Elevator, tilting and rocking sensations that occur when the body is not moving are a form of vertigo. When going up or down in an elevator, the feeling of rising or dropping is created by gravity sensors in the inner ear, the otolith organs. If these sensors malfunction, they can cause an identical elevator-like sensation. This can make you feel like you are suddenly hurtling toward the center of the earth, or as if you are taking off into space strapped to the nosecone of a rocket. This is so disorienting that it can make you immediately crash to the floor.
These sensors also detect tilting sensations and can create feelings that you are rocking forward and back, or side-to-side. As I discussed in the blog on mal de debarquement syndrome, this can be set off by traveling on a boat and the feeling is exactly like the wave action is continuing in the head after disembarkation. Rocking can be found in a few other vestibular diseases, and it can occur in people with migraine even without a history of boat travel.
Gravity is a form of linear acceleration, similar to the acceleration felt when stepping on the gas in a car, so these gravity sensors also play a role when driving. When they malfunction, it is common to feel a change in the dizziness when driving; the feeling can be temporarily reduced or worsened by sudden changes in speed. It can feel like a twisting or banking feeling, as if on a curved racetrack. When it is very severe, the road can appear to tilt up at an angle, as if you were actually banking, then settle back down. People with mal de debarquement often find that their dizziness improves when driving, probably because this suppresses the malfunction in the gravity sensing pathways.
These sensors help maintain head position, and when diseased can cause the head to remain tilted. This problem with head tilting often sets off neck pain. Gravity sensors also help the eyes to remain level in the head, so diseases that affect these can cause double vision, or the illusion that the floor is sloping or constantly tilted at an odd angle.
It is not uncommon to have more than one type of vertigo at the same time. If the inner ear is suddenly damaged, with loss of function in both the spinning sensors and gravity sensors, you might see the world spinning, while also seeing the floor tilted at a crazy angle. This makes it very hard to walk without falling.
In my next post, I’ll discuss another cause of dizziness: problems of visual focusing due to inner ear troubles.