Have You Experienced These Symptoms?

People describe vertigo as:

“The ground seems to undulate under me, even as I no longer feel connected to it through my legs, and then my head starts to slowly spin as if weightless and disconnecting from my body.”

“Like unexpectedly finding myself on a phantom Tilt-A-Whirl.”

“My body feels fixated in place, but my mind feels like it’s spinning in space.”

“I see the real-world surroundings on my periphery begin to move as if perhaps trying to get in sync with the action on the screen, but the movement is disjointed and makes me feel nauseated.”

“I feel as though I live in a tunnel—I can’t turn my head quickly because it makes me feel like the whole world is turning upside down—and I have to constantly just stare straight ahead or move my whole body to look to my right or my left.”

“It feels like the center of my brain, perhaps the core of my very being, is spinning in direct opposition to the movement of the world.”

Doesn’t sound like much fun, does it? Well, millions of people experience such symptoms daily, whether for the first time, periodically, or as part of a chronic condition. For some people, vertigo’s cause may be clearly diagnosed, but for many, the cause may be amorphous, multi-faceted, or—and worst of all for chronic sufferers—undiagnosed. Read on to learn more about this debilitating symptom, its numerous known causes, and the many potential exacerbating factors that may cause your head to spin.  

Vertigo—The Basics

Vertigo is the most common form of dizziness, a symptom expressed by about 20% to 30% of the general population seen in primary care settings. As a non-specific term used by patients to describe a wide range of symptoms, dizziness is broken down by physicians into four main categories:

• Vertigo
• Presyncope/syncope
• Disequilibrium
• Non-specific

Vertigo is typically described as a false sense of rotational movement or swaying that one feels in the absence of real movement. Some people mistakenly believe that vertigo is a fear of heights (acrophobia) and/or that it represents the symptoms experienced by someone with acrophobia when directly confronted by heights. This misperception may have stemmed in part from the classic Alfred Hitchcock movie, “Vertigo,” which conflated acrophobia and vertigo in both dialogue and the special effects of the time, which used a disorienting camera distortion trick to create what became known as the “Vertigo effect.” That said, those with acrophobia may be prone to a visually caused form of vertigo, according to some researchers. 

In general, people experiencing vertigo feel as if the objects around them are moving when they are not (known as objective vertigo), or that they themselves are spinning or swaying while everything else remains stationary (subjective vertigo). A third type of vertigo, referred to as pseudovertigo, involves the intense sensation of spinning inside one’s head. In many cases, though not all, a person can indicate the direction of motion when asked during a vertigo episode. The unpleasantness of vertigo usually feels worse when the episode occurs while a person is moving.  

Vertigo can present with other symptoms—most typically nausea, vomiting, profuse sweating, headache, and trouble walking—or alone. The duration of a vertigo experience can range from a few seconds to a few days, with the underlying condition generally dictating the time span. Most episodes of vertigo, though, tend to fall under the seconds to a few minutes time frame.

Many people may only experience vertigo once or a few times in their lives, perhaps a result of motion sickness, over-intoxication, an adverse drug reaction, or as the prelude to fainting, but some people suffer with ongoing, daily, periodic episodes of vertigo for weeks, months, or years on end due to an underlying condition. Those in the latter category are typically dealing with multiple other uncomfortable symptoms and are hopefully seeking or undergoing medical treatment. 

Doctors characterize vertigo in part by duration: vertigo symptoms or episodes lasting more than a day are referred to as persistent-onset vertigo. Shorter episodes of vertigo, such as those caused by motion sickness or an adverse drug reaction, are referred to as episodic-onset vertigo. The former can become a chronic condition, while the latter is usually just an incidental occurrence.

Vertigo is also classified as either peripheral or central. Peripheral vertigo describes vertigo symptoms that appear to arise due to problems with the inner ear, also known as the vestibular system. The inner ear is responsible for maintaining your sense of balance, controlling eye movement, and providing spatial orientation to coordinate movement. Inflammation caused by colds, the flu, bacterial infections, and certain drugs can affect the inner ear, leading to episodic-onset vertigo, as can physical trauma to the head. Pressure differentials in the middle ear from flying or diving can cause vertigo, and the aforementioned motion sickness also affects the inner ear, which is why it is associated with vertigo.

