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Vertigo

Illustration

A sudden sensation of spinning is one of the first signs of vertigo. According to research or other evidence, the following self-care steps may help you get to the root of the problem and remedy the symptoms:

What you need to know

  • Go for the ginkgo
  • Take 120 to 160 mg a day of a standardized extract of the herb Ginkgo biloba to reduce symptoms
  • Discover vinpocetine
  • Ease vertigo symptoms by taking 15 mg a day
  • See a specialist
  • Consult with healthcare practitioners familiar with therapies that may help your vertigo, such as vestibular rehabilitation exercise, particle repositioning maneuvers, spinal manipulation, or trigger point therapy

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full vertigo article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About vertigo

Vertigo is a sensation of irregular or whirling motion, either of oneself or of external objects.

The word is sometimes incorrectly used as a general term to describe dizziness. The most common form of vertigo is benign positional paroxysmal vertigo (BPPV), in which brief attacks are brought on by certain changes in head position.1 BPPV may be due to a previous head injury, viral infection, and certain drug therapies, although in about half the cases the cause is unknown.2 3 BPPV tends to resolve without treatment within weeks to months, but may persist for years in some cases.4 5

People experiencing vertigo should have a complete medical evaluation to determine the cause. Common causes of non-BPPV vertigo include conditions in which there is decreased blood flow to certain areas of the brain, Ménière’s disease, and infection of the inner ear.6 7 Vertigo may also be a symptom of numerous other conditions,8 9 10 including sinusitis, panic attacks, migraine headaches, and problems with metabolism,11 12 such as hypothyroidism, high blood triglycerides, diabetes, and hypoglycemia.

Product ratings for vertigo

Science Ratings Nutritional Supplements Herbs
2Stars

Vinpocetine

Vitamin B6

Ginger

Ginkgo
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

People with vertigo may have sudden sensations of spinning or whirling motion that may be accompanied by lightheadedness and loss of balance, and less often by sweating, fatigue, nausea, and vomiting.13 14

Medical options

Over-the-counter medication such as dimenhydrinate (Dramamine) and meclizine (Dramamine Less Drowsy Formula) may be helpful.

Medications that are occasionally prescribed include the anticholinergic drug, meclizine (Antivert), as well as sedatives, such as diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax).

Healthcare practitioners recommend getting fresh air, lying down, closing the eyes, and alcohol avoidance. People frequently affected by severe, disabling vertigo may require a surgical treatment, such as vestibular neurectomy or labyrinthectomy. These procedures involve surgical removal of either the nerves or labyrinthine structures that control balance and position senses.

Dietary changes that may be helpful

In preliminary studies, vertigo associated with high triglycerides, diabetes mellitus, and hypoglycemia responded to dietary management of the underlying disorder.15 16 In a preliminary study of people with migraine headaches, most of whom (83%) also experienced vertigo, a multifaceted approach including dietary changes was investigated. Dietary changes involved the elimination of foods and food additives suspected of causing migraine attacks. This approach resulted in complete or substantial improvement of symptoms in a significant number of participants.17 No other research has investigated the effects of diet on vertigo.

Lifestyle changes that may be helpful

Head positions that bring on sudden, acute attacks of vertigo, particularly bending the neck back while looking up, should be avoided. In one report, for example, the head position used in salons for shampooing hair was associated with the onset of vertigo.18 According to one authority,19 certain chronic or repetitive body positions may produce painful nodules, called trigger points, in the muscles of the head and neck, which can lead to dizziness and possibly vertigo. These positions include forward bending of the neck as when sleeping on two pillows, backward neck bending as when painting a ceiling, and turning the neck to one side as in some reading positions.20 A healthcare practitioner knowledgeable in postural education can give advice on avoiding such positions. Trigger point therapy is discussed below in “Other integrative approaches that may be helpful.”

Vitamins that may be helpful

A preliminary trial showed that 15 mg per day of vinpocetine had a moderate or greater effect on reducing the signs and symptoms of vertigo in 77% of patients with this condition.21 Other preliminary reports exist describing benefits of vinpocetine for vertigo and other symptoms of inner ear disorders,22 but controlled research is needed to evaluate these claims.

