Vertigo

Clinic

• Vertigo is a condition in which a person has the sensation of movement or of surrounding objects moving when they are not. Often it feels like a spinning or swaying movement.
• This may be associated with nausea, vomiting, sweating, or difficulties walking.
• It is typically worse when the head is moved.
• Vertigo is the most common type of dizziness.
• Dizziness affects approximately 20–40% of people at some point in time, while about 7.5–10% have vertigo. About 5% have vertigo in a given year. It becomes more common with age and affects women two to three times more often than men. Vertigo accounts for about 2–3% of emergency department visits in the developed world.

Classification

• Vertigo is classified into either peripheral or central, depending on the location of the dysfunction of the vestibular pathway, although it can also be caused by psychological factors.

	Peripheral	Central
Definition	Caused by problems with the inner ear or vestibular system, which is composed of the semicircular canals, the vestibule (utricle and saccule), and the vestibular nerve is called "peripheral", "otologic", or "vestibular" vertigo.	Vertigo that arises from injury to the balance centers of CNS, often from a lesion in brainstem or cerebellum It may have accompanying neurologic deficits such as slurred speech, double vision, pathologic nystagmus (which is pure vertical/torsional). Central pathology can cause Disequilibrium/ Unbalance, which is so severe that paitients are unable to stand or walk.
Causation	Benign paroxysmal positional vertigo (BPPV)(32%) Ménière's disease (12%) Superior canal dehiscence syndrome Vestibular neuritis Common cold, Influenza, and bacterial infections Chemical insults (e.g., aminoglycosides) Physical trauma (e.g., skull fractures). Motion sickness is sometimes classified as a cause of peripheral vertigo Viral  Labyrinthitis	Lesions caused by Infarctions / Hemorrhage /Tumors Epilepsy Cervical spine disorders such as Cervical spondylosis, Degenerative ataxia disorders Migrainous vertigo Lateral medullary syndrome Chiari malformation Multiple sclerosis Parkinsonism Central vertigo may not improve or may do so more slowly than vertigo caused by disturbance to peripheral structures. Alcohol can result in positional alcohol nystagmus (PAN).
Entities	Labyrinthitis Vestibular neuritis Vertigo Hearing impaired	Dysarthria Nystagmus / Diplopia Ataxia Vertigo
Viral miasms	MMP VZV	STLE
Remedies	MMP+ VZV: MERC MMP only: Con, Puls, Sill, Bell, Phyt, Aur, Bar-m, Iod VZV only: Sul, Ars, Sep, Canth, Iris, Nat-m , Ran-b, Rhus-t, Thuj, Agar, Arg-n, Cocc, Mez, Nat-c, Zinc	PHOS, APIS Gels, Op, Cupr, Lach, Merc, Sul, Bell Nux-m, Cocc, Alum, Hell, Plb, Agar

Remedies

Peripheral Vertigo	Central Vertigo	Common
Con Vertigo accompanied by weakness or trembling. Vertigo triggered by sudden Movements / Changes in position. Nausea and vomiting. Vertigo due to age-related changes in the inner ear. Arg-n Tinnitus, Nervous, Sleep on going, Ataxia, weakness, Chilliness, true vertigo Agg: High, looking upward, Mental exertion, bending forward, Closing eyes, Dark room, Crossing bridge, walking	Phos Dizziness with most of his problems such as heart problems (Lach) , Epistaxis, Senile problems (Gels, Sul) etc Neurologic Dizziness (Cocc, Ther, Con) Staggering Agg with eye exertion, Agg withFlower odors, Coffee Agg with Eruption suppression (Lach) Agg in High places (Gels) Agg with Looking up or down Agg with Fluid loss, Fasting	Cocc Everything turning around him Staggering, Falling sides Psychologic vertigo Agg: opening eyes (opp to Arg-n), Motion, rising, Insomnia/ Supportive anxiety Accompanied by Occiput pain Chill/ Coldness agg /Warm amel Being alone amel Senile people (Phos, Gels, Sul) Neurological (Phos, Ther, Con) Vertigo accompanied by Nausea /Vomiting / Motion sickness / jet lag, particularly traveling by car or boat. Dizziness, weak, and lightheaded.
Puls Sensation of Fullness / Pressure in the head. Dizziness, lightheaded, and disoriented. Ringing in the ears Vertigo due to sinus congestion or ear infections. Rhus-t Suppressed eruption	Gels Triggered by Emotional stress / Anxiety / stage fright Dizziness/ Lightheaded/ Faint Staggering / Weakness Trembling/ Sweating/ Pounding heart. Pregnancy Senile problems (Phos) With Cerebral / Nervous origin High places (Phos) Tinnitus, Diplopia	Bell Noise agg, Eruption suppression, senile people, Motion esp turning head , bending double, Lying Sinking Accompanied by tinnitus, Red face, Epistaxis, Heart problems, Head congestion, Stroke, Hypertension, Dilated pupil Pregnancy
Sil Vertigo that is accompanied by pressure in the head. Dizziness, lightheaded, and disoriented. Ringing in the ears Vertigo due to pressure in the inner ear	Lach Faint like, Sinking Closing eyes Agg Sleep after Agg Eruption suppression (Phos) Accompanied by Heart symptoms (Phos)	Agar Cerebellar vertigo (Nystagmus, Ataxia, staggering) Accompanies by Agitation True vertigo (turning in a cycle) Agg: Rolling head / Moving /Walking
Ars Acute Vertigo + Ear noise Pregnancy during	Alum Agg: Closing eyes, Bending forward, Breakfast after, rubbing eyes, Smoke Sinking	Sul High place Ascending Senile people (Phos, Gels, Cocc)
Zinc Vertigo tinnitus, esp in high places
Nat-m Periodic, Sinking Causation (Smoke, Eye exertion, High, Coffee)

Acute vertigo remedies

• Banerji protocols same as Meniere's disease

• Chinin-s
• Con
• Tab
• Chel

Bry

• Vertigo that is worsened by sudden movements or changes in position.
• Spinning or dizziness when moving the head or standing up.
• Nausea and vomiting.
• Vertigo due to dehydration or overheating.

Tissue Salt Remedies

• FP: Dizziness is caused by rush of blood to the head
• KP: Vertigo with nervous / Neurological origin
• SIL: Vertigo in the elderly
• NM: Dizziness on getting up (Orthostatic hypotention)
• NS: Vertigo due to bilious status
• NP: Dizziness with vomiting. In sea-sickness alternate KP with NP