Several diseases and disorders that affect the inner ear can cause a persistent onset of vertigo. These include:

• Benign paroxysmal positional vertigo (BPPV)
• Meniere’s disease
• Superior canal dehiscence syndrome
• Labyrinthitis

Central vertigo refers to a persistent onset of vertigo believed to be caused by the central nervous system’s processing of vestibular signals. Central nervous system injuries affecting the brainstem or cerebellum can cause persistent-onset vertigo, among other neurologic impacts, including balance disorders, speech problems, and double vision. Diseases and disorders that can cause central vertigo include:   

• Tumors
• Lesions
• Migraine headaches
• Epilepsy
• Parkinson’s disease
• Multiple sclerosis
• Cervical spondylosis
• Chiari malformation
• Lateral medullary syndrome
• Stroke

Researchers also believe that some cases of vertigo may stem from psychological factors, with anxiety and panic disorder cited as the primary sources of psychogenic dizziness. Researchers are also taking a closer look at oculomotor dysfunction and other optical-related factors that may cause what is known as visual vertigo (referred to by optometrists as “see sick syndrome”). Coined in 1995, visual vertigo describes vertiginous symptoms arising from visual conflict or intense visual stimulation. The condition can be caused by diseases and disorders that are responsible for other types of vertigo, but can also develop in their absence, with an indeterminate overarching cause.

Vertigo Confounded by the Difficulty in Its Diagnosis

Because vertigo is symptomatic of so many different conditions, those suffering from chronic vertigo often have difficulty finding its cause. Misdiagnosis is not at all unusual, and some sufferers end up with successive diagnoses—from BPPV to Meniere’s to migraine-related, or vice versa—and subsequent treatments that fail to offer relief. Perhaps more worrisome are the many patients who suffer from chronic vertigo that remains undiagnosed, which is clinically referred to as idiopathic vertigo. Not a small number, given that “[d]izziness is a common symptom, potentially deriving from many categories of illness, and our diagnostic acumen and technology is not perfect,” as noted by otoneurologist Dr. Timothy C. Hain. “It is not unusual to conclude that one simply doesn’t know why a person is dizzy, even after a thorough evaluation,” he concluded.

Indeed, researchers cannot even definitively agree on the prevalence of vertigo as a condition. Just Google “prevalence of vertigo” and you’ll find a vast range of responses, including:

• Dizziness (including vertigo) as a condition impacts between 15% to 20% of the population on an annual basis (from about 50 million to 66 million Americans).
• A global prevalence survey of vestibular symptoms found that, among 2,987 respondents, 48.3% reported at least one symptomatic episode of vertigo, 39.1% reported at least one symptomatic episode of unsteadiness, and 35.6% at least one episode of dizziness.
• One-year general population prevalence estimates for vertigo stand at 4.9%, with BPPV accounting for 1.6% and migrainous vertigo accounting for 0.89%.
• Vertigo and dizziness are common symptoms in the general population, with an estimated prevalence of 20% to 56% (OK, so anywhere from 66 million to 184 million Americans in a given year).
• Despite much research on this subject, “relatively little is known about the precise incidence and prevalence of dizziness in the general population.” While common, “it’s not as prevalent as diabetes or heart disease.”     

We could go on, but we’re not trying to disparage the medical research community—we’re just highlighting how difficult it is to pin down potential causes of this debilitating condition that impacts millions, however many millions that may be.         

And of those millions, many will remain undiagnosed or misdiagnosed in terms of cause. Dr. Hain, whose research indicates that about 15% of the population suffers from dizziness symptoms, estimates that 25% of these cases will remain undiagnosed.

The Fast-Paced Modern World’s Role in Vertigo

Whether diagnosed or undiagnosed, there is plenty of anecdotal evidence that the fast pace of today’s modern world could be causing some cases of vertigo and is a likely exacerbating factor in those struggling with chronic vertigo. Consider first that the pace of life was relatively slow, and the amount of daily stimuli our senses had to process was relatively benign for the roughly 200,000 years that man has been on earth. That all began to change in the late 1700s with the advent of the Industrial Revolution, a revolution that presaged an ever-accelerating increase in the amount and pace of external stimuli requiring daily processing by our sensory systems.