Two preliminary human studies reported that vitamin B6 supplementation reduced symptoms of vertigo produced with drugs in a laboratory setting.23 Vitamin B6 supplementation has not been studied in BPPV or other forms of vertigo and may not share the same causative mechanism as experimentally induced vertigo.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Herbs that may be helpful: In a preliminary clinical trial, a standardized extract of Ginkgo biloba (GBE) significantly reduced symptoms of vertigo in a group of elderly people with mild cognitive impairment.24 Participants were given 40 mg three times per day for one year. GBE has also been reported to significantly reduce vertigo of unknown cause in preliminary25 and double-blind26 trials. The amounts given were 120 mg and 160 mg per day, respectively, for three months.

One gram of powdered ginger  (Zingiber officinale) root in a single application has been reported to significantly reduce symptoms of artificially induced vertigo in one double-blind trial.27 In a double-blind trial, 1 gram of powdered ginger root was found to have very little effect in reducing vertigo related to seasickness.28

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

Holistic approaches that may be helpful

Other integrative approaches that may be helpful: Numerous preliminary reports suggest certain “vestibular rehabilitation” exercises may help some cases of vertigo.29 30 31 32 33 34 These exercises were also found to be effective in relieving vertigo in two controlled studies,35 including one on BPPV.36 While vestibular rehabilitation exercises may be done at home, initial guidance by a qualified practitioner is necessary.

BPPV appears to be caused by an accumulation of free-floating cell fragments in the fluid of the inner ear.37 38 Certain manipulation therapy maneuvers, referred to as particle repositioning maneuvers (PRMs), are intended to relocate this debris to a harmless location,39 40 41 in order to improve symptoms. Both preliminary42 43 44 45 46 and controlled47 48 49 trials achieved significant improvement in, or elimination of, BPPV using these maneuvers. Most studies report that over 90% of people with BPPV treated one or two times with PRM respond to this treatment, although up to 45% may develop BPPV again within a few years, requiring further treatments.50 51 52

Research indicates some cases of vertigo are related to spinal disorders affecting the head and neck.53 54 55 56 57 58 59 Preliminary studies report that certain treatments, such as spinal manipulation,60 61 62 63 physical therapy,64 and combined approaches including manipulation and specific exercise programs,65 66 result in significant improvement of vertigo symptoms.

Trigger points are thought by most,67 68 69 though not all,70 authorities to potentially cause pain and abnormal function in other parts of the body. Trigger points appear to develop as the result of injury, poor posture, structural abnormalities of the leg or pelvis, emotional tension, and other body stressors.71 72 Also known as myofascial pain dysfunction (MPD), this condition, when it affects certain muscles of the head and neck, has been associated with vertigo in preliminary research.73 74 75 Musculoskeletal healthcare specialists and other practitioners can often treat MPD with a variety of natural therapies, including deep pressure massage,76 77 78 79 80 transcutaneous electrical nerve stimulation (TENS),81 82 and other approaches,83 but no controlled studies have investigated the effectiveness of these treatments specifically for vertigo.

In a preliminary study of people with migraine headaches, most of whom (83%) also experienced vertigo, a combined and individualized approach using dietary changes, medication, physical therapy, lifestyle changes, and acupuncture resulted in complete or substantial improvement of symptoms in a significant number of participants.84 In addition, a large number of case studies presented in two preliminary reports suggest acupuncture may help to reduce symptoms of vertigo.85 86 These preliminary studies have yet to be confirmed by controlled clinical trials.

References:

1. Sauron B, Dobler S. Benign paroxysmal positional vertigo. Diagnosis, course, physiopathology and treatment. Rev Prat 1994;44:313–8 [in French].

2. Baloh RW. Vertigo. Lancet 1998;352:1841–6 [seminar].

3. Daroff RB, Martin JB. Vertigo. Harrison’s Online 1999. http://www.harrisonsonline.com/hill-bin/Chapters.cgi (Feb 10, 2000).

4. Sauron B, Dobler S. Benign paroxysmal positional vertigo. Diagnosis, course, physiopathology and treatment. Rev Prat 1994;44:313–8 [in French].

5. Daroff RB, Martin JB. Vertigo. Harrison’s Online 1999. http://www.harrisonsonline.com/hill-bin/Chapters.cgi (Feb 10, 2000).

