5 Common Misunderstandings About Vertigo

Hi,  it’s Joey, director and founder of Seeking Balance Australia here.

Today I want to sing “it” from the top of the highest buildings so that everyone with dizziness can hear these 5 common misunderstandings about vertigo. Let’s take a look at these commonly asked questions:

  1. Is there a generic, one-size-fits-all, quick fix to vertigo?
  2. Can vestibular suppressant medication fix vertigo or dizziness?
  3. Do “Brandt-Daroff exercises” (flopping side to side on the bed repeatedly) fix vertigo or dizziness?
  4. Are ALL doctors and ALL specialists experts in vertigo?
  5. Is it true that you can’t cure vertigo and there is nothing you can do to help with vertigo?

  1. Is there a generic, one-size-fits-all, quick fix to vertigo?

The ears are complex and the impact of vertigo can cause a cascade of events unique to each and every person. We need to look at all of it. Our postural changes, our emotional reactions, our inner ears, our balance filters, our hormones, our visual sensitivity, our relationships, our lifestyle restrictions, our workload and so on.

Recovery from vertigo is a process that takes delicate fine-tuning and commitment.

I see it happen daily. It is all about developing clarity.  We need you understand our dizziness in order to rebuild balance.  We must create a gentle daily plan, and find patterns in our life that build better balance pathways from our ears, to our brain, and all along our musculoskeletal body.  Everyone is different, but the process of recovery has common elements.

  1. Can vestibular suppressant medication fix vertigo or dizziness?

There are many names for these medications (e.g. Serc, Stemetil) but essentially they are designed to reduce nausea and discomfort during a severe attack of vertigo. This is the sort of vertigo where our visual world is spinning for longer than 20-minutes. Most dizziness is brief or better described as dizziness inside the head rather than spinning in the vision. Vestibular suppressants are designed to stop the spinning vision and error signals that the balance brain is receiving from the ears.

These do not stop recurrent vertigo or cure vertigo.

Vestibular suppressant medications actually numb the communication from the inner ears to the eyes and the balance brain. This means that during a severe attack of spinning type vertigo, the brain is told to ignore these ‘error’ signals. The benefit of this is that when symptoms are at their worst, this medication can reduce the impact of the event. There are moments in life when this is very useful and this medication feels perfect.

However, most of the time, we are not experiencing the severe, spinning type of vertigo, and this medication is not needed. If taken daily, it will interfere with the communication pathways vital for re-establishing balance. We use our inner ear signals, travelling to our eyes and parts of our brain and back again, to recover from vertigo. We need them.  It is not ideal to ‘mute’ these balance signals daily.

Problem: long-term use of these vestibular suppressant medications can delay recovery from an inner ear condition. It is important that the inner ears and brain have robust communication for rebuilding balance pathways following a vertigo attack.

Vestibular suppressant medications make it difficult for our balance brain and ears to re-connect. People who accidentally over-medicate can become at risk of Parkinson type symptoms. In these cases, the brain has been told repeatedly to ignore the inner ear balance signals and it begins to weaken in this area of the balance brain.

Unfortunately, the patients who I have seen on long-term vestibular suppressant medication are often lacking self-confidence and feeling dizziness in daily life. Their natural balance mechanisms have not rewired or rebuilt. The medications have suppressed their natural balancing process. It is a common misunderstanding that vestibular suppressants treat vertigo, when in fact they can delay its recovery.

How did this happen you ask? Misunderstandings.

Someone would have been told to take the medication when dizzy. So they took it daily in the hope that it would prevent dizziness. Medication is often also used as an emotional support for people. It can feel good to take pills and feel that we are doing ‘something’ to help us feel better. Doing ‘something’ can feel better than ‘waiting’ for a miracle. However, getting updated information is really important.

