What conditions can cause chronic vertigo?
June 26, 2013 1:06 PM   Subscribe

What medical conditions are out there, particularly ones that do not necessarily involve the ears, that can cause bouts of long-term vertigo?

From February to April I had 8 weeks of vertigo. It was constant but after the first two weeks or so, it let up enough that I was able to drive and mostly get back to normal - I just couldn't bend over and it was worst when I woke up. I also had a similar bout in July of 2011 but it lasted less than a week. In all cases my blood pressure was fine.

After my regular doctor assumed an ear infection and tried antibiotics, Epley maneuvers, meclizine at maximum dose, and a low dose of valium (which is standard for people with Meniere's disease who have dizziness), I went to the otolaryngologist. He did a VNG (videonystagmography) test and determined that it was/is not BPPV (benign paroxysmal positional vertigo) and is probably not due to my ears at all, but is in my brain. The vertigo cleared up around the time of the test and when I went to the followup appointment, he speculated that it was a viral infection in my brain, and that I would need to see a neurologist if it came back. Naturally it's going to take a few weeks to get in to see the neurologist once I get a referral.

Well, I woke up with the vertigo again this morning. The room spins when I move my head, usually counterclockwise, sometimes sideways, sometimes vertically, sometimes a little of both. I don't particularly feel nauseated.

You're not my doctor and I'm not seeking medical advice, but I'd like an idea of what I could be up against. What conditions are out there, particularly those involving the brain rather than the ears, could cause long-term bouts of vertigo?

(Probably coincidental: After 3 days of the vertigo in February, the room spun violently and wouldn't stop, even when I held still. I went to the ER. My potassium was so low on blood test that they immediately hooked me to a heart monitor and ran the test again. Mine was 1.8, normal is 3.5-5.5. I got an IV infusion plus was sent home on supplements and have been on a multivitamin with potassium ever since. However, if it was the low potassium causing the dizziness, a week later my blood levels were normal on blood test and the dizziness should have cleared up by then, instead of lasting 6-7 more weeks.)
posted by IndigoRain to Health & Fitness (20 answers total) 5 users marked this as a favorite
Was labyrinthitis (scroll down) considered? I've known a couple of people over the years who got it. It's thought to be viral, so it just has to run its course.
posted by rtha at 1:16 PM on June 26, 2013 [2 favorites]

Irregularities of/damage to the 8th cranial nerve (vestibulocochlear) can cause issues like this.
posted by elizardbits at 1:18 PM on June 26, 2013

Depending on how you define 'long-term', pregnancy can also cause vertigo lasting weeks (my wife had it frequently). I imagine you would have discovered this to be the cause by now, but I figured I'd throw it out there anyway.
posted by jquinby at 1:26 PM on June 26, 2013

posted by raztaj at 1:27 PM on June 26, 2013 [2 favorites]

My mother had TMJ which gave her vertigo.
posted by Flamingo at 1:32 PM on June 26, 2013

I have vertigo that comes and goes, but is virtually always correlated with bad sinus congestion. There are two things that can cause that, Superior Canal Dehiscence Syndrome and Meniere's disease; both were ruled out in my case. Rather than spending money and time chasing the cause down, we decided to just focus on managing my chronic sinus issues.

I was driven to seek treatment after the worst episode of vertigo of my life, an acute spell that lasted several hours and a more moderate episode that lasted for a couple of weeks. The ENT put me on a giant dose of prednisone, and my vertigo VANISHED within two hours of taking the first dose. If you haven't tried that, you might consider it.

Good luck; vertigo is really disabling and unpleasant. Memail me if you want to know more.
posted by KathrynT at 1:35 PM on June 26, 2013 [1 favorite]

My mother had TMJ which gave her vertigo.

Yeah, TMJ can cause spasms of the tympani tensor muscle which sometimes leads to horrible vertigo. There is also an accompanying throbbing noise that is very irritating.
posted by elizardbits at 1:38 PM on June 26, 2013

I used to get sinus infections where the only symptoms were vertigo and sometimes a general feeling of being run down--none of the more typical sinus pain or congestion at all. I don't think any ever lasted 8 weeks, though.
posted by orange (sherbet) rabbit at 1:49 PM on June 26, 2013

My mother had it; at least for her, apparently it was related to very low (dangerously low) blood pressure.
posted by easily confused at 1:51 PM on June 26, 2013

Is there a clinic in your area that specializes in vestibular issues? This could be many, many different things, ranging from an acoustic neuroma on the scary end, to stubborn BPPV on the less scary end (I know you said you were tested negative for BPPV, but there are a lot of ways to miss BPPV)

It could be cardiac, or neurological, or musculoskeletal, or vestibular. My best advice is to find a good specialist, and stick with it until you get a diagnosis.
posted by jennyjenny at 2:09 PM on June 26, 2013

You can get vertigo from anything affecting the brainstem, but unless you have other symptoms, this is unlikely. You'd normally also notice double vision and incoordination, along with a whole raft of other possibilities.

They may want an MRI of your brain - this is a good way to look for anything affecting your brainstem but also anything affecting the vestibulocochlear nerve between the ear and the brain.
posted by kadia_a at 2:24 PM on June 26, 2013

I suffered a horrible bout of this a few years ago. Doctor's best guess is that it was otolith displacement in the inner ear. There was a head movement they can do to help resolve it, but it's not always successful, and sometimes you just have to wait it out.
posted by NotMyselfRightNow at 2:31 PM on June 26, 2013

I got some wonky thyroid numbers back last week and in my reading I found that thyroid problems (specifically hyperthyroidism) can sometimes cause vertigo and dizziness (which I have had for the last few months but not nearly as bad as yours). You may want to ask your doc to check your thyroid.
posted by hungrybruno at 2:34 PM on June 26, 2013

My EMT diagnosed my vertigo as a new manifestation of migraines. I no longer get severe headaches anymore, but I have at least one dizzy day a month, more when I'm under stress An MRI from a few years ago showed scarring on the brain that my neurologist said we're from migraines as well. Apparently this change often happens around perimenopause. Joy.

