Written by Sophie Hose, DC, MS, CCSP
What is Vertigo?
Vertigo is a sensation of self-motion when no self-motion is occurring or a sensation of distorted self-motion during an otherwise normal head or body movement. This condition can lead to balance issues, nausea, and difficulty with daily activities. Vertigo is often used interchangeably with dizziness and lightheadedness. While all three situations can have tremendous effects on somebody’s quality of life, there are subtle differences between them:
Lightheadedness, which is the feeling one gets before losing consciousness (aka presyncope), is usually due to vascular reasons (not enough blood flow to the head or not enough nutrients or oxygen in the blood).
Dizziness however is defined as a sensation of impaired spatial orientation without a distorted sense of motion. This makes dizziness a broader term that actually includes vertigo, as it encompasses false spinning sensations (eg. Spinning vertigo), as well as other false sensations, such as swaying or tilting (eg. Non-spinning vertigo).
Vertigo and dizziness are both caused by dysfunction either in the vestibular system or in the parts of the brain that interpret information from the vestibular system. The vestibular system is located in our inner ears and consists of two functional divisions:
- The three semicircular canals (anterior, posterior and horizontal) are responsible for detecting angular movements of the head (eg. Tilting your head forwards or backwards).
- The utricle and saccule are responsible for detecting linear motion. This includes moving straight up and down, left and right and forwards and backwards.
Each division of the vestibular system has a bony ‚shell‘ that contains a membranous tube system. There are two fluids inside the vestibule system, one inside the tubes and one outside. Information about head movements is collected by tiny hair cells inside the membranous tubes that are bent one way or the other by the fluid inside the tubes which moves whenever we move our head. The signals created by the hair cells travel along a nerve (the vestibulocochlear nerve) to an area in our brain called the brainstem. The brainstem houses neurons that are responsible for controlling all vital functions (eg. Heart rate, blood pressure, breathing, digestion, etc.), also known as the autonomic nervous system.
The purpose of the vestibular system is for our brain to know at all times where our body and our head specifically are located in space and what their relationship to gravity is. This information is important for many reasons, some of them include the modification of blood flow based on our position (for example ensuring appropriate blood flow to the brain when we are laying down versus standing up) or producing accurate movement pattens of our head and neck, which is only possible if our brain knows where the‚starting position‘ of our head is.
Vertigo affects millions of people worldwide, and its management requires a comprehensive understanding of its underlying causes.
In short, vertigo is caused by a mismatch between the three senses that help our brains orientate themselves in space. Apart from the information the brain receives from the vestibular system, the other two systems that we use for orientation are our eyes (vision) and receptors all over our muscles, joints, tendons, ligaments, fascia, etc. The information from these receptors is called proprioception – our sense to ‚perceive‘ own bodies. When a person sees with their eyes that they are not moving and feel with the proprioceptors in their bodies that they are not moving but their vestibular system tells their brain that they are spinning – they will most likely experience vertigo.
Types of Vertigo: Central vs. Peripheral
Vertigo can be broadly categorized into two types: central and peripheral. Understanding the differences between these types is crucial for effective diagnosis and treatment.
Peripheral Vertigo
Peripheral vertigo originates in the inner ear or the vestibular nerve, which connects the inner ear to the brain. This type is more common and often less serious than central vertigo.
Common Causes of Peripheral Vertigo:
- Benign Paroxysmal Positional Vertigo (BPPV): Small crystals in the inner ear (called otoconia) become dislodged and travel within the fluid of the membranous tube into one of the semicircular canals, where they bend the hair cells and cause firing into the brainstem. This leads to short, intense episodes of dizziness triggered by head movements, such as turning over in bed. BPPV is the most common peripheral vestibular disorder. In fact it is so common that healthcare providers have observed that when somebody has a head injury of any sort, it is more common for this person to have BPPV than to not have it.
- Meniere’s Disease: A condition characterized by fluid buildup in the inner ear, causing vertigo, hearing loss, and tinnitus.
