There are four broad causes of vertigo, for which specific regimens of drug therapy can be tailored. Otological vertigo includes disorders of the inner ear such as Ménière's disease, vestibular neuritis, benign paroxysmal positional vertigo (BPPV) and bilateral vestibular paresis. (Hain, 2003) Vertigo treatment may be directed to the underlying disease, or it may be lessened by one of several centrally acting pharmacologic agents. (Ranalli, 2019)
Central vertigo is a heterogeneous group of disorders with diverse clinical spectrums. Strokes and transient ischemic attacks account for one-quarter of acute transient vestibular syndrome. (Choi et al, 2018)
BPPV is always of brief duration and patients are asymptomatic when not triggered with position changes. Vestibular neuritis symptoms are still present at rest but worsened with movement. BPPV is caused by calcium carbonate debris that becomes dislodged from the utricle. Calcium carbonate is denser than endolymph; therefore, it will move to the most dependent portions of the canal. Particles can enter the horizontal canal and rarely the anterior canal as well, causing different examination findings and requiring different maneuvers to diagnose and treat. (Omron, 2019)
Cervical vertigo is characterized by vertigo from the cervical spine. So far, there are 4 different hypotheses explaining the vertigo of a cervical origin, including proprioceptive cervical vertigo, Barré-Lieou syndrome, rotational vertebral artery vertigo, and migraine-associated cervicogenic vertigo. (Li, 2015)
Vertigo and migraine are commonly co-occurring problems. The diagnostic criteria for vestibular migraine have recently been updated in the International Classification of Headache Disorders, 3rd edition (beta version), which allow better detection of this under-recognized condition. (Swaminathan et al, 2015)
Menière's disease causes feelings of fullness or pressure in the ear, hearing loss, tinnitus, and recurrent bouts of vertigo, and mainly affects people aged 30-60 years. Menière's disease is at first progressive but fluctuating, and episodes can occur in clusters. Vertigo usually resolves eventually, but the hearing deteriorates and the tinnitus and pressure may persist regardless of treatment. (Wright, 2015)
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