Ending Vertigo Today

Dizziness: Tilting and elevator feelings

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.

Dizziness: Fainting vs. Inner ear disease

Dizziness, lightheadedness, or giddiness can result from many different diseases and is not limited to problems in the inner ears. In general, these symptoms can be broken into two broad categories: presyncopal lightheadedness, and vestibular dizziness.

Syncope is the medical term for a faint. When you feel as if you are passing out or about to faint, you are experiencing presyncopal lightheadedness. During fainting loss of consciousness occurs, and you will usually slump or fall to the floor. Just prior to fainting there is a sensation that vision is dimming, the world is fading far away, and thoughts are hard to keep focused. There may be a rushing or ringing sound in the ears and a feeling of weakness or nausea. A faint typically occurs when the blood flow to the head is abruptly reduced, either because the blood pressure or volume is too low, or the heart rhythm is disturbed. There are many different disorders that can cause faints or lightheadedness. For example, dehydration, medications, and palpitations can all result in a faint.

Making the diagnosis: The first spell

Vertigo and dizziness come from many different causes, and it is important to figure out exactly which one is the source. When people come to me with a dizziness problem, one of the key things to narrow down the diagnosis is to have them describe their first spell. Here are a couple of examples:

Beth recalled having three bouts of vertigo over the last several years. The first one was very similar to the other two. She was in bed, and in the early morning she woke up with vertigo immediately after rolling over to her right side. The room was spinning violently but only for about 15 seconds. When she tried to get out of bed, it happened again. All the spells were short. That morning after she was up and about, she felt better, but when shampooing her hair in the shower, she had another brief bout. She had to be careful when lying down on her right side for a couple of weeks, but it all gradually went away.