6. Baloh RW. Vertigo. Lancet 1998;352:1841–6 [seminar].

7. Sloane PD, Dallara J, Roach C, et al. Management of dizziness in primary care. J Am Board Fam Pract 1994;7:1–8.

8. Sloane PD, Dallara J, Roach C, et al. Management of dizziness in primary care. J Am Board Fam Pract 1994;7:1–8.

9. Baloh RW. Vertigo. Lancet 1998;352:1841–6 [seminar].

10. Daroff RB, Martin JB. Vertigo. Harrison’s Online 1999. http://www.harrisonsonline.com/hill-bin/Chapters.cgi (Feb 10, 2000).

11. Rybak LP. Metabolic disorders of the vestibular system. Otolaryngol Head Neck Surg 1995;112:128–32 [review].

12. Lehrer JF, Poole DC, Seaman M, et al. Identification and treatment of metabolic abnormalities in patients with vertigo. Arch Intern Med 1986;146:1497–500.

13. Baloh RW. Vertigo. Lancet 1998;352:1841–6 [seminar].

14. Daroff RB, Martin JB. Vertigo. Harrison’s Online 1999. http://www.harrisonsonline.com/hill-bin/Chapters.cgi (Feb 10, 2000).

15. Lehrer JF, Poole DC, Seaman M, et al. Identification and treatment of metabolic abnormalities in patients with vertigo. Arch Intern Med 1986;146:1497–500.

16. Rybak LP. Metabolic disorders of the vestibular system. Otolaryngol Head Neck Surg 1995;112:128–32 [review].

17. Johnson GD. Medical management of migraine-related dizziness and vertigo. Laryngoscope 1998;108(1 Pt 2):1–28.

18. Endo K, Ichimaru K, Shimura H, Imakiire A. Cervical vertigo after hair shampoo treatment at a hairdressing salon: A case report. Spine 2000;25:632–4.

19. Travell JG, Simons DG. Myofascial pain and dysfunction; the trigger point manual. Baltimore: Waverly Press ,1983, 204–17.

20. Travell JG, Simons DG. Myofascial pain and dysfunction; the trigger point manual. Baltimore: Waverly Press ,1983, 204–17.

21. Taiji H, Kanzaki J. Clinical study of vinpocetine in the treatment of vertigo. Jpn Pharmacol and Ther (Japan) 1986;14:577–89.

22. Ribari O, Zelen B, Kollar B. Ethyl apovincaminate in the treatment of sensorineural impairment of hearing. Arzneimittelforschung 1976;26:1977–80.

23. Claussen CF, Claussen E. Antivertiginous action of vitamin B 6 on experimental minocycline-induced vertigo in man. Arzneimittelforschung 1988;38:396–9 [in German].

24. Vorberg G. Ginkgo biloba extract (GBE): A long-term study of cerebral insufficiency in geriatric patients. Clin Trials J 1985;22:149–57.

25. Claussen CF. Diagnostic and practical values of craniocorpography in vertiginous syndromes. Presse Med 1986;15:1565–8 [in French].

26. Haguenauer JP, Cantenot F, Koskas H, Pierart H. Treatment of disturbances of equilibrium with Ginkgo biloba extract: A multicenter, double-blind, drug versus placebo study. Presse Med 1986;15:1569–72 [in French].

27. Grontved A, Hentzer E. Vertigo-reducing effect of ginger root. A controlled clinical study. ORL J Otorhinolaryngol Relat Spec 1986;48:282–6.

28. Grontved A, Brask T, Kambskard J, Hentzer E. Ginger root against sea sickness. A controlled trial in the open sea. Acta Otolarygol 1988;105:45–9.

29. Herdman SJ, Clendaniel RA, Mattox DE, et al. Vestibular adaptation exercises and recovery: acute stage after acoustic neuroma resection. Otolaryngol Head Neck Surg 1995;113:77–87.

30. Asai M, Watanabe Y, Shimizu K. Effects of vestibular rehabilitation on postural control. Acta Otolarygol 1997;528:116–20.

31. Herdman SJ. Advances in the treatment of vestibular disorders. Phys Ther 1997;77:602–18 [review].

32. Whitney SL, Rossi MM. Efficacy of vestibular rehabilitation. Otolaryngol Clin North Am 2000;33:659–72 [review].

33. Gizzi M. The efficacy of vestibular rehabilitation for patients with head trauma. J Head Trauma Rehabil 1995;10:60–77.

