When possible, lean your head against the back of the seat or headrest when traveling in vehicles with seats.

• When you feel the onset of any symptoms try and take slow, deep breaths.

Diet and nutrition choices

Certain types of foods and/or the lack of proper hydration can make you more susceptible to symptoms  associated with motion sickness and vertigo. As simple as it may seem, minding what and when you eat can really help. Here are a few ideas to consider:

• Avoid heavy, greasy and acidic foods before traveling, and avoid drinking coffee. Such foods are slow to digest and coffee can speed up dehydration. Better choices include breads, cereals, grains, milk, water, apple juice, apples or bananas.

• Do not skip eating but do not overeat.

• If possible, eat light meals or snacks that are low in calories during the 24 hours before you plan to travel.

• Drink plenty of water and drink it often.

• Do not drink large amounts of alcohol before traveling. Alcohol speeds up dehydration and generally lowers the body’s resistance to motion sickness.

• Don’t smoke and avoid secondhand smoke.

• Try eating salty crackers or sunflower seeds to help settle a queasy stomach.

• Some herbs such as ginger or peppermint have been used by many with positive results. Gingersnap cookies may also work.

Exercise suggestions

Although there are no specific exercises that help you overcome the symptoms of motion sickness, many people have learned relaxation techniques that help. Relaxation techniques such as deep muscle relaxation and learning how to use mental imagery have proven helpful to some. If this sounds like something that you may be interested in, it might be worth your time to learn more about such techniques.

References

Reference Books

1. eMedicine Health. “Dizziness.” Accessed January 13, 2011, www.emedicinehealth.com/dizziness/article_em.htm.

2. eMedicine Health. “Vertigo.” Accessed January 13, 2011, www.emedicinehealth.com/vertigo/article_em.htm.

3. Remedy Health Media. “Vertigo Causes.” Accessed January 13, 2011, www.neurologychannel.com/vertigo/causes.shtml.

4. Rubinstein, J. “Vertigo: Frequently Asked Questions.” University of Iowa Hospitals and Clinics, 2004, accessed January 13, 2011, ww.uihealthcare.com/topics/medicaldepartments/otolaryngology/vertigofaq/index.html.

5. WebMD. “Dizziness: Lightheadedness and Vertigo - Topic Overview.” Accessed January 13, 2011,  ww.webmd.com/brain/tc/dizziness-lightheadedness-and-vertigo-topic-overview.

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