Relieving Vertigo - Treatment Modalities and Home Exercises

What Is Vertigo?

Vertigo is defined as an abnormal perception of the movement of self or the environment because of conflicting visual, proprioceptive, and vestibular information. It most commonly occurs when there is an imbalance in vestibular input. The most common type of vertigo is benign paroxysmal positional vertigo (BPPV). Vertigo can last for a few seconds and a few days as well, and it depends on the underlying cause. It is not a disease and is rather considered a symptom of an underlying disease.

What Are the Symptoms of Vertigo?

• Spinning sensation.

• Loss of balance.

• Headaches.

• Ringing in the ear (tinnitus).

• Abnormal eye movements.

• Sweating.

• Nausea.

• Hearing loss.

When to Seek Medical Advice?

In case of these symptoms, consider seeking immediate medical help:

1. Severe headache.

2. Weakness in extremities.

3. High fever.

4. Trouble speaking, walking, hearing, or seeing.

5. Fainting.

6. Chest pain.

7. Prolonged and frequent episodes of vertigo.

What Does Vertigo Indicate?

Vertigo commonly occurs due to vestibular dysfunction, and patients with vertigo might have acute vestibular failure, BPPV, or Meniere's disease.

• Acute Vestibular Failure: It is commonly called “labyrinthitis.” Symptoms are severe vertigo, vomiting, and unsteadiness. It begins immediately, often while walking.

• Benign Paroxysmal Positional Vertigo: It is due to the presence of otolithic debris affecting the free flow of endolymph in the semicircular canals located in the inner ear. It occurs after a minor head injury but is spontaneous.

• Meniere’s Disease: It is due to an abnormality in the endolymph that in turn, causes episodes of vertigo that last for an hour, accompanied by tinnitus and fullness in the ear.

What Are the Possible Causes of Vertigo?

Vertigo is caused due to an abnormality or dysfunction in the vestibular system. This can be due to the following reasons, and it is divided into two categories:

1. Central (brain and spinal cord).

2. Peripheral (nerves outside the brain and spinal cord).

Multiple sclerosis is associated with both central and peripheral lesions. Vertigo can also occur due to Anticonvulsants like Phenytoin, Antiemetics like Promethazine, and sedatives like Diazepam.

How Is Vertigo Diagnosed?

Vertigo is usually diagnosed using a routine gold standard test called “Dix-Hallpike maneuver.” In this test, the patient is allowed to lie down sideways, in a recumbent position toward the affected ear, causing the otolith to move away in the course of the ear canal. After 20 seconds, this will cause vertigo and cause nystagmus (rapid eye movement) and will eventually resolve in a minute. This proves vertigo. A follow-up MRI and other diagnostic procedures are done to assess if there is any abnormality.

What Are the Treatment Modalities for Vertigo?

1. Medications are given for patients having acute episodes that are short-lasting. Antihistamines, Benzodiazepines, and Antiemetics are usually prescribed. A commonly used Antihistamine is Meclizine, and it can also be given to pregnant women.

2. Physical therapy can be done along with vestibular rehabilitation.

3. Avoiding the triggers that cause vertigo has been found effective in Meniere’s disease.

4. A head rotation maneuver called the “Epley” maneuver is performed for BPPV.

Are There Any Home Exercises That Can Be Done for Vertigo?

Many at-home exercises can be done, out of which the Epley maneuver is the common practice for BPPV.

What Is an Epley Maneuver?

Modified Epley can be done at home with the patient sitting upright in a bed (fall-safe places) with their head turned 45 degrees to their left, not more than their shoulder level. A pillow has to be kept behind the patient vertically, and the patient should get back quickly on the pillow so that the head is reclined. After holding for 30 seconds, without raising their head, they should turn 90 degrees to the right and hold for another 30 seconds. After that, they should again turn 90 degrees to the right and hold for another 30 seconds. Finally, the patient will be sitting on the right side, and this has to be done on the opposite side in the same manner.

What Is Brandt-Daroff Exercise?

It is important to relax after doing this workout, as it can cause dizziness that lasts for a few minutes. Sit in the middle of the bed and turn the head 45 degrees to the right and quickly lie on the left side. Rest for a while by relaxing the neck. Wait for the dizziness to subside and wait for 30 seconds. After this, quickly sit back up and wait for 30 seconds. Now repeat the same, turning to the left side. Repeat this five times thrice a day for twice a week.

What Is Mobilization?

Manual therapy is a technique in which passive movement to a joint or soft tissue is applied at varying speeds and amplitude. Mobilization (non-thrust) and manipulation(thrust), both when used with exercise, are effective in manual therapy.

Mobilization is a technique in which rhythmic oscillating movement with the patient’s control using physiologic or accessory motions increases ROM (range of motion) and decreases pain. The physical therapists tend to identify the muscles of cervical areas that are tight and weak. They instruct the patients to include stretching, strengthening, conditioning, and coordinating exercises. Geoff Maitland described this form of manual therapy called passive joint mobilizations. Another type of manipulation was identified by Brian Mulligan, and it is termed SNAG (sustained natural apophyseal glides).

1. Maitland Mobilization: This mobilization technique is performed by the physiotherapist with the patient lying on the floor and the face facing the floor. The physiotherapist identifies the spinous process of the cervical vertebrae and runs over vertically by applying pressure using thumbs with one over the other. Each mobilization lasts for 30 seconds and three times on each level.

2. Mulligan Mobilization: The physiotherapist identifies the spinous or transverse process of the cervical vertebrae and performs a sustained natural apophyseal gliding using the thumbs towards the patient’s eyeballs. If flexion or extension produces dizziness, pressure is applied over the C2 spinous process, and if rotation produces dizziness, pressure is applied over the C1 spinous process. It is done six times.

Conclusion:

Manual therapy is effective for treating vertigo in the short term. Both Mainland and Mulligan mobilization approaches are effective in treating vertigo. After manual therapy, patients have reported decreased incidence of dizziness. In any case, even if the symptoms are very mild and infrequent, seeking medical help is the right thing to do. Finding out the cause of vertigo and eliminating them through treatment can greatly help in reducing the incidence of vertigo. Avoiding the triggers and preventing any falls can also help the individual. Vertigo is not a life-threatening condition, but if it is due to some other underlying condition, it has to be intervened.