What is Dizziness or giddiness?

Dizziness or giddiness is a symptom which encompasses a variety of sensations experienced by the patients. It includes vertigo, blackout, imbalance of gait, confusion, lightheadedness, whirling, spinning, reeling, rotating, movement of the environment, tilting, falling, pushing, rocking sensation, drunken walking, unsteadiness, swaying, visually induced vertigo, head motion induced dizziness etc.

What are the types of dizziness and what is the difference between dizziness and vertigo?
There are 5 different types of dizziness.
First is ‘Vertigo’, which means the patient feels the illusory movement of head or surroundings i.e. Spinning of head or environment.
The second type is ‘Syncopal dizziness’ in which patient feels blackout or lightheaded which may or may not be followed by loss of consciousness.
The third type is ‘Disequilibrium dizziness’ in which patient feels imbalance on standing and or while walking.
The fourth type of dizziness is particularly seen in elderly due to deficient vision, impaired sensations, and balance control issues. It is called ‘Multisensory deficit dizziness’.
The last and fifth type of dizziness is ill-defined dizziness in which its very difficult for the patient to describe the symptoms. It is usually seen in patients with anxiety and panic disorder.

What is vertigo?
Vertigo is one of the most common types of dizziness in which patient feels spinning, reeling, whirling, rotating, tilting or pushing sensation. The patient feels either the head is rotating, or the environment is rotating.

Where is the problem located in cases of vertigo?
Vertigo can be caused by three main categories in the causes.
First one is called Peripheral vertigo which is the due problem in balance control system of the body located in the inner ear. The most common causes of peripheral vertigo are Benign paroxysmal positional vertigo (BPPV), Vestibular neuronitis, Meniere’s disease etc.
The second one is called Central vertigo which is due to a problem in the balance controlling structures in the brain (Brainstem and small brain). The most common causes of Central vertigo are Vestibular migraine, Stroke, Multiple sclerosis, Tumors etc.
Thirdly, other causes of dizziness like stress, panic disorder, anxiety, dizziness triggered in crowded places (Agoraphobia), dizziness due to complex lights etc.

Is there any dedicated vertigo clinic in Aster ?

We run a dedicated ‘Vertigo clinic’ at Aster specialty clinic, Discovery Gardens, Dubai. We have a specialized equipment called Video-nystagmography (VNG) to detect different causes of vertigo. We have successfully treated more than 980 patients suffering from vertigo in last two years.

What are the most common causes of vertigo in Dubai population?
The most common causes of vertigo at our clinic is Vestibular migraine (including both the Definite and probable). The second most common cause is Benign paroxysmal positional vertigo (BPPV).

How are patients with vestibular migraine treated at the vertigo clinic?
The vertigo due to vestibular migraine gets better with treatment of migraine (Life-style modification and medicines).

How are patients with BPPV treated at Vertigo clinic?
The vertigo due to benign paroxysmal positional vertigo (BPPV) in most cases improves instantly with certain positioning maneuvers without the need of the medicines. I have treated around 60 patients of BPPV with positioning maneuvers in last one year. Most of them were suffering from incapacitating attacks of vertigo affecting the quality of life. All the patients improved with positioning maneuvers without the need of medicines.

How can one detect vertigo/early signs of vertigo and what one needs to do?
Any patient who is feeling from spinning of self or environment, reeling sensation with or without the change of position is supposed to be suffering from vertigo. Vertigo is a symptom and not the diagnosis. Hence, one needs to consult the doctor to find out the cause of the vertigo.
Vertigo disorder is diagnosed by detailed history taking, symptom analysis and focused examination of the patient which involves specialized positioning maneuvers done by experts. There are various specialized tests for the diagnosis of vertigo like Video-nystagmography (VNG), MRI Brain, Audiometry etc. These tests are requested based on the symptoms described by the patient.

What is VNG? How does it help in the diagnosis of Vertigo?
Eyes serve the important function of vision. The movements of eyeballs help in focusing the attention on one target and also in shifting the attention from one target to another target. The eye movements are adjusted according to the position and velocity of the head with the help of widespread brain circuits.
Various diseases can affect these brain circuits and can lead to eye movement abnormalities. Hence, the eyes provide a window for the diagnosis of numerous neurological disorders.
Video-nystagmography (VNG) is an equipment which does video-recording of the eye movements. During the VNG test, the patient wears the VNG goggles and sits in front of a TV screen which displays various stimuli as shown in the diagram. The eye movements occurring in response to these stimuli are recorded in graphical as well as video format. This record aids in the accurate diagnosis, monitoring and treatment of the neurological disorders.

What are the treatment options available for patients with vertigo?
Vertigo is a symptom and not a diagnosis. Hence, the most important step is correct diagnosis of the cause of vertigo. The treatment of the Vertigo differs according to the cause.
If the cause of the Vertigo is benign paroxysmal positional vertigo, the treatment is various repositioning maneuvers which are done by experts in this field.
If the cause of the Vertigo is Vestibular migraine, the treatment is lifestyle modifications and preventive medications for migraine.
If the cause of the Vertigo is stroke, multiple sclerosis or tumors, we have to treat the underlying disease.

What are the common myths about the Vertigo?
1) Cervical spondylosis is the most common cause of vertigo!
True spinning vertigo is uncommon in Cervical spondylosis. Cervical problems can lead to dizziness in specific circumstances which are not as common as the Vestibular migraine and Benign paroxysmal positional vertigo (BPPV).

2) I have low blood pressure problem!
Many patients attribute the cause of vertigo to low blood pressure. The low blood pressure problem (Syncope) can cause black-out and sometimes lead to loss of consciousness in certain situations like sudden fear, prolonged standing, sight of blood, needle prick while giving the blood sample, unpleasant odors etc. It is very surprising to see Vertigo patients with absolute normal blood pressure (Less than 120 mm Systolic and less than 80 mm of diastolic) consider themselves having low blood pressure.

3) Migraine can cause headache. It doesn’t cause Vertigo.
In fact, migraine is one of the most common cause of Vertigo and dizziness. Its more common in people with longstanding migraine. The vertigo, imbalance can occur with or without associated headaches.

4) Vertigo can be treated only with medicines.
Not all the causes of vertigo are treated with the help of medicines. As a matter of fact, taking long-term medicines to suppress the feeling of vertigo for some causes can be detrimental.

There are some causes of Vertigo which are treated mainly with the help of Repositioning maneuvers. BPPV is one such cause of vertigo which can be treated only with the help of repositioning maneuver without any medicines.

There are some causes (like unilateral or bilateral vestibulopathy, Persistent postural phobic dizziness) where the vestibular rehabilitation therapy or exercises play integral role in the management.

In Summary,

Vertigo and dizziness is a common symptom in general population. The causes can be trivial to life threatening. Vertigo is a symptom and not a diagnosis. Identifying the correct underlying cause by the experts and its specific management plays vital role to reduce the suffering and to improve the quality of life of the patients.

Dr. Vishal Pawar,

Specialist Neurologist

Aster Speciality Clinic, Discovery Gardens



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