Dizziness and Vertigo: Causes, Diagnosis, and Effective Treatment

What are Dizziness and Vertigo?

Dizziness is a common sensation that can manifest as mild instability, lightheadedness, or a presyncopal state. It is not a disease, but rather a symptom indicating potential disruptions in the body. Unlike general dizziness, vertigo is a specific sensation of spinning or movement, where it feels as though you or your surroundings are revolving. Vertigo is often accompanied by nausea, vomiting, and balance disorders, which significantly impair the quality of life.

Main Causes of Dizziness

The causes of dizziness and vertigo are diverse and can be associated with dysfunctions of the vestibular system (inner ear, vestibular nerve, cerebellum) as well as other body systems. It is important to understand that many conditions can cause these symptoms:

• Migraine and vestibular disorders. Migraine is one of the frequent causes of vestibular symptoms, which can significantly impact daily activity, even in the absence of a formal diagnosis of vestibular migraine [2]. Chronic migraine frequently coexists with other neurological conditions, such as functional seizures [1]. Vestibular migraine is a specific form of migraine in which dizziness is the dominant or most bothersome symptom.
• Neurological diseases. Certain neurological conditions, such as multiple sclerosis, can be accompanied by seizures and other manifestations, including dizziness and balance disorders [6].
• Vascular disorders.
  • Anemia caused by chronic bleeding (e.g., in hereditary hemorrhagic telangiectasia, or HHT) can lead to dizziness and general weakness [4].
  • Cerebral vascular malformations characteristic of HHT can also cause neurological symptoms, including dizziness [4].
  • Intracranial hemorrhages, including iatrogenic ones associated with the use of oral anticoagulants, are a serious, albeit rare, cause of acute neurological disorders that may present with dizziness [5].
• Medication side effects. Certain medications, especially anticoagulants, can cause bleeding, which in turn can lead to dizziness [5].
• Other causes. These include inner ear disorders (e.g., benign paroxysmal positional vertigo, Meniere's disease), cerebral circulation disorders, psychogenic factors, and general conditions such as dehydration or low blood sugar.

Diagnosis: How to Find the Cause?

Accurate diagnosis of the cause of dizziness requires a comprehensive approach and a thorough examination. The physician performs:

• Anamnesis and physical examination. The doctor details the nature of the dizziness (spinning, instability), its duration, provoking factors, and accompanying symptoms (headache, nausea, hearing loss, weakness). A neurological examination, along with an assessment of coordination and balance, is performed.
• Specialized vestibular tests.
  • Dizziness Handicap Inventory (DHI): Used to assess the degree of impact of dizziness on the patient's daily life and emotional state [2].
  • Video Head Impulse Test (vHIT): Evaluates the function of the semicircular canals of the inner ear, identifying impairments in the vestibulo-ocular reflex [2].
  • Other tests: caloric test, posturography, electronystagmography.
• Instrumental studies. May include brain MRI, CT, and ultrasound of the neck and head vessels to rule out structural pathologies or circulatory disorders.
• Laboratory tests. Complete blood count (to detect anemia) [4], blood chemistry, and hormonal tests may be prescribed to rule out systemic causes.

Modern Approaches to Dizziness Treatment

Treatment for dizziness is always aimed at eliminating or controlling the underlying cause. The therapeutic approach can vary significantly depending on the diagnosis:

• Migraine therapy.
  • Preventive migraine treatment significantly reduces vestibular symptoms and related disability in patients with migraine, including vestibular migraine [2].
  • Botulinum toxin type A (BoNT-A) has proven effective in reducing headache frequency in chronic migraine, which can improve the overall condition of patients with concomitant neurological symptoms [1].
  • CGRP-targeted therapy. Drugs blocking the calcitonin gene-related peptide (CGRP) are a modern method for treating migraines [7]. Reducing CGRP activity can help alleviate both headache and associated vestibular symptoms.
• Treatment of other conditions.
  • For anemia: correction of iron deficiency, treatment of the underlying disease (e.g., HHT, including embolization of vascular malformations if necessary) [4].
  • For neurological diseases (e.g., multiple sclerosis): specific therapy aimed at controlling the underlying disease [6].
  • For iatrogenic bleeding: discontinuation or dose adjustment of anticoagulants, hemostatic therapy [5].
• Symptomatic treatment. Vestibular suppressants (e.g., antihistamines, benzodiazepines) and antiemetics can be used to manage acute bouts of dizziness.
• Vestibular rehabilitation. Special exercises aimed at training balance, coordination, and adapting the vestibular system play an important role in the long-term management of dizziness.

When to See a Doctor?

You should seek medical attention immediately for sudden, severe dizziness, especially if it is accompanied by:

• Acute, unusual headache.
• Speech or vision disturbances.
• Sudden weakness or numbness in the limbs.
• Loss of consciousness.
• High fever.
• Severe nausea and vomiting that does not bring relief.

You should also consult a doctor if you experience chronic or recurrent dizziness that interferes with daily life, causing anxiety or depression.

Sources

1. Effect of chronic migraine treatment on functional seizure frequency: An exploratory study. https://pubmed.ncbi.nlm.nih.gov/42401138/
2. Prospective cohort study of the impact of preventive migraine treatment on vestibular function and symptoms: The SPIRAL study. https://pubmed.ncbi.nlm.nih.gov/41265241/
3. Diagnosing Glaucoma Based on the Ocular Hypertension Treatment Study Dataset Using Chat Generative Pre-Trained Transformer as a Large Language Model. https://pubmed.ncbi.nlm.nih.gov/39346574/
4. How to manage patients with hereditary haemorrhagic telangiectasia. https://pubmed.ncbi.nlm.nih.gov/26205234/
5. Iatrogenic causes of an ICH: OAT therapy. https://pubmed.ncbi.nlm.nih.gov/18289410/
6. Management of seizures in patients with multiple sclerosis; an Iranian consensus. https://pubmed.ncbi.nlm.nih.gov/31151870/
7. CGRP-targeted migraine treatment and early pathophysiology in experimental subarachnoid hemorrhage. https://pubmed.ncbi.nlm.nih.gov/42215868/
8. Assessing the reliability and readability of migraine treatment information on Turkish websites. https://pubmed.ncbi.nlm.nih.gov/39334340/

Disclaimer: The information provided in this article is for reference purposes only and cannot replace professional medical advice. For accurate diagnosis and treatment prescription, always consult a qualified specialist.