Daily suppression of the vestibular system can prevent the balance system from finding its steadiness and clarity. These dizzy patients may have missed out on valuable opportunities for neuroplasticity.  Neuroplasticity is a word that describes the body’s ability to change and rebuild neural pathways, a process that is necessary for relearning balance.

Rebuilding balance is possible without vestibular suppressants.

There are ways to retrain both the balance pathways and our emotional reaction to dizziness. We can remain calm within the storm and no longer need to grab the medications. These are skills we can learn. We can stay supported. We can rebuild steadiness.

Have you been on a wild goose chase for months and years? Have you tried medications and not felt quite right? Thousands of people have been in your place. You are not alone.

Many vertigo clients have tried various medications, including anxiety and depression medications, to help treat their dizziness. And they still don’t feel quite right. There can be side effects and some medications can cause increased dizziness! Some medications interact and cause fatigue, digestive upset, fogginess or increased sensitivity to light/sound/movements.

Some medications help some people. We are all different. It can feel like a never-ending story.

What to do?

Know that you have not done anything wrong. This has been a misunderstanding. Learn more. Get information and support. In the long run, you may not need to rely on medications for vertigo or dizziness. They may offer a temporary relief. You may learn how to cultivate steadiness as a daily practice and try to find ways to reduce your reliance on medications.

Talk to your doctor about the medications you are currently trialling for dizziness. To help with positional dizziness that is exacerbated by movements, find a program or a health professional to gently guide you to start vestibular exercises daily. Consider some therapy to help with the fears, anxieties or unwanted sensations that you are likely to experience while the inner ears and brain recalibrate their balance over time. Mindfulness tools can help clients build emotional resilience with great results. Give yourself a solid six-months to adjust and to actually implement specific daily actions that support your balance system and to help you feel better. You will have to do it your way.

Am I Crazy?

  1. Do Brandt-Daroff exercises, flopping side to side on the bed repeatedly, fix vertigo or dizziness? And why hasn’t it worked after days of repetition?

This exercise was developed decades ago to help with positional vertigo. While it has helped many people over the years, it is not a quick fix for everyone. This is not an ear specific exercise and can actually increase both dizziness and anxiety if it is not appropriate/applicable.

These days, when diagnosing and treating positional vertigo, we usually opt for a treatment that is canal specific. This means we take a very careful look at the balance canals of each ear to diagnose where the problem is. Then we treat that canal only.

If we are flopping around randomly on either side, we can further disturb the delicate calcium particles that are floating around the inner ears. It can make the positional vertigo more complicated, shifting debris in multiple canals, and it can prolong effective treatments.

What to do?

Make sure that you test your ears for specific causes of positional vertigo. Check both the horizontal and posterior semicircular canals for an accurate diagnosis. You can do this with a vestibular specialist or use the video treatment kit that guides you through this at home.

Once you have established which ear and which canal is affected, use the appropriate treatment. Treat one canal at a time to make sure your inner ear debris is not further aggravated. Keep it simple. Keep it gentle. Seek support and further information if you are unsure.

 

  1. Are ALL doctors and ALL specialists experts in vertigo?

I am a fan of GPs and I think that they do an amazing job; a difficult job. General Practitioners are responding to every question, concern, complaint and condition known to man. They are constantly challenged and can be time poor. They may have received limited training related to vertigo and this may have been many years ago.

They do their best. Realistically, they may not have all the information, resources and treatment plans specific for your needs. They may opt for trialling medications as an early treatment plan, despite this not being the most effective long-term solution.

Ear, Nose and Throat (ENT) surgeons may specialise in throat cancer or nasal passages. They may not have chosen to specialise in vertigo or dizziness. Thus, they may not be your best resource for information on managing vertigo.

Some ENT surgeons are specialists in surgical procedures for conditions such as superior canal dehiscence (SCD) or vestibular schwannoma. Not all ENT surgeons will be familiar or expert in these rare conditions. Sometimes the chosen treatment is the non-invasive option of ‘wait and see’. So in these cases, dizzy patients are likely to benefit from the multidisciplinary approach to recovery including emotional support tools and gentle vestibular therapy.