For the past 120 years or so, our vestibular systems—our inner gyroscopes—have had to adapt to ever-increasing speeds and assorted speed anomalies (such as standing still on a fast-moving train or airplane). Before the turn of the 20th century, falling off a cliff represented about the only way a person would ever move at speeds nearing or topping 100 m.p.h. Today, such speeds—and much higher—are commonplace. And yes, our physical bodies are highly adaptable and resilient, with our vestibule system perfectly capable of keeping us balanced and functioning at high speeds. Though perhaps our adaptation to such has evolved with unperceived stress to the system.

Consider also what modern man’s vestibule and ocular systems have had to evolve to process the expansive stimuli generated by our digital age. A teenager playing Halo or Call of Duty today probably processes far more outside stimuli in an hour than a teenager herding sheep did in an entire day in 1750. Again, able to handle such stimuli with apparent ease, but what of unperceived physiological stress to the systems? Unperceived, that is, other than the presentation of vertiginous symptoms in some people.

Direct research into how the fast pace of modern life may impact our inner balance and, perhaps, cause vertiginous symptoms is limited. However, recent studies independently examining visual vertigo, vestibular motion sickness, and the ocular system all suggest a link. A 2016 study—”Moving in a Moving World: A Review of Vestibular Motion Sickness”—notes that the prevalence of motion sickness was primarily limited to the small numbers of seafarers until the arrival of trains, automobiles, and planes. Add in the more recent rise in extensive exposure to the illusion of passive motion through TV, video games, 3D movies, and virtual reality, and you have likely reasons why motion sickness has become such a prevalent problem in modern life.

“All sensory signals are merged in the brainstem and cerebellum, where they are weighted according to their reliability to obtain the best estimate for the body’s own natural motion. This process also forces the brain to factor sensory signals that should be impossible in the real world (such as passive artificial motion and illusion of passive motion), resulting in sensory conflict as the brain has to solve apparently conflicting information.”

Sensory conflict that undoubtedly leads to motion sickness and related symptoms. Given that researchers in the 1980s found a strong association between the susceptibility to motion sickness and migraine headaches, it probably wouldn’t be too much of a stretch to believe that such sensory conflict could cause or exacerbate vertiginous symptoms.

Big Increase in Screentime Warrants Closer Look at Visual Vertigo 

A 2018 paper calling for more research on visual vertigo warns that inattention to this source of vertigo could be detrimental to children growing up in our excessively digital world. The author of “Visual Vertigo: Vertigo of oculomotor origin” acknowledges that many researchers and doctors question whether true “visual vertigo really exists,” but posits that excessive screen time may be causing oculomotor dysfunction, and in turn, vertigo.

Seong Chin notes that most doctors and researchers consider visual vertigo only in relation to the ocular system’s connection to the vestibular system, rather than considering the ocular system as a source of vertigo independent of the vestibular system. He suggests that excessive near-point visual fixations induced by screentime lead to prolonged pupil contraction, resulting in ischemic strain and errors in signaling between the ocular and proprioceptive systems. Chin believes this can cause vertiginous symptoms absent the vestibular system’s role, but is more focused in his research about how screentime may have a profound impact on young children with their immature neuromuscular system and developing cerebellar coordination.”  

In conclusion, Chin suggests that non-vestibular system-related visual vertigo warrants much more research because the ever-increasing amount of daily screentime is inevitably going to lead to more eye muscle strain and related conditions such as vertigo. 

Other Vestibular Pathways to Vertigo?

The theory that modern life is placing undue stress on our vestibular (and ocular) systems may not yet have been adequately researched, but it is certainly palpable. In fact, whatever impact the fast pace of modern life has on our vestibular system may be manifested beyond just causing problems relating to gyroscopic functioning. In the past few years, researchers have found significant evidence that the vestibular system may be more than just a gyroscope that maintains our balance and spatial orientation. Not only have scientists found a clear link between vestibular function and some psychiatric disorders, but they have also found neural network linkage between the vestibular system and parts of the brain involved in cognitive and emotional processing.

