Vertigo: The Real Thing

The psychological thriller “Vertigo” is considered an Alfred Hitchcock masterpiece, filled with suspense and intrigue. In that classic film, life starts to unravel for a police officer who develops vertigo, a feeling of debilitating dizziness, after a terrifying incident.

The movie is fiction, but the condition of vertigo is very real for about 70 million Americans. Although people at any age are at risk, vertigo is most often diagnosed in those who are 60 years old and older. By age 65, it is the most common reason that adults make appointments to see their doctors.

Vertigo is a specific type of dizziness caused by an inner-ear problem, which is triggered by when the head moves. People who experience it often say it feels as though they are spinning or as though the room around them is spinning when neither is moving.

Vertigo and imbalance can be caused by ear infections, drug toxicity, migraines or a general decrease in the functioning of the inner ear. When the symptoms are at their worst, a person may not be able to stand or walk without falling. Nausea and/or vomiting can also be other side effects.

The most common type of vertigo is benign paroxysmal positional vertigo (BPPV). This happens when crystals in the inner ear, which normally work with the brain to keep people properly balanced, move from their intended spot and migrate into one of the canals of the inner ear so that when the head moves, these crystals send incorrect communication to the brain. These wrong messages result in vertigo and rapid involuntary eye movements. That’s why the spinning feeling happens when individuals bend over, look up, get in and out of bed and roll over in bed, among other situations.

Vertigo is not life threatening, but it can be very disruptive because of the intense dizziness and imbalance that it causes. Sufferers are also at an increased risk for falls.

BPPV is very common in older adults. However with younger individuals, head injuries are the main cause. There is a 30 percent recurrence rate in the first year after treatment, and by five years, about half of all patients have experienced it again.

BPPV is commonly diagnosed with a maneuver called the Dix Hallpike. The person being evaluated should have both vertigo and rapid alternating eye movements for an official diagnosis.

Treatment for BPPV is pretty clean-cut. Physical therapists will use certain maneuvers to put the head and body into positions that direct the inner ear’s crystals back into their proper place.

However, in cases of dizziness and imbalance from other conditions, or from a poorly functioning inner ear, the treatment program is much more individualized.

Physical therapists will do eye/head exercises and will improve gaze stabilization. These can involve having a person focus on a stationary (or moving) target while moving his/her head. Other exercises use repetitive movements so that the brain can get used to certain positions until they no longer cause dizziness.

Treating vertigo is a partnership. A large part of a person’s success can be linked to doing the exercises that their physical therapists give them to complete at home.

While Hitchcock’s “Vertigo” may be scary, with the proper help, the medical condition should not cause any fear.

Susan Bloom is a physical therapist in the Outpatient Rehabilitation Services Department at Northwest Hospital.

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