Judee B. Ayap woke up with an uneasy sensation in her head that was getting worse by the minute. She felt weak, dizzy and as though she had not slept for a couple of days. She tried to go back to sleep but the woozy feeling in her head kept worsening. However, it was when her bedside alarm went off that her world turned topsy turvy.
"That's when my world went completely out of control,'' recalls the Dubai resident. "I opened my eyes and I found everything a blur. I felt as though I was on a roller coaster and was being thrown off my seat. My head weighed a tonne and I could not balance it or coordinate my arms to reach for the clock to turn off the alarm. I wanted to scream for help but only a tiny gurgle escaped my mouth. I had no clue what was happening and began to wonder if I was going to die.''
After what seemed forever, she took a deep breath and called out for her husband Richard. "He was startled by my condition. He carried me to the living room and gave me some water. But the spinning sensation kept getting worse. I vomited. I also found I was too weak to stand.''
Judee, who has two children Ricah, three, and Charles, one, was rushed to hospital where the duty nurse administered some medication. "When I woke up, things were better and I felt as though I had survived a cyclone."
After undergoing tests, the duty doctor concluded that Judee had suffered a severe vertigo attack. She was prescribed some medication and was discharged from the hospital by the end of the day.
Back home, a lot of questions raced through her mind. "I wanted to know whether it would recur, what I must do or not do to help myself during an attack... I was ... scared. After all, it isn't every day that you see your life flash by you and you cling on to your world with all your strength,'' she says.
On the recommendation of a friend she consulted a doctor who seemed to have answers to almost all of her questions. "Interestingly, his first question was in a sense the answer to several questions that were racing through my mind," she recalls. "‘Does anyone in your family suffer from this condition?', he asked. I remembered the dizzy spells my mum and sister often said they experienced when they were my age. It kind of helped me accept what had happened to me."
In simple terms vertigo means "a feeling of motion when one is stationary", says Dr Bakul Kotak, ENT Specialist at Welcare Hospital, Dubai. It is a condition in which the external world seems to revolve around the individual or where the individual experiences a feeling of revolving in space," says the doctor. He answers a few questions on this condition:
What does someone with vertigo experience and why?
Vertigo is medically distinct from light-headedness and unsteadiness. Some patients may describe it as a feeling of being pulled towards the floor or towards one side of the room. Moving the head, changing position, and turning while lying down often worsens the condition.
Vertigo is a symptom, not a diagnosis. These symptoms are due to a damage or dysfunction of the labyrinth in the inner ear (responsible for balance and hearing), vestibular nerve, or that part of the brain responsible for receiving information from the inner ear. It is often associated with nausea and vomiting, as well as difficulty in standing and walking.
When the head moves, signals are transmitted to the labyrinth, which is an apparatus in the inner ear. The labyrinth transmits movement information to the vestibular nerve, which then carries the information to the brain and cerebellum (areas of the brain that control balance, posture, and motor coordination). Vertigo could result if any of these areas are affected.
What causes vertigo?
Vertigo can be classified into either peripheral or central depending on the location of the dysfunction of the vestibular pathway.
Peripheral Vertigo is caused by problems with the inner ear or vestibular system. The most common cause is benign paroxysmal positional vertigo, but other causes include Ménière's disease (disease of the inner ear), trauma and ear infection. Symptoms include vertigo, nausea, vomiting, visual difficulty, hearing loss, ringing in the ear, walking difficulty and a tendency to fall. There is usually no accompanying neurological issues. Any cause of inflammation such as common cold, influenza, and bacterial infections may cause short-lived vertigo if they involve the inner ear. Many chemicals and some antibiotics can cause short-term or persistent damage to the inner ear as well.
Central vertigo arises from the balance centres of the brain. It is usually milder and is accompanied by neurological issues such as slurred speech, double vision or involuntary eye movement, headache, nausea and vomiting. Brain pathology can cause a sense of imbalance. A number of conditions that involve the central nervous system may lead to vertigo including migraine headaches, multiple sclerosis, stroke, brain tumour.
What factors aggravate it and what must you do to prevent onset of a relapse?
Factors that aggravate vertigo depend of the cause of vertigo.
If it is due to an ear infection then you must avoid sleeping in a position that lays stress on the affected ear.
If it is due to disturbed blood flow then avoid foods that cause vascular spasm and use an anti-coagulant that the doctor prescribes.
Motion sickness can aggravate the symptoms - take a labyrinthine sedative prior to unavoidable journey (your doctor will prescribe one for you).
Be aware of your condition. Stay on a salt free diet and do adaptive exercises regularly.
Does it affect children? If so what are the signs and symptoms to look out for?
