Dizziness / Vertigo

Dizziness is one of the most common reasons to seek medical care, with 20-30% of the adult population likely to suffer from dizziness at some time. Dizziness is a subjective symptom rather than a diagnosis and can be caused by a wide number of health problems. Categories of dizziness can include:

Disequilibrium: general dizziness, feeling off balance or wobbly

Presyncope: feeling faint, symptoms of blacking out or light headedness

Disorientation: feeling of dissociation from body, floating, vague feelings of light headedness

Medication induced: Cardiac, CNS active, urological and ototoxic medications

True Vertigo: Feeling that the world is spinning, drunk/ travel sickness, sense of motion; can be associated with nausea/ vomiting and accounts for about 25% of all dizzy patients.

Physiotherapists can help with disequilibrium and vertigo issues, as well as helping to decipher whether medical review is required for the other categories with a thorough interview regarding your symptoms and physical assessment.

CERVIGOGENIC DIZZNESS

Cervicogenic dizziness falls into the disequilibrium category. It is thought to be due to dysfunction in the upper cervical spine. There is no gold standard test to diagnose and therefore it tends to become a diagnosis of exclusion. The dizziness tends to be brought on by neck positions and neck movements. Our physiotherapists can thoroughly assess your condition to determine if you might be suffering from this type of dizziness and treat your neck accordingly to resolve the issue.

VERTIGO

There are many causes of vertigo such as Benign Paroxysmal Positional Vertigo (BPPV), vestibular migraine, Meniere disease, labrynthitis/ vestibular neuritis, central nervous system issues, as well as drinking too much alcohol! Of these, the most common presentation at our clinic is Benign Paroxysmal Positional Vertigo, or BPPV. This is characterised by brief episodes of vertigo directly related to change in head position (rolling over, sitting up, looking up, lying down, bending forward). Attacks tend to last less than 30 seconds following which the individual is symptom free.

The issue is caused by dislodged otoconia or calcium carbonate “crystals” in the semicircular canals of the inner ear. These semicircular canals are lined with fine hairs that detect the movement of fluid within the canals whenever the head is moved and send messages to the brain about position and movement. The calcium carbonate crystals, which are usually embedded in a sort of gel further inside the ear, become dislodged and float in the fluid, causing messages being sent to the brain to be amplified when a crystal hits the fine hairs instead of just fluid! As they are heavier and react to gravity, it can give the sensation that the head is moving when it isn’t.

Most of the time, the cause of the disruption of the calcium carbonate crystals is unknown, it can occur overnight, or it can be the result of any sort of head trauma, whether it be as minor as an intense aerobics class or miss-stepping off a curb or more severe, and it tends to become more common with age.

Often when you have been suffering from vertigo, neck stiffness can become a secondary consequence that then affects the resolution of your symptoms. Your Physiotherapist can assess and treat you for the symptoms of BPPV as well as helping to resolve your neck stiffness. Often you will be guided through some exercises to do at home that will help to resolve your BPPV quite quickly.

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