Why does vertigo make me sick?

Nausea and vomiting commonly accompany vertigo.  People vary in how sensitive they are to motion.  Some vomit with even mild dizziness, and others can experience violent vertigo with only mild nausea.  If you can see the environment spinning, and it continues for more than a few minutes, nausea will usually begin to build.   Vomiting can be set off by several different bodily systems (food poisoning in the stomach and intestines, for example) and it is controlled by the brain with a very complex set of subsystems. 

The vestibular system is interconnected with the reticular formation, part of the brainstem that coordinates and controls key centers for consciousness.  This formation includes the reticular activating system, a network in the brain that helps in arousal and awakening.  It is important that a person awaken when the head is suddenly moved, because it can indicate an impending fall.  When you abruptly jerk your head upright after starting to nod off, or when someone shakes you to help wake you up, you are using this system.  

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The problem of falling

Falling  can occur due to vestibular disease, but also happens in normal people.  Humans stand on two feet, which is much less stable than the four-footed mobility of most animals.  To master this, we had to develop a tight system of reflexes and feedback to our balance system.   There are three critical areas:

1) The vestibular system of the inner ears and brain.  This keeps your brain informed about any head movements that occur and sends out appropriate reflexes to the eyes and body.

2) Vision, including 3-D vision and visual tracking.  Vision overlaps with the inner ear in keeping track of head movements. It also gives feedback if vision is blurred by movement that helps fine-tune the reflexes.

3) Sensation, strength and mobility in the legs and feet.  The arms, hands and neck are also part of this system.  These body parts need to be able to respond smoothly and quickly to the reflex information being sent to the balance system and give feedback about the ground or environment that is conveyed by touch and position sensors.

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How are imbalance and dizziness connected?

When a person has a dizziness disorder, they will often feel off balance when on their feet.  Imbalance  or unsteadiness can be as simple as  just feeling “off”, or slightly uncertain of your balance.  As imbalance worsens, you might begin to fear that you will fall, and you may bump into doorways or have to touch counters in the house to steady yourself.  A more severe imbalance can cause you to stagger from side to side when walking or have to walk with your feet wide apart to maintain balance.  Most people will start using support aids like a cane or walker when this stage is reached.  In the most severe cases, you might be unable to walk unless someone is physically holding you up.   People with this very severe imbalance will be confined to a wheelchair or their bed.

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