34. Johnson GD. Medical management of migraine-related dizziness and vertigo. Laryngoscope 1998;108(1 Pt 2):1–28.

35. Yardley L, Beech S, Zander L, et al. A randomized controlled trial of exercise therapy for dizziness and vertigo in primary care. Br J Gen Pract 1998;48:1136–40.

36. Steenerson RL, Cronin GW. Comparison of the canalith repositioning procedure and vestibular habituation training in forty patients with benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1996;114:61–4.

37. Furman JM, Cass SP. Benign paroxysmal positional vertigo. Primary Care 1999; 341:1590–6 [review].

38. Epley JM. Positional vertigo related to semicircular canalithiasis. Otolaryngol Head Neck Surg 1995;112:154–61.

39. Epley JM. Particle repositioning for benign paroxysmal positional vertigo. Otolaryngol Clin North Am 1996;29:323–31.

40. Lempert T, Gresty M, Bronstein A. Epley’s procedure should be used to treat benign positional vertigo. BMJ 1996;312:1300 [letter].

41. Brooks JG, Abidin MR. Repositioning maneuver for benign paroxysmal positional vertigo (BPPV). J Am Osteopath Assoc 1997;97:277–9.

42. Epley JM. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1992;107:399–404.

43. Brandt T, Daroff RB. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol 1980;106:484–5.

44. Welling DB, Barnes DE. Particle repositioning maneuver for benign paroxysmal positional vertigo. Laryngoscope 1994;104:946–9.

45. Coppo GF, Singarelli S, Fracchia P. Benign paroxysmal positional vertigo: follow-up of 165 cases treated by Semont’s liberating maneuver. Acta Otorhinolaryngol Ital 1996;16:508–12 [in Italian].

46. Appiani GC, Gagliardi M, Urbani L, Lucertini M. The Epley maneuver for the treatment of benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol 1996;253:31–4.

47. Herdman SJ, Tusa RJ, Zee DS, et al. Single treatment approaches to benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg 1993;119:450–4.

48. Steenerson RL, Cronin GW. Comparison of the canalith repositioning procedure and vestibular habituation training in forty patients with benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1996;114:61–4.

49. Itaya T, Yamamoto E, Kitano H, et al. Comparison of effectiveness of maneuvers and medication in the treatment of benign paroxysmal positional vertigo. ORL J Otorhinolaryngol Relat Spec 1997;59:155–8.

50. Furman JM, Cass SP. Benign paroxysmal positional vertigo. N Engl J Med 1999;341:1590–6 [review].

51. Beynon GJ. A review of management of benign paroxysmal positional vertigo by exercise therapy and by repositioning manoeuvres. Br J Audiol 1997;31:11–26 [review].

52. Beynon GJ, Baguley D, da Cruz MJ. Recurrence of symptoms following treatment of posterior semicircular canal benign positional paroxysmal vertigo with a particle repositioning manoeuvre. J Otolaryngol 2000;29:2–6.

53. Strek P, Reron E, Maga P, et al. A possible correlation between vertebral artery insufficiency and degenerative changes in the cervical spine. Eur Arch Otorhinolaryngol 1998;255:437–40.

54. Franz B, Altidis P, Altidis B, Collis-Brown G. The cervicogenic otoocular syndrome: A suspected forerunner of Meniere’s disease. Int Tinnitus J 1999;5:125–30.

55. Galm R, Rittmeister M, Schmitt E. Vertigo in patients with cervical spine dysfunction. Eur Spine J 1998;7:55–8.

56. Karlberg M, Johansson R, Magnusson M, Fransson PA. Dizziness of suspected cervical origin distinguished by posturographic assessment of human postural dynamics. J Vestib Res 1996;6:37–47.

57. Rzewnicki I. The examination of vestibular system in patients with degenerative changes of the cervical spine. Otolaryngol Pol 1995;49:332–8 [in Polish].

58. Hulse M, Holzl M. [No title available] HNO 2000;48:295–301 [in German].

59. Benech A, De Gioanni PP, Fasciolo A, et al. Evaluation of the posture of patients before and after orthodontic surgery. Minerva Stomatol 1997;46:435–41 [in Italian].

