- Brian Sass
Unwanted Sensations of Dizziness Part 2: Which Type of Dizziness Do I Have?
This is the 2nd part of the blog series on dizziness and how to treat dizziness symptoms through neuroplasticity. In the last blog, we discussed the different approaches to dizziness symptoms; stage one (diagnosis/medical clearance) and stage two (neuroplasticity treatment). This blog will go into more detail on vestibular symptoms and which symptoms are commonly associated with different vestibular conditions, and some general advice on what you can do at home to help.
Dizziness is a very common symptom that people describe in many different ways. Feeling dizziness usually implicates dysfunction in one of the main systems that give us a sense of balance; making us feel unsteady or imbalanced. The three main systems that give us a sense of balance in our environment is the visual system (what we see), the vestibular organs (the movement of our body and gravity that we sense), and our proprioceptive sense (our “touch” sensations that arise from our muscles and ankle/foot interactions with the ground). These systems, when working optimally and uninjured, work in harmony together and provide matching feedback to other areas of the brain. Amazingly, through neuroplasticity and the adaptive nature of the brain, one of these systems can become damaged and your overall sense of balance in the world can remain intact. For example, if you become blind, the proprioceptive and vestibular organs become hypersensitive and the brain “resets” itself to rely on those systems for balance. The same scenario can happen if the proprioceptive system gets damaged or if the inner ear organs become dysfunctional. The adaption, or neuroplastic changes in the brain following injury, takes time and training to occur. Common descriptions of dizziness include:
-Spinning -Disorientation -“Swimming” inside my brain -“Cotton wool” inside my head -Rocking on a boat -Feeling “drunk” all the time -Feeling “tilted” to one side
-Head pressure - Straining behind the eyes -“Bouncing” vision
-Visual distortions (spots, auras) - Nausea -“Dropping” of the stomach
-Panic -Anxiety -Double Vision - “Floating” -General Discomfort
-Feeling “disconnected” to the ground or world -“Don’t feel right” feeling -Lightheadedness. -Heaviness of the feet or head -Feeling of the eyes “crossing”
Let’s go through some common syndromes and injuries that can cause dizziness, with some recommendations and considerations for each type.
Persistent Postural-Perceptual Dizziness (PPPD)
PPPD is a relatively new diagnostic term that is usually given to people who experience dizziness in their head or whole body with no injury to the inner ears on medical imaging. Since there is no structural injury or physical damage observed on imaging, the usual diagnostic route by doctors is to consider other forms of dizziness (like Meneire’s, BPPV, etc.) and then diagnose PPPD as a diagnosis if there is no evidence of other dizziness syndromes. Because of this, sometimes people will be told “it’s all in your head” or “it’s just anxiety or stress”. It is important to remember in times like these that the sensations that you feel are very real, even if certain testing procedures can’t explain or prove it! In terms of symptoms, most people with PPPD feel some type of dizziness more than 50% of their day, and the dizziness can be triggered or increased with postural changes or with visual stimuli. From a rehabilitation standpoint, many people with PPPD are able to decrease their symptoms by generally focusing on the proprioceptive system (restabilizing the “touch” system) and vestibular retraining (when performed correctly it serves as a recalibration or “reset” button).
Benign Paroxysmal Positional Vertigo (BPPV)
There are calcium crystals inside of your inner ear that are used to sense gravity. Sometimes these crystals can dislodge and get stuck in one the canals of the vestibular system. When this happens, people usually feel strong sensations of dizziness or vertigo when looking upward or when rolling over in bed. This dizziness is always positional; meaning the dizziness is triggered by having your head in a certain position (when your head is in the certain position, the crystal moves through the canal and causes dizziness). This particular type of dizziness is usually short in duration; 30 seconds to a minute is common (the crystal moves for a period of time and then settles). BPPV is very common but can be over-diagnosed – most people with dizziness symptoms will get treated for BPPV and if their symptoms are not attenuated, they are left with few options other than medication (they were treated for BPPV but they had another condition causing their dizziness). The treatment for BPPV is a repositioning maneuver (for the correct canal) to move the dislodged crystal back to its proper place. Repositioning maneuvers can take a few minutes to 20-30 minutes depending on symptoms and is a non-invasive procedure. Sometimes BPPV can be corrected in as little as one repositioning maneuver; other times it takes a few maneuvers. Most often, people with BPPV can correct this condition fairly quickly and not have recurring symptoms.
Vestibular migraine is a complex syndrome. Many people mistakenly think vestibular migraines have to include headaches (headaches may or may not be present in this condition). Vestibular migraines include a cluster of symptoms, which may include a combination of vertigo, visual issues, motion sickness, hearing symptoms (like tinnitus), light and sound sensitivity, brain fog, and/or general discomfort or feeling “not right”. There is no rhyme or reason to symptom patterning with vestibular migraine; some think it may be due to oxygen deficiencies, some think abnormal blood sugar regulation, and others think it has to do with neural communication “mismatches” and confusion. On top of that the timing and duration is highly variable; sometimes people experience vestibular migraine on a near daily basis, and others experience vestibular migraine once a week or a couple times a month. Duration of symptoms is usually a few hours to a day, but can be shorter or longer as well. Triggers can include stress, fatigue, changes in hormones, trauma, extended motion experiences (long car rides), or other factors. When considering treatment, sometimes lifestyle management is valuable (restricting certain activities or modifying activities for a period of time). Rehabilitation is a viable option as well, as long as proper diagnosis of neurological dysfunction is correctly evaluated to ensure proper therapy application.
Mal de Debarquement Syndrome (MdDS)
MdDS is a condition in which the dizziness is usually characterized as a rocking, bobbing, or swaying sensation. People often describe this dizziness as “rocking on a boat”. This syndrome can be caused by extended time on a boat (some people step off of a boat or airplane and feel like they never truly got off). Unfortunately, many times this type of dizziness lasts for hours or most of the day. At its peak, many people don’t feel balanced except for very small amounts of the day (they almost constantly feel the rocking sensations). Typically, visual motion signals, movement of the person’s body or head, or “busy” environments (like a crowded grocery store or heavy traffic) increase the dizziness sensations. Fortunately, sometimes people can correct this syndrome at home, or at least manage it for a time before getting more help at a clinic or therapy location. Exercise, especially resistance-based training (not cardio), works very well for some people with MdDS. Weighted blankets also provide substantial benefits in many cases. Some people have been able to sleep with a weighted blanket and feel significantly better the next day, while others use the weight blanket to escape their symptoms for a period of time. A combination of visual-vestibular or proprioceptive-vestibular therapy is warranted if symptoms persist for an extended time (my personal opinion is more than 7-10 days of symptoms).
There are many other types of dizziness syndromes and conditions. Hopefully this helps shed some light and direct your thoughts and help you take the necessary actions if you are experiencing one of the above-mentioned dizziness syndromes. Remember, if you are feeling sensations of dizziness, they are very real and not just “in your head”. They can be treated through neuroplasticity and other therapies that heal the brain!
1. Remenyi, Joey. Rock Steady: Healing Vertigo or Tinnitus with Neuroplasticity. Published by Page Two Books, 2021.
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