Equally, not all neurologists specialise in vertigo or dizziness either. There are so many pathways that a medical doctor can take, and not all of them include detailed education about the vestibular system, the vestibular compensation process or the ‘how to’ of recovering vertigo symptoms.

What to do?

For complex vertigo conditions, make sure you are consulting with an oto-neurologist or neuro-otologist. These are the medical professionals who specialise in vertigo and will expertly investigate and diagnose your vertigo condition. They will guide you to explore the treatment options that best suit your body and your lifestyle needs. They will most likely reduce your medications to the minimum and use them as a temporary measure. They will encourage you to seek a daily home program for strengthening your balance organs and building your confidence.

Find a vestibular program that will introduce new movements gently and methodically. It is through daily movements and stillness that we reset our balance filters.  Get support and build you home program.

 

  1. Is it true that you can’t cure vertigo and there is nothing you can do to help with vertigo?

This one drives me crazy! Total myth. Don’t believe it.

Vertigo is spontaneous and unpredictable.  This is true.   But… there is a lot we can do to help treat and ease our vertigo symptoms. Firstly, learn about it. Learn about the type of dizziness or vertigo that you are experiencing. Learn to separate the anxiety and worry from the physical vertigo symptoms. This in itself can dramatically reduce the severity of your vertigo.

Seek support and find ways to return to natural movements in daily life. If we avoid activities or movements that make us feel dizzy, then we deprive our balance brain of that enrichment. Staying active and cultivating curiosity within the uncertainty of symptoms will help you support the natural vestibular compensation process.

We know that stress, worry, doubt and anxiety delay our recovery of vertigo. It impacts on our emotional brain and this interacts with our vestibular area of the brain.

Feeling anxious and stressed when dizzy is normal! Who wouldn’t freak out while their world is spinning? So having the anxiety initially is to be expected. The problem is only once the anxiety is present when the dizziness is not. This means we are worried about becoming dizzy. It is apprehensive anxiety and it can eat into our mental and emotional health.

The good news is that all of this worry is actually serving a purpose and we can learn to use it to help us feel better. We can transform worry. We can retrain our brain to perceive the dizziness differently. We can view our worries with an open mindset. We can change our brain and we can feel different.

We can feel balance, clarity and confidence despite our diagnosis.

However, I need to get honest here.

I have seen people believe there is nothing that can be done.

I have seen them stuck inside their vertigo symptoms. They think about symptoms constantly and worry about it daily. They feel genuinely dizzy, and stuck without a way out.

Certain head movements make them dizzy, so they avoid them. The brain is unable to relearn those movements and retrain.

They believe they can’t retrain balance, they feel dizzy daily and they are reluctant to try anything new because they feel stuck, and because they have been told there is nothing they can do. So they feel it isn’t worth trying. And that becomes their truth and their reality.

It can become this cycle of worry, dizziness, believing that they’re stuck, worried about being stuck, still dizzy, more dizzy, yep definitely feeling stuck, worry about that…. And so on.

What to do?

Find support and seek a therapist who you feel comfortable with. Try a program that gives you skills and tools to break the worry cycle and to feel better in your body. Even if this has been 30-years of dizziness for you and it feels like a lifetime, I have seen people make simply remarkable recoveries. They change their mindset, their behaviours, their posture, their actions and they change their symptoms. It happens.

Find a way to do it in your own time. Go gently and believe in your ability to ease dizziness and find steadiness. Your body wants to feel balanced. Your brain wants to feel calm and clear.

Find the tools you need to make it happen. Break the cycle. Feel yourself again.

Happy balancing!  Find your balance and find it your way.

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Joey Remenyi is a vestibular audiologist focused in the art of neuroplasticity, senior yoga teacher and the Founder and Director of Seeking Balance.