What this means in relation to vertigo is unclear, as scientists know only that there is a link, not whether the pathways between the vestibular system and cognitive and emotional processing are one-way or two-way. Thus, if one is feeling emotionally or cognitively unbalanced, is that feeling picked up by the vestibular system and then treated in some way similar to outside stimuli-induced unbalancing? And-or how do the cognitive and emotional processing areas of our brain address real-world, physical unbalancing that is passed on to them by the vestibular system? Whatever the answer, stress-related impacts of modern-day living picked up by one are apparently passed on to the other.

Stress that may be compounded by the unnatural need to stay seated for long periods, staring at a video screen, whether for work or entertainment. Or even physiological stressors caused by constant head-down attention to the small screen of a smartphone or tablet. Extended periods of limited movement are undoubtedly unhealthy, as evidenced in part by feeling stiff, but extensive screen time can also result in longer-term problems with posture, back, and neck, not to mention eye strain. All of these are known to contribute to or exacerbate vertiginous symptoms.  

Along with the potential physiological stress our fast-paced, modern world places on our overworked vestibular and ocular systems, we need to consider psychological stressors. The digital world allows us to be continuously bombarded with the world’s stress. Whether through television, websites, or social media platforms such as Twitter, YouTube, Instagram, and Facebook, we can (and tend to) receive a near-constant diet of data about a world in conflict and turmoil, whether by dint of war, politics, disease, crime, natural disaster, or any number of other adverse situations.

Sure, we’re also connecting with loved ones and watching cute kitty cat videos in our digital world, but conflict is ever-present. The average American probably processes more “news” in a day than an average American did in a month back in 1800. And much of our modern news is definitely disheartening and often quite distressing. Indeed, a constant diet of such should be enough to make anyone spin out.

Unfortunately, our digital world can also be somewhat addictive, whether gaming, tracking social media, or just feeling the need to get the latest COVID-19 news. And this addiction, especially among the younger generations, can create a disassociation from the real world. For some people, the disassociation is so extreme that the digital world is their real world. This is so commonplace that many younger people struggle to interact with the real world. And even if not to the extreme level, how can we successfully find equilibrium between the real world and the digital world, both of which “spin” at different speeds and with varying movement?

Along with dissociation, addiction to our digital world is changing our spatial relation to the world, as we tend to move far less and sit for longer periods than most people did just a few decades ago. Not only does this impact our posture, but so does the significant increase in small-screen use with cell phones and smartphones, which is also putting considerable strain on our backs and necks. You can easily picture the standard head-tilted-forward-and-down stance of anyone texting or looking down at their cell phone, a habit the average American engages in more than 50 times per day. But did you know that that standard cell phone stance doubles to triple the head weight strain your neck and spine have to support, with a 15-degree forward-head-down tilt adding more than 15 pounds and a 30-degree tilt adding about 30 pounds?      

Posture’s Vertiginous Role

Such changes to our posture and increased neck and back strain can cause or contribute to vertiginous symptoms. In fact, some researchers believe that many idiopathic causes of vertigo may be due to poor posture and spatial misalignment of the head. Anatomical physiologist Pete Egoscue thinks that “when the head is out of balance, either leaning to one side or jutting forward, the systems designed to maintain balance [vestibular, ocular, and proprioception] start arguing.” And when these systems send conflicting messages to the brain, “enter vertigo.”

Vertigo caused by this typically resolves on its own as the systems recalibrate to the new head position, but posture and changes in head position usually continue to get worse, causing ever-new bouts of vertigo. For some people, misaligned head position may cause fluid in the inner ear to thicken and/or develop microscopic calcifications that affect the inner ear’s cilia and can lead to longer-term vertigo. And indeed, massage, head repositioning efforts, and posture exercises are all used as therapies for vertigo relief, both for short-term and chronic vertigo.

In addition to one’s personal spatial balance, consideration should also be given to one’s balance with the world. In today’s fast-paced, modern world, most people often feel out of balance. In fact, a Google search of “how to find balance in your life” will offer you more than 300 million search results. Which of these results might actually answer the question is debatable, but it certainly signals a massive demand for finding balance.

