Heath Notes

Vertigo

A sudden sensation of spinning is one of the first signs of vertigo. According to research or other evidence, the following self-care steps may help you get to the root of the problem and remedy the symptoms:

Go for the ginkgo
Take 120 to 160 mg a day of a standardized extract of the herb Ginkgo biloba to reduce symptoms

Discover vinpocetine
Ease vertigo symptoms by taking 15 mg a day

See a specialist
Consult with healthcare practitioners familiar with therapies that may help your vertigo, such as vestibular rehabilitation exercise, particle repositioning maneuvers, spinal manipulation, or trigger point therapy

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full vertigo article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About vertigo

Vertigo is a sensation of irregular or whirling motion, either of oneself or of external objects.

The word is sometimes incorrectly used as a general term to describe dizziness. The most common form of vertigo is benign positional paroxysmal vertigo (BPPV), in which brief attacks are brought on by certain changes in head position.¹ BPPV may be due to a previous head injury, viral infection, and certain drug therapies, although in about half the cases the cause is unknown.² ³ BPPV tends to resolve without treatment within weeks to months, but may persist for years in some cases.⁴ ⁵

People experiencing vertigo should have a complete medical evaluation to determine the cause. Common causes of non-BPPV vertigo include conditions in which there is decreased blood flow to certain areas of the brain, Ménière’s disease, and infection of the inner ear.⁶ ⁷ Vertigo may also be a symptom of numerous other conditions,⁸ ⁹ ¹⁰ including sinusitis, panic attacks, migraine headaches, and problems with metabolism,¹¹ ¹² such as hypothyroidism, high blood triglycerides, diabetes, and hypoglycemia.

Product ratings for vertigo

Science Ratings	Nutritional Supplements	Herbs
	Vinpocetine Vitamin B6	Ginger Ginkgo
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

Science Ratings

Nutritional Supplements

Herbs

Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars

Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star

For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

People with vertigo may have sudden sensations of spinning or whirling motion that may be accompanied by lightheadedness and loss of balance, and less often by sweating, fatigue, nausea, and vomiting.¹³ ¹⁴

Dietary changes that may be helpful

In preliminary studies, vertigo associated with high triglycerides, diabetes mellitus, and hypoglycemia responded to dietary management of the underlying disorder.¹⁵ ¹⁶ In a preliminary study of people with migraine headaches, most of whom (83%) also experienced vertigo, a multifaceted approach including dietary changes was investigated. Dietary changes involved the elimination of foods and food additives suspected of causing migraine attacks. This approach resulted in complete or substantial improvement of symptoms in a significant number of participants.¹⁷ No other research has investigated the effects of diet on vertigo.

Lifestyle changes that may be helpful

Head positions that bring on sudden, acute attacks of vertigo, particularly bending the neck back while looking up, should be avoided. In one report, for example, the head position used in salons for shampooing hair was associated with the onset of vertigo.¹⁸ According to one authority,¹⁹ certain chronic or repetitive body positions may produce painful nodules, called trigger points, in the muscles of the head and neck, which can lead to dizziness and possibly vertigo. These positions include forward bending of the neck as when sleeping on two pillows, backward neck bending as when painting a ceiling, and turning the neck to one side as in some reading positions.²⁰ A healthcare practitioner knowledgeable in postural education can give advice on avoiding such positions. Trigger point therapy is discussed below in “Other integrative approaches that may be helpful.”

Other therapies

Healthcare practitioners recommend getting fresh air, lying down, closing the eyes, and alcohol avoidance. People frequently affected by severe, disabling vertigo may require a surgical treatment, such as vestibular neurectomy or labyrinthectomy. These procedures involve surgical removal of either the nerves or labyrinthine structures that control balance and position senses.

Vitamins that may be helpful

A preliminary trial showed that 15 mg per day of vinpocetine had a moderate or greater effect on reducing the signs and symptoms of vertigo in 77% of patients with this condition.²¹ Other preliminary reports exist describing benefits of vinpocetine for vertigo and other symptoms of inner ear disorders,²² but controlled research is needed to evaluate these claims.

