Vertigo

Vertigo is a symptom where a person feels as if they or objects around them are moving when they are not. It is often a spinning or swaying movement. A person may experience nausea, vomiting, sweating, or difficulties walking. It is usually worse when the head is moved.

Benign paroxysmal positional vertigo (BPPV) is where specific head movements cause vertigo – is the most common type of vertigo.

Prevalence
According to the Canadian Consensus Criteria, Vertigo only occasionally affects ME/CFS patients.

Vertigo in ME/CFS
Vertigo is not commonly experienced by ME/CFS patients (although possible as neurological problems in general are a prominent feature of ME/CFS). Dizziness is a far more common symptom of ME/CFS, and is usually due to Postural orthostatic tachycardia syndrome (POTS) or other forms of orthostatic intolerance.  which are prominent co-morbid symptoms and just two of the [:Category:Cardiac_signs_and_symptoms |cardiac signs and symptoms]] they can experience.

Symptom recognition
The Canadian Consensus Criteria recognizes vertigo occuring within ME/CFS, although vertigo is not a diagnostic symptom of ME/CFS: "Vertigo accompanied by nystagmus, nausea and/or vomiting and often associated with tinnitus and/or impaired hearing acuity requires an anti-nauseant but there is no good treatment."

Possible causes
General causes for vertigo include:
 * Benign paroxysmal positional vertigo (BPPV) – where specific head movements cause vertigo
 * Labyrinthitis – an inner ear infection caused by a cold or flu
 * Vestibular neuronitis – inflammed vestibular nerve
 * Ménière's disease – a rare inner ear condition, which may also cause tinnitus or hearing loss
 * Migraines, which can occur in ME/CFS patients, including "silent migraines" (migraine causing neurological symptoms but without headache)

Certain drugs can also cause vertigo, this should be listed as a side effect on the patient information (PI) leaflet.

Tests
https://www.youtube.com/watch?v=79Iol892EPw Videonystagmography (VNG eng testing) is used for testing inner ear and central motor functions.

There are 4 main parts to a VNG test:

1. Occular Mobility

You will be asked to have your eyes follow objects that jump from place to place, stand still, or move smoothly. The technician will be looking for any slowness or inaccuracies in your ability to follow visual targets. This may indicate a central or neurological problem, or possibly a problem in the pathway connecting the vestibular system to the brain.

2. Optokinetic Nystagmus

2. You will be asked to view a large, continuously moving visual image to see if your eyes can appropriately track these movements. Like the occular mobility tests, the technician will be looking for any slowness or inaccuracies in your ability to follow visual targets. This may indicate a central or neurological problem, or possibly a problem in the pathway connecting the vestibular system to the brain.

https://www.youtube.com/watch?v=_EnAGlTibd0 3. Positional Nystagmus

The technician will move your head and body into various positions to make sure that there are no inappropriate eye movements (nystagmus), when your head is in different positions. This test is looking at your inner ear system and the condition of the endolymph fluid in your semi-circular canals. The technician is verifying that small calcium carbonate particles called otoconia are not suspended in the fluid and causing a disturbance to the flow of the fluid.

4. Caloric Testing

The technician will stimulate both of your inner ears (one at a time) with warm and then cold air. They will be monitoring the movements of your eyes using goggles to make sure that both of your ears can sense this stimulation. This test will confirm that your vestibular system for each ear is working and responding to stimulation. This test in the only test available that can decipher between a unilateral and bilateral loss.

Potential treatments
Meclozine is a suggested treatment for vertigo, it is acts against nausea and is also an antihistamine.

The Canadian Consensus Criteria is suggests "Finding Center" for balance issues (Jones and Clarke, 2002) and the Cawthorne/Cooksey System for vistibular injuries to restore equilibrium.

Learn more

 * Vertigo: Symptoms, Causes and Treatment - WebMD
 * Vertigo - NHS
 * Cawthorne-Cooksey Exercises - Information for patients - St George's Hospital, NHS