Brain & Neuro Health

Vertigo: When You Think You’re in Motion (but You’re Not)

The runaway roller coaster descended in a free fall that left me breathless. I jerked awake, sat up in bed and clenched the sheets only to realize I was still moving. I was having a vertigo attack.

On that night seven years ago, the link between my inner ear and my brain that helps maintain balance—called the vestibular system—had gone haywire. I didn’t know it then, but I was at the beginning of a journey that would literally shake my world for the next three months.

The Vestibular System Defined

The inner ear contains the cochlea for hearing and a balance apparatus that’s part of the vestibular system.1 When the vestibular system is functioning, you feel properly oriented to the earth and gravity is your benevolent coworker. You make adjustments to maintain posture and balance without really thinking about it.

Vertigo is a symptom that the vestibular system is feeding the brain a pack of lies. The brain misperceives that the body is spinning, tilting or dropping…even when at rest. These sensations can strike when walking, sitting in a chair, or reclined. Vertigo is the distortion of the reality of normal motion, often exaggerating it to the extreme.

Vertigo can signal a number of vestibular disorders2, including these five that I was tested for:

  1. Meniere’s disease: A common symptom is fullness in the affected ear that’s caused by excess fluid in the inner ear. Meniere’s can be caused by an allergy, virus or an autoimmune reaction. In addition to attacks of vertigo, sufferers hear persistent ringing, or rushing or roaring sounds (called tinnitus) and can experience hearing loss that can worsen over time. In some cases hearing loss is permanent.
  2. Perilymphatic fistula: Also called PLF, this is a tear or defect between the middle ear and the inner ear. PLF can cause vertigo and hearing loss. Some people are born with PLF. Or a tear can develop from increased pressure in the ear, a head injury, or even lifting a heavy object. Surgery is sometimes used to correct PLF.
  3. Benign paroxysmal positional vertigo: Also called BPPV, it’s the most common cause of vertigo. BPPV occurs when tiny calcium crystals in one part of the ear slip into an area where they shouldn’t be, kind of like puppies who escape from the behind the baby gate separating them from the brand-new sofa in the family room. With BPPV, the inner ear gives misinformation to the brain, saying the body is moving when it really isn’t. Spinning and motion sickness are common. BPPV can be treated with a series of repetitive head movements that coax the errant crystals back to their rightful place. If BPPV is diagnosed, the doctor often prescribes head movement exercises.
  4. Inner ear infection: Also called labyrinthitis, the infection occurs when the delicate structure called the labyrinth inside the inner ear becomes inflamed. It can be very painful. Common symptoms include pressure, and in severe cases fluid or pus can drain from the ear. (Yikes). Vertigo is common, and so is nausea and a high fever. Obviously, if you experience these symptoms, get in touch with your doctor, like now. An inner ear infection is generally treated with antibiotics.
  5. Vestibular neuritis: This is a viral infection (a cold, flu, measles, chicken pox, etc.) that can temporarily impair or even damage the nerve cells that send sound and balance info from the inner ear to the brain. Common symptoms are sudden vertigo, nausea, vomiting and walking with difficulty. Vestibular neuritis can be treated with medication to address the original virus.

Are Vertigo and Dizziness the Same Thing?

The answer to that is yes and no, depending on whom you ask. Some people use the word vertigo when they mean dizziness. Dizziness is light-headedness without the feeling of motion, which is a hallmark of vertigo.

Among many medical professionals, vertigo is defined as a false sensation of movement.3 But physicians I’ve spoken to tend to use vertigo and dizziness in the same sentence. I’ve experienced both dizziness and vertigo and attest that they are two different sensations.

What’s more important to understand is that vertigo and dizziness are symptoms, not diseases. Both can cause falls, injuries and intense discomfort (like throwing up). But they may also indicate that something medically serious is going on.

If you’re experiencing dizziness or vertigo, especially over a period of time, it’s a good idea to see a doctor.

My Herky-Jerky Vertigo Diagnosis Journey

For three months after the runaway roller coaster nightmare in 2012, I continued to experience acute, round-the-clock vertigo attacks. The floor pitched, the ground quaked, the seas roiled and the roller coaster screamed down endless declines. Vertigo was a thousand times worse than the continuous morning sickness I’d experienced years earlier with two pregnancies.

My quest for a diagnosis led to a brief hospitalization, an MRI and numerous other tests, several examinations by my primary care physician, a neurologist, and an ear, nose and throat (ENT) specialist.

The ENT specialist and his technicians ran hours of tests. I had an electro/video-nystagmography, (ENG/VNG) that measured the movement of my eyes when my head was placed in different positions. Conclusion: my eyes jerked.

I sat in a rotating chair that was like riding a mechanical bull in a Texas honky tonk. The chair rotation test checked if my eyes and inner ears worked together. Conclusion: they didn’t.

The computerized dynamic posturography analyzed the working relationship between my muscles, joints, eyes and ears by recording my balance and posture as I stood on a platform that abruptly shifted and tilted. I was wrapped in a harness to keep me upright. Conclusion: I was slow to regain balance when the platform moved.

The final test was conducted by an audiologist who delivered some good news: no hearing loss.

The Path to Balance

The diagnosis of vestibular neuritis was mostly a process of elimination. The ENT diagnosed damage to the vestibular center in the right inner, probably caused from a virus. He concluded that the damage would mostly repair itself over time. By that time it had been 10 weeks since the first vertigo attack and I was still having difficulty with balance. I worried that I would miss my oldest son’s wedding coming up in two weeks. The specialist prescribed medications, but it took a couple of different kinds to find one that worked. With only three days to go before the wedding, one drug did work. Whew!

For safety, I used a cane for balance. The ENT specialist ordered four weeks of “rebalance therapy” to reteach me to navigate a variety of surfaces, like carpeted floors, sidewalks, grass, gravel and stairs. The severe symptoms started to ebb and the balance came back.

The more I walked, the better I felt. I tossed the cane in a corner and added more steps, first a mile each day, then three or four. Walking continues to keep the vertigo at bay, rendering it to an inconvenience, though I still feel slight earth-tilting sensations almost every day.

If I learned anything from my vertigo adventure, it was the value of putting one foot in front of the other day after day. Walking was and remains my ticket to near normal balance. I’m also grateful for my excellent healthcare insurance provided by my employer.

During this ordeal I learned that vertigo is a common occurrence, regardless of age. How common is it? Check out our infographic: Vertigo Quick Facts.

More Resources

WebMD, “Understanding Dizziness, the Basics”
U.S. News, “Vertigo: Why it Happens, Diagnosis and Treatment”
Video, “The Difference Between Vertigo and Dizziness”

1, “A Patient’s Guide to the Vestibular System”
2 VEDA, Life Rebalanced, “Types of Vestibular Orders”
3, “Vertigo: Causes, Symptoms & Treatment”

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