60. Galm R, Rittmeister M, Schmitt E. Vertigo in patients with cervical spine dysfunction. Eur Spine J 1998;7:55–8.

61. Hulse M, Holzl M. [No title available] HNO 2000;48:295–301 [in German].

62. Cronin PC. Cervicogenic vertigo. Eur J Chiropractic 1997;45:65–9.

63. Cagle PL. Cervicogenic vertigo and chiropractic: managing a single case—a case report. J Am Chiropractic Assoc 1995;32:83–4.

64. Franz B, Altidis P, Altidis B, Collis-Brown G. The cervicogenic otoocular syndrome: A suspected forerunner of Meniere’s disease. Int Tinnitus J 1999;5:125–30.

65. Bracher ES, Almeida CI, Almeida RR, et al. A combined approach for the treatment of cervical vertigo. J Manipulative Physiol Ther 2000;23:96–100.

66. Cote P, Mior SA, Fitz-Ritson D. Cervicogenic vertigo: a report of three cases. JCCA 1991;35:89–93.

67. Hong CZ. Pathophysiology of myofascial trigger point. J Formos Med Assoc 1996;95:93–104 [review].

68. Gerwin RD. Neurobiology of the myofascial trigger point. Baillieres Clin Rheumatol 1994;8:747–62 [review].

69. Wyant GM. Chronic pain syndromes and their treatment. II. Trigger points. Can Anaesth Soc J 1979;26:216–9.

70. Quintner JL, Cohen ML. Referred pain of peripheral nerve origin: an alternative to the “myofascial pain” construct. Clin J Pain 1994;10:243–51 [review].

71. Fischer AA. Documentation of myofascial trigger points. Arch Phys Med Rehabil 1988;69:286–91 [review].

72. Fricton JR, Kroening R, Haley D, Siegert R. Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. Oral Surg Oral Med Oral Pathol 1985;60:615–23.

73. Travell JG, Simons DG. Myofascial pain and dysfunction; the trigger point manual. Baltimore: Waverly Press ,1983, 204–17.

74. Curtis AW. Myofascial pain-dysfunction syndrome: the role of nonmasticatory muscles in 91 patients. Otolaryngol Head Neck Surg 1980;88:361–7.

75. Johnson GD. Medical management of migraine-related dizziness and vertigo. Laryngoscope 1998;108(1 Pt 2):1–28.

76. Fricton JR. Management of masticatory myofascial pain. Semin Orthod 1995;1:229–43 [review].

77. McClaflin RR. Myofascial pain syndrome. Primary care strategies for early intervention. Postgrad Med 1994;96:56–9, 63–6, 69–70 [review].

78. Schneider W, Dvorak J. Functional treatment of diseases and injuries of the cervical spine. Orthopade 1996;25:519–23 [in German].

79. Toto BJ. Chiropractic correction of congenital muscular torticollis. J Manipulative Physiol Ther 1993;16:556–9.

80. Murphy GJ. Physical medicine modalities and trigger point injections in the management of temporomandibular disorders and assessing treatment outcome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83:118–22 [review].

81. Chee EK, Walton H. Treatment of trigger points with microamperage transcutaneous electrical nerve stimulation (TENS)—(the Electro-Acuscope 80). J Manipulative Physiol Ther 1986;9:131–4.

82. Graff-Radford SB, Reeves JL, Baker RL, Chiu D, Effects of transcutaneous electrical nerve stimulation on myofascial pain and trigger point sensitivity. Pain 1989;37:1–5.

83. Travell JG, Simons DG. Myofascial pain and dysfunction; the trigger point manual. Baltimore: Waverly Press,1983, 204–17.

84. Johnson GD. Medical management of migraine-related dizziness and vertigo. Laryngoscope 1998;108(1 Pt 2):1–28.

85. Zhang LJ. Thirty-one cases of vertigo treated by acupuncture based on the doctrine of supplying water to nourish wood. Int J Clin Acupunct 1999;10:99–100.

86. Yan SM. Warm-needling in treatment of vertigo due to cervical vertebral hyperosteogeny: observation of 389 cases. Int J Clin Acupunct 1998;9:193–4.
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