Month: December 2019

Know anyone who’s had vertigo? It’s more common than you might think, especially among the “over 60” crowd.

Vertigo is a sensation of spinning and loss of balance. While it can be associated with looking down from a great height, it can also be caused by disease or condition affecting the inner ear. The most common type of vertigo is called BPPV…

• Benign (not cancerous)

• Paroxysmal (comes and goes, and doesn’t last long—usually less than a minute)

• Positional (triggered by moving the head in a certain position or direction)

• Vertigo (dizziness, sensation your surroundings or the inside of your head are spinning)

  • Often accompanied by nausea

  • Affects women twice as often as men

I just had a bout of it, and it’s not much fun…a bit scary, actually. But it stopped so quickly–in about 10 seconds–I didn’t think it could be a serious problem (and it isn’t for most people). Of course, dizziness can be a sign of other problems, some quite serious, so it’s a good idea to discuss your dizziness with your doctor if you start to experience this.

BPPV vertigo usually only lasts for a week or two. It’s diagnosed by first eliminating anything more serious, and by getting you to lay back with your head 45 degrees to one side. You may need to repeat the movement with your head to the other side. If it’s vertigo, your eyes will start to move back and forth, as they do after you’ve spun yourself around enough to feel dizzy, and this movement will trigger the feeling of dizziness. This eye movement is called nystagmus.

Vertigo originates in part of the inner ear called the semicircular canals (note the top loopy part of the purple structure in the diagram above). As the name suggests, these are 3 semicircular loops filled with liquid and, when we turn, tiny hairs that line the loops can sense the movement of the liquid inside the loops. Your brain uses this information to sense what direction your head is moving, even when your eyes are closed or you’re inside a plane or large ship.

There are tiny crystals, called otoliths, attached to the base of the semicircular canals. When one of these breaks off and enters a canal, its movement (controlled by gravity when you lay down or turn quickly) can confuse the tiny hairs that detect movement of liquid in the canals. This can make you feel like you’re moving when you are not, creating the dizziness in BPPV vertigo. It usually takes only a few seconds for the crystal to fall to the bottom of the canal, and that is why BPPV vertigo only lasts a short time. I posted a video below that explains it better…

Treatments

One of the treatments for BPPV vertigo uses this information. The patient is helped through a series of movements designed to move a loose crystal (otolith) out of the affected canal. It’s not difficult to do and can be repeated as needed, once you understand the movements. It is called the Epley manoeuvre. Here’s a link to a video that demonstrates this and the theory of the crystal movement.

A few medications are available to treat vertigo, although they are more commonly used with longer-lasting types like Meniere’s disease. One medication is Betahistine (brand name Serc), a type of antihistamine that some find helpful, although its effectiveness has been questioned. Another is a combination of Meclizine (antihistamine) and low-dose Niacin (vitamin B3), formerly available as Antivert tablets, but now discontinued. However, the individual ingredients, Meclizine and Niacin, are still available and can be bought without prescription in most countries. Meclizine is usually on the pharmacy shelf next to the Gravol or is sometimes kept behind the pharmacy counter. Niacin is found in the vitamin section, and you would take only 1/2 of a 100mg tablet. A compounding pharmacist could make this combination into capsules for you, and I often made these in my pharmacy. However, since episodes of BPPV vertigo are so short and usually last only 1 to 2 weeks, these medications are generally reserved for other types of dizziness, such as Meniere’s disease or labyrinthitis.

What causes otolith crystals to dislodge, causing BPPV?

BPPV can be caused by a minor injury to the head, but it can occur without an injury, as it did to me. Some drugs are reported to increase the chance of developing vertigo, and medication should always be considered if there is no obvious cause. The list includes some very common drugs, such as codeine, prednisone, omeprazole (Losec), furosemide (Lasix), melatonin and many others. Here is a link to a good reference about this.

I had just started using a new medication and, although it isn’t included on the list, I believe it caused my vertigo. Here are my reasons: the medication I started using is the corticosteroid, budesonide, and it is in the same drug family as prednisone (which is on the list). Although the product is designed to be inhaled as a treatment for asthma in children, my prescription was to mix it with saline and use it as a sinus rinse (neti pot). This is an “off label” use for this product, meaning that it has not been tested or approved for this use. It is similar to corticosteroid nasal sprays that are commercially available, however, but stronger and generally used this way only short-term for inflamed sinuses, when regular sprays have failed.

My vertigo started when I’d been using the new medication for about 3 weeks. It gradually improved over a couple of days when I stopped the medication and got worse again when I restarted it. When I stopped it a second time, the vertigo improved again over a few days and hasn’t returned. However, I have been left with tinnitus, ringing of the ears, that 3 weeks later is still a nuisance (especially at night, when it’s quiet). So, a bit of an experiment, but it convinced me that the medication is a problem for me.

But the experience has left me wondering whether others have developed vertigo after using budesonide as a nasal rinse. One problem with “off label” use of drugs is that adverse reactions are often not reported as they would have been while being tested for official approval. I will ask my doctor about this when I see him at my upcoming appointment.

So, have you ever had vertigo? Was the cause identified? Could it have been caused by a medication you were using? I’d love to hear about it…click the Questions/Comments button and send me an email!

References (click to link to article):

Epley manoeuvre

Medicine-induced Vertigo—Medsafe, New Zealand

Benign paroxysmal positional vertigo—Wikipedia