- Vestibular Neuritis: Inflammation of the vestibular nerve, often due to a viral infection, resulting in severe vertigo.
Central Vertigo
Central vertigo is less common and originates in the central nervous system (CNS), particularly the brainstem or cerebellum. This type of vertigo can indicate more serious underlying conditions and often presents with more severe neurological symptoms.
Common Causes of Central Vertigo:
- Migraines: Migrainous vertigo can occur with or without headache and includes episodes of vertigo.
- Multiple Sclerosis: MS can damage parts of the brain that control balance, leading to vertigo.
- Stroke: Reduced blood flow to certain areas of the brain can cause vertigo and other neurological deficits.
- Tumors: Brain tumors can press on areas involved in balance, resulting in vertigo.
Most commonly however, patients with central vertigo are not experiencing the above named severe disorders. Instead, there is dysfunction in the areas of their brains that are responsible for integrating information from the vestibular system. What exactly caused this dysfunction in the first place is often difficult to pinpoint in the aftermath. With chiropractic neurology, this vestibular dysfunction can be treated.
Chiropractic Neurology and Vertigo
Chiropractic neurology, also known as functional neurology, is a field that combines chiropractic principles with neurological science to diagnose and treat disorders of the nervous system. This approach can be particularly effective in managing vertigo by addressing the root causes and restoring balance to the nervous system.
Assessment and Diagnosis
A chiropractic neurologist conducts a thorough assessment to determine whether vertigo is peripheral or central. This involves:
- Patient History: Understanding the onset, duration, and triggers of vertigo episodes.
- Physical Examination: Checking for nystagmus (involuntary eye movement), balance issues, and other neurological signs.
- Diagnostic Tests: Using maneuvers like the Dix-Hallpike test for BPPV or assessing reflexes associated with the vestibular system (eg. vestibule-ocular reflex).
Treatment Approaches
The treatment for vertigo in chiropractic neurology is personalized and may include:
- Vestibular Rehabilitation: Exercises designed to improve the function of the inner ear and balance system .
- Chiropractic Adjustments: Gentle manipulations to address misalignments in the spine that could affect the nervous system.
- Eye Movement Exercises: Training to improve the coordination between the visual and vestibular systems .
- Lifestyle Modifications: Advising on diet, stress management, and other factors that can influence vertigo.
The Role of Chiropractic Neurology in Vertigo Management
Chiropractic neurologists use a multi-faceted approach to treat vertigo, which involves understanding the intricacies of the nervous system and its interaction with other bodily systems. This comprehensive care model not only addresses the symptoms but also the underlying causes, providing a holistic treatment plan.
Case Studies and Evidence
A study published in the Journal of Chiropractic Medicine highlighted the efficacy of chiropractic care in treating patients with BPPV. The study found that patients who received canalith repositioning maneuvers, a common technique used to reduce the impact of the dislodged otoconia on the brainstem, experienced significant improvement in their vertigo symptoms. Another research article in Frontiers in Neurology demonstrated that vestibular rehabilitation exercises can effectively reduce the severity and frequency of vertigo episodes in patients with vestibular disorders.
Conclusion
Vertigo, whether peripheral or central, can be debilitating, but understanding its origins is the first step towards effective treatment. Chiropractic neurology offers a holistic and non invasive approach to managing vertigo, focusing on restoring the balance and function of the nervous system. By addressing the underlying causes and implementing personalized treatment plans, individuals suffering from vertigo can find relief and regain their quality of life. The integration of chiropractic adjustments, vestibular rehabilitation, and lifestyle modifications underscores the comprehensive nature of chiropractic neurology in vertigo management, providing hope and improved outcomes for those affected by this challenging condition.
If you or someone you love is suffering from vertigo and you would like to learn how chiropractic neurology can help, contact the team at Georgia Chiropractic Neurology Center today. We look forward to hearing from you.
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