Unfortunately, he didn't have any sort of treatment for the vertigo, but I can let go of the brain tumor nightmares now.
posted by bibliowench at 5:00 PM on June 26, 2013

I had something similar years ago. I had a diagnosis of labrynthitis, which didn't stop the doctor from giving me antibiotics. That, let me say right now, was not good. I also was given Antivert, which seemed to me no help at all. Marijuana, of all things, proved useful in dealing with the dizzy spells which were bad enough to cause nausea. Alcohol was no help whatsoever, just made things worse. Over the course of a year or more the vertigo would come and go.
After a while, I came to the conclusion that my problem wasn't labrynthitis. I had blocked sinuses that drained constantly. And -- this is key -- the openings to my eustachian tubes also kept draining. I read about yeast stuff, which was big then, and tried some remedies associated with that but came to the conclusion that it was mostly bogus quackery. Two things that were helpful, though: cutting way down on sugar, which really seemed to increase the sinus congestion; and working to restore my natural body flora which had been destroyed by the antibiotics.
The revelation came one day after I washed my hair. For most of my life I have harbored a fungus called Tinea versicolor. It wasn't until I was in my thirties that a doctor told me about using selenium-based shampoo to kill the stuff. I used it all over my body and the fungus would disappear for a while. I hadn't done that treatment for quite a long time when the vertigo started. I washed my hair with Selsun (the strong stuff, not the Blue) for the first time in many months and felt much better. I use that as my regular shampoo now and have not had a recurrence of the vertigo.
So -- anecdotal, self-diagnosing -- I believe that fungus, perhaps not T.versicolor but still something that was vulnerable to selenium, had taken up residence in my sinuses. The anti-biotics took away some of my resistance to this stuff and, I believe, for a while I may have had some Candida that took advantage but this was not the long term problem. The vertigo resulted when the eustachian tube to the middle ear was blocked -- this left some kind of vacuum that sometimes caused pain in my ears and disrupted my balance mechanism.
It is pretty hard to scrub your sinuses but a good hairwashing will leave you with selenium in places that count. (Don't drink it! It will poison you! But that trace left from hairwashing works well.) I google Tinea remedies from time to time but the oral fungicides are simply not up to the task yet -- treatments have to be repeated or kept up forever -- and there are often side-effects, like liver damage, that I want to avoid. So, for now, Selsun works for me.
posted by CCBC at 5:22 PM on June 26, 2013

Damage to the vestibular nerve is a possibility. Probably have an MRI, as Kadia_a suggests to rule other things out. Then you want an exam where they watch your eyes as you focus on designated things along with a test where cold and warm probes are placed in your ears, while your eye movements are monitored.

As bibliowench states, some migraine sufferers find that their balance is affected.
posted by PickeringPete at 6:35 PM on June 26, 2013

Gluten and thyroid issues can cause unstable gait and ataxia. Not sure if that includes vertigo.
posted by Neekee at 6:50 PM on June 26, 2013

Meniere's disease suggests itself. The attacks of vertigo from Meniere's are typically shorter than you describe, but not always. There are often other symptoms, but sometimes not at first.

Seems like vertigo can have a zillion possible causes, though. I hope it's identified soon and turns out easily treatable. Good luck.
posted by wjm at 1:32 AM on June 27, 2013

Labyrinthitis was indeed the first condition my GP considered, and was my diagnosis in 2011. I'd forgotten that until you mentioned it. Maybe it is viral. I have had sinus problems and chronic infections my whole life... that could also very well be the problem. I also suffer migraines and I've never heard of vertigo being associated with them - very interesting, thank you.

I do occasionally use the neti method - actually I use the WaterPik SinuSense - but I always use distilled water and it seems to have no correlation with when the dizzy spells occur.

Pregnancy - been celibate over a year, so no. As far as dehydration, I drink about 3 20oz mugs of water every day, plus sometimes some juice on top of that. (I keep the mug next to me wherever I am and drink from it all day long.) In February they did test my thyroid and it was normal. I had the head-movement exercise, that's the Epley maneuver. Didn't work for this case. Otolith displacement is the cause of BPPV and Epley normally helps. :/ Also, the exam where you focus on things and have hot and cold air blown in your ears is the VNG test I mentioned.

I did find a neurologist who specializes in balance issues in my area so hopefully he'll be able to figure out what's wrong. By some small miracle I haven't felt dizzy today so I'm hoping I maybe had the shortest episode I've ever had and it's gone for now. I am still going to call the neurologist and see if I should come in now or maybe wait until I'm actually suffering the vertigo again. Thank you everyone for your answers!
posted by IndigoRain at 7:54 AM on June 27, 2013

If you can go to a neuro-otologist working in a balance center, that would be ideal. It looks like you might not be too far from Dr. Timothy Hain in Chicago(?). That would be my next move unless there happens to be someone else a bit closer. It is good that you had a VNG, but there are additional tests you might want to pursue with a balance specialist.

From your description of spinning vertigo, it does sound like it's likely related to a vestibular (inner ear) disease of some kind...and there are several that can lead to chronic vertigo. I guess it could be central in origin, but IANAD. (I am someone whose lived with a chronic vestibular disorder for a long time.)
posted by bennett being thrown at 12:19 PM on June 27, 2013

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