Edited transcript

How many of you played that game as a kid where you put your head down ion the bat, you go in circles as fast as you can, and then you get up, and you try to run in a straight line? What happens you fall off to one side, and everybody has a good laugh. What are you inducing there is vertigo so what I’m going to talk about today is vertigo.

The sensation of movement when you’re not moving

A couple of quick pointers of what you ought to do if you develop vertigo: the first thing I’m going to say is that vertigo is the sensation of movement when you’re not moving. It’s particularly a rotational movement. Folks will describe that the room is spinning even though they’re sitting still, so that’s the symptom of vertigo.

Now I have to say, vertigo is a symptom, not a diagnosis I’ve had folks that will come in and say, “You know, I went to the doctor, and they diagnosed me with vertigo.” Well, that’s not actually a diagnosis; it’s kind of like the way a headache is a symptom, but it’s not a diagnosis. The question if somebody has a headache is, “Why do I have migraines? Do I have a tension headache, driver, caffeine withdrawal headache?

It’s the same thing with vertigo. The symptom of vertigo has a why behind it: why do I have vertigo?

Vertigo is a humongous topic. I mean, I spent lots of time in medical school and residency hearing talks on different components of vertigo and spent hours studying and trying to make sense out of it, so it’s not like I’m going to give you any exhaustive topic on it. I do want to say if you develop it, what are some practical pointers in terms of what to do?

The first thing here to say is my opinion is that all new vertigo needs evaluation. Say that again:

All new vertigo needs evaluation

If somebody has, say, vertigo associated with a migraine, and this is the thirty eighth time that they’ve had the migraine associated vertigo, that probably doesn’t need to be evaluated. If somebody wakes up and has vertigo and they’re like, “Oh gosh, I’ve never had this before!” that needs evaluation.

Okay, now with that in mind, the question is how to approach evaluation and where to seek care. I’m not going to be able to cover all the different ways that vertigo can show itself, but I want to hit a few common categories. If you experience vertigo and it’s not one of these categories, call your doctor and get some advice.

When to go to the ER with vertigo

The first thing that I’ll say is if vertigo is very severe and, in that case, it’s probably going to be associated with vomiting and inability to keep things down, you get dehydrated. It’s miserable. You’re probably going to figure this out, but you should go to the emergency room for that. Really severe vertigo? go to the emergency room.

Same thing if you have vertigo with neurologic symptoms; in particular, if you have double vision or a clumsy tongue and difficulty speaking or difficulty swallowing or facial weakness these are worrisome additional symptoms, and I would say in that case get to the emergency room ASAP.

The same thing as well if somebody has new vertigo and new neck pain that’s potentially concerning so that one may also need emergency room evaluation and it needs to be evaluated really fast. So that’s the emergency category.

Vertigo that has been getting worse

So that’s the emergency category. Now, a second category would be someone who has vertigo that’s not so intense and maybe it’s been building over a few days or even a few weeks. It needs evaluation, but that one doesn’t kind of grab you and shake you and say you need to go to the ER. This is one where you know you call the office and get an appointment and get this checked out.

Benign positional paroxysmal vertigo

A third category, very common, probably the most common one that I see in the office is one where a person describes that all of a sudden every time they move their head in a certain way they get 10 seconds of intense vertigo, especially laying down in bed or rolling over in bed produces 10 seconds of very intense vertigo so that’s a that’s a relatively common phenomenon worth evaluation. That’s a great one to come in and see me partly so we can do an evaluation to identify the underlying cause and then if it’s what it usually is, this condition called benign positional paroxysmal vertigo, there’s a maneuver I can teach you to put a stop to it.

I hope this has been helpful and reasonably pragmatic. I hope you never get vertigo but if you do get it checked. [Music]