The causes of such modern-day personal imbalances are also debatable, but we are constantly pulled in so many different directions by competing demands on our time, as well as by competing appeals that seek to capture our attention and influence how we spend our time and money. Rather than focusing on what’s truly important in life, many people are constantly in a virtual tizzy, trying to keep up with the fast-paced, superficial changes to make sure they don’t miss out on what life has to offer. Much of this is driven by near-constant market manipulation that feeds what becomes for many an addictive way of life. From worrying about style and self-image to social media popularity, to getting hold of the latest gadgets or watching all of the recent trending hits on Netflix or Amazon, who has time to pause and smell the proverbial roses?

And we would posit that taking regular time to smell those proverbial roses, or otherwise to “just be” in the world without succumbing to the many superficial distractions of the modern world, is an important vehicle for retaining at least some balance in life. We also assume that, as happens with internal vestibular system-related imbalance, this real-world imbalance creates a variety of physiological and psychological stressors that can also cause and exacerbate vertigo. 

There could be other reasons that drive vertigo into someone’s head—whether on an episodic or persistent basis—but we believe we’ve, for the most part, detailed the known and suspected causes and exacerbating factors. If you’re struggling with vertigo or have been unnerved by an episodic onset case, by all means, seek medical guidance. But also consider any potential non-medical triggers that may be impacting your inner balance and your relationship with life itself.       

Sources:

Joshua M. Ammerman, MD. “Is Your Cell Phone Killing Your Back?” Aug. 12, 2019. Spine Universe. Retrieved at: https://www.spineuniverse.com/wellness/ergonomics/your-cell-phone-killing-your-back

Giovanni Bertolini and Dominik Straumann. “Moving in a Moving World: A Review on Vestibular Motion Sickness. Feb. 15, 2016, Frontiers in Neurology. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753518/

Alexandre Bisdorff, Gilles Bosser, et al. “The epidemiology of vertigo, dizziness, and unsteadiness and its links to co-morbidities. March 22, 2013. Frontiers in Neurology. Retrieved from: https://www.frontiersin.org/articles/10.3389/fneur.2013.00029/full

Seong Chin. “Visual vertigo: Vertigo of oculomotor origin.” July 2018. Medical Hypotheses. Retrieved at: https://www.sciencedirect.com/science/article/pii/S0306987718301324

Pete Egoscue. “What Causes Vertigo? How Posture Plays a Role.” Aug. 23, 2016. Sonima. Retreived at: https://www.sonima.com/fitness/what-causes-vertigo/

Caroline Gurvich, Jerome J. Maller, et al. “Vestibular insights into cognition and psychiatry.” Nov. 6, 2013. Brain Research. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0006899313012134

Timothy C. Hain, MD. “Epidemiology of Dizziness.” Jan. 1, 2020 (last modified). Chicago Dizziness and Hearing. Retrieved at: http://dizziness-and-balance.com/disorders/dizzy_epi.html

Timothy C. Hain, MD. “Unlocalized and Psychogenic Dizziness.” 2019. Chicago Dizziness and Hearing. Retrieved at: https://dizziness-and-balance.com/practice/approach/unlocalized.htm

James D. Hogue. “Office Evaluation of Dizziness.” 2015. Georgia Campus, Philadelphia College of Osteopathic Medicine. Retrieved at: https://www.sciencedirect.com/science/article/abs/pii/S0095454315000159?via%3Dihub

Ali Maloney. “Getting diagnosed with a chronic disease with no treatment or cure is like entering a Kafka novel.” Feb. 20, 2017. Quartz. Retrieved at: https://qz.com/909898/getting-diagnosed-with-a-chronic-disease-with-no-treatment-or-cure-is-like-entering-a-kafka-novel/

Michael Strupp, Mathew J. Thurtell, Asef G. Shaikh, et al. “Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus.” April 2, 2011. Journal of Neurology. Retrieved at: https://link.springer.com/article/10.1007/s00415-011-5999-8

Rand Swenson. “Disorders of the Nervous System.” 2008. Dartmouth Medical School. Retrieved at: http://www.dartmouth.edu/~dons/part_2/chapter_14.html#chpt_14_introduction