Two preliminary human studies reported that vitamin B6 supplementation reduced symptoms of vertigo produced with drugs in a laboratory setting.²³ Vitamin B6 supplementation has not been studied in BPPV or other forms of vertigo and may not share the same causative mechanism as experimentally induced vertigo.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Herbs that may be helpful: In a preliminary clinical trial, a standardized extract of Ginkgo biloba (GBE) significantly reduced symptoms of vertigo in a group of elderly people with mild cognitive impairment.²⁴ Participants were given 40 mg three times per day for one year. GBE has also been reported to significantly reduce vertigo of unknown cause in preliminary²⁵ and double-blind²⁶ trials. The amounts given were 120 mg and 160 mg per day, respectively, for three months.

One gram of powdered ginger (Zingiber officinale) root in a single application has been reported to significantly reduce symptoms of artificially induced vertigo in one double-blind trial.²⁷ In a double-blind trial, 1 gram of powdered ginger root was found to have very little effect in reducing vertigo related to seasickness.²⁸

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

Holistic approaches that may be helpful

Other integrative approaches that may be helpful: Numerous preliminary reports suggest certain “vestibular rehabilitation” exercises may help some cases of vertigo.²⁹ ³⁰ ³¹ ³² ³³ ³⁴ These exercises were also found to be effective in relieving vertigo in two controlled studies,³⁵ including one on BPPV.³⁶ While vestibular rehabilitation exercises may be done at home, initial guidance by a qualified practitioner is necessary.

BPPV appears to be caused by an accumulation of free-floating cell fragments in the fluid of the inner ear.³⁷ ³⁸ Certain manipulation therapy maneuvers, referred to as particle repositioning maneuvers (PRMs), are intended to relocate this debris to a harmless location,³⁹ ⁴⁰ ⁴¹ in order to improve symptoms. Both preliminary⁴² ⁴³ ⁴⁴ ⁴⁵ ⁴⁶ and controlled⁴⁷ ⁴⁸ ⁴⁹ trials achieved significant improvement in, or elimination of, BPPV using these maneuvers. Most studies report that over 90% of people with BPPV treated one or two times with PRM respond to this treatment, although up to 45% may develop BPPV again within a few years, requiring further treatments.⁵⁰ ⁵¹ ⁵²

Research indicates some cases of vertigo are related to spinal disorders affecting the head and neck.⁵³ ⁵⁴ ⁵⁵ ⁵⁶ ⁵⁷ ⁵⁸ ⁵⁹ Preliminary studies report that certain treatments, such as spinal manipulation,⁶⁰ ⁶¹ ⁶² ⁶³ physical therapy,⁶⁴ and combined approaches including manipulation and specific exercise programs,⁶⁵ ⁶⁶ result in significant improvement of vertigo symptoms.

Trigger points are thought by most,⁶⁷ ⁶⁸ ⁶⁹ though not all,⁷⁰ authorities to potentially cause pain and abnormal function in other parts of the body. Trigger points appear to develop as the result of injury, poor posture, structural abnormalities of the leg or pelvis, emotional tension, and other body stressors.⁷¹ ⁷² Also known as myofascial pain dysfunction (MPD), this condition, when it affects certain muscles of the head and neck, has been associated with vertigo in preliminary research.⁷³ ⁷⁴ ⁷⁵ Musculoskeletal healthcare specialists and other practitioners can often treat MPD with a variety of natural therapies, including deep pressure massage,⁷⁶ ⁷⁷ ⁷⁸ ⁷⁹ ⁸⁰ transcutaneous electrical nerve stimulation (TENS),⁸¹ ⁸² and other approaches,⁸³ but no controlled studies have investigated the effectiveness of these treatments specifically for vertigo.

In a preliminary study of people with migraine headaches, most of whom (83%) also experienced vertigo, a combined and individualized approach using dietary changes, medication, physical therapy, lifestyle changes, and acupuncture resulted in complete or substantial improvement of symptoms in a significant number of participants.⁸⁴ In addition, a large number of case studies presented in two preliminary reports suggest acupuncture may help to reduce symptoms of vertigo.⁸⁵ ⁸⁶ These preliminary studies have yet to be confirmed by controlled clinical trials.

References
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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2009.

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