Vertigo

Vertigo is a symptom where a person feels as if they or objects around them are moving when they are not. It is often a spinning or swaying movement. A person may experience nausea, vomiting, sweating, or difficulties walking. It is usually worse when the head is moved.

Benign paroxysmal positional vertigo (BPPV) is where specific head movements cause vertigo – is the most common type of vertigo.

Prevalence

According to the Canadian Consensus Criteria, Vertigo only occasionally affects ME/CFS patients.

Vertigo in ME/CFS

Vertigo is not commonly experienced by ME/CFS patients (although possible as neurological problems in general are a prominent feature of ME/CFS). Dizziness is a far more common symptom of ME/CFS, and is usually due to Postural orthostatic tachycardia syndrome (POTS) or other forms of orthostatic intolerance. which are prominent co-morbid symptoms and just two of the [:Category:Cardiac_signs_and_symptoms |cardiac signs and symptoms]] they can experience.

Symptom recognition

The Canadian Consensus Criteria recognizes vertigo occuring within ME/CFS, although vertigo is not a diagnostic symptom of ME/CFS:

"Vertigo accompanied by nystagmus, nausea and/or vomiting and often associated with tinnitus and/or impaired hearing acuity requires an anti-nauseant but there is no good treatment."

Possible causes

General causes for vertigo include:

• Benign paroxysmal positional vertigo (BPPV) – where specific head movements cause vertigo
• Labyrinthitis – an inner ear infection caused by a cold or flu
• Vestibular neuronitis – inflammed vestibular nerve
• Ménière's disease – a rare inner ear condition, which may also cause tinnitus or hearing loss
• Migraines, which can occur in ME/CFS patients, including "silent migraines" (migraine causing neurological symptoms but without headache)

Certain drugs can also cause vertigo, this should be listed as a side effect on the patient information (PI) leaflet.

Tests

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In our Vestibular Tests Video Series, Kristen Janky, Au.D, Ph.D., CCC-A, Vestibular Audiologist at Boys Town National Research Hospital, explains the VNG test. By BoysTownHospital

Videonystagmography (VNG eng testing) is used for testing inner ear and central motor functions.

There are 4 main parts to a VNG test:

1. Occular Mobility 

You will be asked to have your eyes follow objects that jump from place to place, stand still, or move smoothly. The technician will be looking for any slowness or inaccuracies in your ability to follow visual targets. This may indicate a central or neurological problem, or possibly a problem in the pathway connecting the vestibular system to the brain.

2. Optokinetic Nystagmus

2. You will be asked to view a large, continuously moving visual image to see if your eyes can appropriately track these movements. Like the occular mobility tests, the technician will be looking for any slowness or inaccuracies in your ability to follow visual targets. This may indicate a central or neurological problem, or possibly a problem in the pathway connecting the vestibular system to the brain.

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Vestibular Tests - Roll Test (Positional Nystagmus): The maneuver we can use to assess for horizontal canal BPPV is called the Roll Test. For this maneuver the patient starts sitting up and then they will lay straight back and you will hold their head at a 30 degree angle. For more information on our Balance and Vestibular. By BoysTownHospital

3. Positional Nystagmus 

The technician will move your head and body into various positions to make sure that there are no inappropriate eye movements (nystagmus), when your head is in different positions. This test is looking at your inner ear system and the condition of the endolymph fluid in your semi-circular canals. The technician is verifying that small calcium carbonate particles called otoconia are not suspended in the fluid and causing a disturbance to the flow of the fluid.

4. Caloric Testing 

The technician will stimulate both of your inner ears (one at a time) with warm and then cold air. They will be monitoring the movements of your eyes using goggles to make sure that both of your ears can sense this stimulation. This test will confirm that your vestibular system for each ear is working and responding to stimulation. This test in the only test available that can decipher between a unilateral and bilateral loss.

Potential treatments

Meclozine is a suggested treatment for vertigo, it is acts against nausea and is also an antihistamine.

The Canadian Consensus Criteria is suggests "Finding Center" for balance issues (Jones and Clarke, 2002) and the Cawthorne/Cooksey System for vistibular injuries to restore equilibrium.

See also

• Dizziness
• Nausea
• Migraine
• Orthostatic intolerance

Learn more

• Vertigo: Symptoms, Causes and Treatment - WebMD
• Vertigo - NHS
• Cawthorne-Cooksey Exercises - Information for patients - St George's Hospital, NHS

See myalgic encephalomyelitis.

See chronic fatigue syndrome.

See postural orthostatic tachycardia syndrome.

postural orthostatic tachycardia syndrome (POTS) - A form of orthostatic intolerance where the cardinal symptom is excessive tachycardia due to changing position (e.g. from lying down to sitting up).

See adverse reaction.

adverse reaction Any unintended or unwanted response to a treatment, whether in a clinical trial or licensed treatment. May be minor or serious.

See Canadian consensus criteria.

Canadian Consensus Criteria (CCC) - A set of diagnostic criteria used to diagnose ME/CFS, developed by a group of practicing ME/CFS clinicians in 2003. The CCC is often considered to be the most complex criteria, but possibly the most accurate, with the lowest number of patients meeting the criteria. Led to the development of the International Consensus Criteria (ICC) in 2011.