Dizziness and Vertigo

The term vertigo refers to the sensation of spinning, which, when severe, may be accompanied by nausea and vomiting. There are many causes of vertigo. In MS the problem usually results from an irritation of the brain stem structures that help to maintain balance by coordinating the eyes, arms, and legs. The inner ears also play a major role in balance, and disturbances in the conduction of input to the brain from the inner ear may be very distressing. Dizziness and the sensation of lightheadedness are less severe than vertigo, but nonetheless they cause discomfort. Obviously, other diseases that involve these structures produce similar symptoms, and it should not be assumed that they are necessarily due to MS.

Antihistamines, including diphenhydramine (Benadryl®), meclizine (Antivert®), and dimenhydrinate (Dramamine®), frequently provide relief when vertigo or sensations of dizziness are relatively mild. Niacin (a component of vitamin B complex) occasionally is used to dilate blood vessels in the hope that this will reduce the problem.

Benzodiazepines, the class of medications that includes diazepam (Valium®), clonazepam (Klonopin®), and oxazepam (Serax®), directly suppress the structures of the inner ear that stimulate dizziness. They are potent antidizziness treatments but they must be used judiciously. These medications, individually or occasionally in combination, provide sufficient relief to allow the person affected by dizziness to continue functioning reasonably well.

A physical therapist may teach effective exercises if dizziness is made worse by positional changes. The therapist determines which positions of the head make the dizziness worse. Therapy consists of holding the head in those positions for as long as is tolerated. If this is done successfully, tolerance develops and comfort results.

Dizziness frequently accompanies an attack of influenza. When flu and its accompanying fever and muscle aches occur, the symptoms are managed with aspirin or other medication, and the dizziness often disappears as the flu symptoms ease.

If vertigo is severe and vomiting prevents the use of oral medications, intravenous fluids are administered in combination with high doses of cortisone to decrease inflammation in the region that produces these symptoms, the brain stem area at the base of the brain.

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