It is much more common than thought. Common causes of vertigo in children are benign paroxysmal vertigo of childhood (caused due to deposits in the inner ear), vestibular neuronitis (viral infection of the vestibular nerve), otitis media (inflammation or infection of the middle ear) and migraine-associated dizziness.
Children often cannot describe their signs and symptoms well and detailed history is one of the most important tools in diagnosis of vertigo. Hence in children it is not easy to come to a conclusion about the presence of vertigo. However, if a child repeatedly complains of headache, has a history of repeated falls and minor head injuries, has chronic ear complaints like ear infection, pain or discharge, it is cause for concern.
Do any particular foods trigger an attack?
Certain foods can trigger an attack in a specific type of vertigo. These are:
Salt: Excessive sodium can create imbalance in body fluids. It causes fluid retention in the body and affects pressure buildup in the inner ear, causing vertigo. A vertigo diet therefore needs to be salt-free.
Tyramine: Tyramine causes dilation of blood vessels and can trigger migraine, which can lead to vertigo. Chicken liver, smoked meats, yogurt, chocolate, bananas, citrus fruits, figs, ripened cheeses and nuts all contain the amino acid tyramine that can cause vertigo.
Alcohol: The inner ear plays an important role in maintaining body equilibrium by detecting motion and changes in position of the body and by sending appropriate signals to the brain. Alcohol interprets this function by sending false signals of motion to the brain, conflicting with the signals from the inner ear. This disrupts body equilibrium, triggering vertigo.
How does vertigo impact general well-being?
The first attack of vertigo can be a devastating experience for the patient. Depending upon the cause and severity, they may end up bed ridden for half an hour to a couple of days.
The patient usually thinks there is something seriously wrong with central nervous system. Certain types of vertigo can prevent people from carrying out their day-to-day activities and they may end up scared and may lose confidence in themselves.
It is therefore important not only to relieve the symptoms but to discuss the nature and likely cause of vertigo with the patient.
A realistic time frame should be given to the patient about how soon they would feel better and be able to return to usual normal daily activity. It is vital to stress that they are going through this attack which would eventually settle (depending upon the cause) and that they will be able to return to their normal routine.
Examining the history of the patient plays an important role in diagnosing the cause of vertigo. Similarly reassuring the patient is the most important part of treatment after controlling the acute attack. It is important to make sure that the patient doesn't drive or operate machinery for a few days until they are totally asymptomatic.
What are the measures that can be taken to contain the problem?
Medication is provided depending on the nature and severity of the condition.
It is a good idea to educate patients about certain exercises that they can do at home. For example, The Brandt-Daroff exercises are a form of habituation exercise, designed to allow the patient to become accustomed to the position that causes the vertigo symptoms. The Brandt-Daroff exercises are typically performed three times a day with five to ten repetitions each time, until symptoms of vertigo have resolved for at least two days.
From diagnosis to cure - what are the steps that a patient needs to take to ensure recovery is quick and hassle-free?
A detailed history (the most important part of diagnosis) with systematic neuro-otological clinical examination usually clinches the diagnosis. Reassurance plays a major role in curing the patient. The first attack is often severe, so it is important for the doctor to understand the case and offer reassuring treatment to boost the confidence of the patient. This should be followed by reference to a specialist (ENT) for further management.
Measuring blood pressure and heart rate are the first steps of evaluation. Neurological examination includes testing facial and vestibular nerves and muscle strength, coordination, balance during walking, positional vertigo test, audiometry and electronystagmography.
Blood tests include a complete blood count, kidney and thyroid panels to rule out systemic diseases. Imaging tests may be used to detect brain abnormalities (e.g. stroke, tumour). Computed tomography (CT scan) produces an X-ray images of the brain and magnetic resonance imaging (MRI scan) uses a magnetic field to produce detailed images of brain tissue and arteries in the neck and brain which may be required in some cases.
Early referral of vertigo to the neurologist is important because it could be associated with some underlying serious disorder and thus needs to be properly investigated and treated. Treatment differs from case to case - in some instances a person may recuperate in one to four weeks while in other cases a long-term medical follow-up may be required. Surgical intervention is rarely required but if the disease is in a very severe stage then it could be an option the doctors may consider.
Making progress
It has been three months since Ayap had her first attack. The course of medicine that she had been initially advised is now complete but she has a daily tablet that she must take to keep the symptoms at bay. She has learnt to understand what her body says. Though it is hard, she tries to keep stress levels low. She has worked on keeping calm and doing her chores without demands on her time, energy and body. She carries her medication with her at all times. Speaking to her family and sharing her concerns and fears helps her cope with her struggle, she says.
"Dealing with vertigo isn't easy but once you know that its there you need to learn to take control of it instead of it taking control of your life," she says.
