your vertigo just won’t go away?
Chronic vertigo can be a whole mixed bag. It can cause anxiety that your symptoms could come on at any time, fear of feeling out of control, frustration that your vertigo is not getting better, all leading down a path of depression and hopelessness that you will never find a fix.
I created this site to give you hope that you will see better days! My desire for this site is to explore what has the best evidence for success in recovering from vertigo and what has worked for others. Whether or not you are able to completely resolve your vertigo, you can definitely get to a point where it is managed better. I hope this is a pathway to help you along the way and guide you in the direction you need to go.
Vestibular Migraines
While what happens during a migraine is still not completely understood, it is thought that there is an electrical event leading to depolarization of cells in the brain, changes in the flow of neurotransmitters, vascular changes, and inflammation. These events can cause people who experience migraines to be hypersensitive to their environment, as the brain is unable to efficiently process information it receives. There is often light, sound, motion, and/or visual sensitivity.
how do I know if I have vestibular migraines?
Unlike a vestibular neuritis which is a sudden onset of vertigo and progressively improves (only occurring once), vestibular migraines will have
Several episodes (technically at least 5), lasting 5 minutes to 72 hours
More likely to have vestibular migraines if you have a history of classic migraine
You have at least one of the following with 50% of your migraine episodes
headache with two of these characteristics
one sided location
pulsing in quality
moderate or severe in pain intensity
worse with physical activity
light or sound sensitivity
visual aura (seeing lights or colors before your migraine episode or during)
Keep in mind that you do not have to have a headache to have vestibular migraines. A big indicator you should look into vestibular migraines is if you have multiple recurring vertigo episodes with the qualifications above.
Persistent Postural Perceptual Dizziness
Persistent Postural Perceptual Dizziness, also known as 3PD, is often described as a swaying or rocking sensation. These symptoms are often more constant or lasting hours and will get worse in busy visual environments such as a grocery store, crowded area, or with busy visual patterns like gingham, chevron, etc. People often describe their symptoms being worse with standing and better with sitting or laying down. When you sit or lay down you have more sensory input through your body to give your brain a better sense of where you are in space, compared to just having the bottom of your feet in contact with a stable surface. 3PD often is seen after other vestibular disturbances like vestibular migraines or vestibular neuritis, or has an onset after stressful life events, affecting how the brain processes sensory information.
how do I know if I have 3PD?
3PD is typically diagnosed based off of how your symptoms are presenting. To have a diagnosis of 3PD, you need to have:
Dizziness that is non-spinning (often it is described as a rocking or swaying)
Dizziness occurs most days
Have had these symptoms for longer than 3 months
Dizziness lasts hours or longer, may get better or worse throughout the day
Symptoms are worse with standing, movement (whether you are moving or riding in a car), and busy visual environments
Symptoms came on after another medical condition, stress, or vestibular disorder
Symptoms cause distress or impact your ability to perform daily tasks
Other conditions have been ruled out
Cervicogenic Dizziness
All the muscles and joints in your neck give you a sense of where you are in space (we call that proprioception). The neck in particular has more proprioceptive input and connection with the vestibular system than other areas of the body. Proprioception gives us the ability to tell that our elbow is bent, even when your eyes are closed. When there are imbalances in the neck, there can be poor quality signals sent to the brain on where the head is in space, this will cause a mismatch between what the vision and inner ear are telling the brain, causing dizziness or vertigo symptoms.
how do I know if I have cervicogenic dizziness?
People with cervicogenic dizziness often describe their dizziness as a disorientation or “head up in the clouds” type of feeling. Sometimes people also describe fuzzy or blurry vision that goes along with it, or a heavy headed feeling.
It’s important to exclude common causes of dizziness before to arriving at a diagnosis of cervicogenic dizziness. You want to make sure that you do not have BPPV, vestibular migraines, 3PD, or other causes of vertigo. With that in mind, you can often have overlapping diagnoses. Maybe you are experiencing vestibular migraines, 3PD, AND cervicogenic dizziness.
Often these symptoms will be worse in the morning and improve throughout the day. I sometimes attribute this to sleeping position/posture, as neck ergonomics while sleeping can perpetuate cervicogenic dizziness. People will also have an increase in symptoms if they are looking down or looking up for a prolonged period of time. This often occurs when looking down at your phone for a while and then looking back up you may experience some disorientation. If laying down with your neck extended (such as in the dix hallpike test) is causing dizziness but you have no nystagmus, and your dizziness stays the same or worsens the longer you are in that position, you may want to consider cervicogenic dizziness. There are some clinical tests we can do but they need to be correlated with the entire presentation as the tests alone are not enough to say “yes, you have cervicogenic dizziness.”
Taking into account your symptoms, the duration, frequency, description of how they feel, and when they are worse/get better help vestibular specialists to narrow down a diagnosis. I often will try doing some massage therapy on my patient’s neck, if their symptoms improve afterward, then I can say more confidently that cervicogenic dizziness may be contributing to their symptoms.