A reader writes: I have a general sensation that I am on a boat. It is the worst in the morning and I am finding that I have difficulty walking straight and really have to concentrate on keeping my balance during the first hour of the day.
Read more: Rocking vertigo and PMDDRocking vertigo is a feeling of continuous up-and-down, boat-like rocking. Usually this sensation is inside your head and there is no visual appearance of motion. It can occur spontaneously or can arise immediately after travel in a boat or airplane.
Most people with this sensation have experienced migraine headaches or auras in the past, suggesting that it may be a form of migraine-associated vestibulopathy. Usually vestibular testing is normal, although some people show a low-grade positional nystagmus. The disorder does not worsen over time, causes no permanent damage to the ears, and tends to spontaneously disappear.
It is common to experience a rocking sensation for a few hours after returning to land from a boat trip. This sensation tends to increase when lying down with the eyes closed and can cause nausea similar to seasickness. A French term, Mal De Debarquement, is often used to refer to this normal sensation.
In some people the symptom can drag on for weeks, months or even years after travel, and is relieved by going back on a boat. This has been named Persistent Mal De Debarquement, or PMDD. It is also sometimes called Disembarkation Syndrome. The cause of this disorder is not known. The vestibular system is able to adapt to the rocking motion of the boat, part of the process that reduces motion sickness as one acquires “sea legs” on a voyage. PMDD likely results from a difficulty in shutting off this adaptation when returning to land. This sensation can also occur after turbulent airplane flights or other long-term exposure to rhythmic motion.
Part of this syndrome is is that you may become permanently programmed to the rocking feeling. This programming can be helpful in some ways; if you travel by boat often, you will adapt more quickly to the motion than most people do. Even after your symptoms resolve you might go into a room that triggers the memory months later, causing the rocking to instantly reappear.
There is a connection between OCD (obsessive compulsive disorder) and rocking vertigo. Once the rocking subsides, it is best to stop checking in your head for little signs of the feeling. It is better to distract yourself with other movement and not to pay close attention to it. Treatment with Paroxetine, a medication that affects serotonin in the brain, is one of the more effective drugs for this condition. Typically a remission develops gradually, with a day free of symptoms followed by a recurrence of the rocking, with more and more normal days over the next few weeks until the condition disappears. Activities that involve a great deal of head motion are also helpful, but rhythmic vertical movement should be avoided (tennis is a better choice, for example, than jogging). Vestibular rehabilitation is often useful when combined with medication. Since the rocking feeling is a vertical motion, you can counteract this by rotating your head side to side in the same rhythm as the rocking you feel. This helps override the programming.
Ending Vertigo Today 