Spinning, swaying, dizziness, unsteadiness, feeling “not quite right.” No matter how you describe it, vertigo—the sensation of movement or disorientation when standing, sitting or lying still—is extremely unpleasant. Moderate-to-severe vertigo affects 30% of people at some point in their lives. Most patients get relief in about six weeks or less from simple rest or by working with a vestibular rehabilitation specialist, a specially trained physical therapist who prescribes exercises to improve balance and ease dizziness-related problems.
But for some patients, vertigo can become debilitating, making it feel like the room is spinning for hours on end. It can become difficult to work, exercise and socialize. Medical tests and bloodwork often come back normal, leading ear, nose and throat doctors, physical therapists, audiologists and psychologists to say, “I can’t find anything. Just take it easy, and wait for it to go away.”
Balance expert and vestibular audiologist Joey Remenyi—a former vertigo sufferer herself—assures vertigo patients that the sensations they feel are real…they are not alone…and they don’t need to just wait for their vertigo to disappear.
Vertigo actually isn’t a condition in and of itself but rather a symptom. It can be caused by a bump to the head, a virus that damages inner-ear cells, stress or mental trauma or several balance-distorting conditions, including (but not limited to)…
Benign Paroxysmal Positional Vertigo (BPPV)—the most common cause of vertigo among older adults. This is when tiny calcium crystals in the inner ear become dislodged because of some sort of head trauma, a fall, an infection, a chronic condition such as diabetes or migraines, or simply from age. It causes brief, rapid spinning that tends to last five to 30 seconds and flares during sudden head or body movements, when lying down and/or leaning over.
Ménière’s Disease—this fluid imbalance in the inner ear leads to severe vertigo that can last 20 minutes or longer—sometimes even hours at a time—as well as tinnitus (ringing in the ears), hearing loss and a sense of ear pressure or fullness. The exact cause of Ménière’s is unknown, but it likely has to do with a combination of genetics and lifestyle stressors that aggravate the inner-ear system.
There are treatments that provide relief for many vertigo sufferers. BPPV often can be resolved using the Epley Maneuver, which involves transitioning from sitting to lying with the head turned in various directions at specific angles to help reposition the dislodged crystals. The Epley Maneuver can be done at home following video instructions or with the help of a health-care provider. Ménière’s Disease may be treated with a low-sodium diet and various medications, but there is no cure. If a patient’s vertigo is causing intense nausea, then antinausea or motion sickness medications may be used as well.
But when conventional treatments fail, patients’ lives can be wholly disrupted. Depression and anxiety can flare up…a small percentage of sufferers even become suicidal. But there is a new treatment that may help.
The brain and nervous system are made up of neurons, cells that send messages from the brain to the body and back to the brain. When neurons repeatedly exchange the same message, a firing pattern called a neural pathway is created that eventually becomes hardwired. This saves our bodies and brains from relearning how to do things—neural pathways exist for walking, eating, talking and much more.
For reasons we don’t quite understand, during a vertigo episode, some neurons fire off pathways that cause dizziness, nausea, spinning, rocking, swaying and other vertiginous sensations. The vertigo is a sort of error message sent between the brain, eyes and ears, resulting in the sensation that the world is moving even though you are remaining still.
This sensation is upsetting and disorienting…and it sparks many negative emotions—fear, sadness, anger, resentment, anxiety and hopelessness. All of this works against the patient in a specific, brain-oriented way because our emotional state impacts our neural pathways. Things we enjoy, severely dislike or simply pay lots of attention to become hardwired faster. With every failed attempt to treat the vertigo, the patient becomes increasingly hyper-focused on getting rid of his/her symptoms. Patients want so badly for the spinning to stop that they may spend their free time researching fixes, talking to friends about their troubles, seeing health-care providers and wishing they could just return to normal.
Neurons notice this increased attention to the misfiring pathways. Every time you talk, think or worry about your vertigo, you’re confirming to your brain that the sensation is important. You’re like a symphony conductor telling the dizziness section of your orchestra to play louder and louder.
But focusing on eliminating your symptoms doesn’t work. Instead, you can use the power of neuroplasticity—the brain’s ability to modify, change, and adapt structure and function in response to experience—to help resolve vertigo.
Take these steps to override the vertigo-inducing neural pathways and create new pathways. Note: Make sure you’ve been cleared by your health-care provider to try neuroplasticity and that other medical conditions, such as a stroke or tumor, have been ruled out.
Believe you can heal. You can use neural plasticity to repattern your neural connections, but you have to believe that you have the capacity to heal. You are the only one who can change your neural patterns. This requires an open mind, curiosity about how the human body works and trust in your own power.
Commit to no longer focusing on your symptoms (what you don’t want), and instead identify your goal (what you do want). Setting a goal of “feeling normal again” won’t work because it’s loaded with judgment—as if there is something abnormal with you—and will only reinforce unhelpful neural firing. For some people, the goal may be to feel calm, at peace or confident, rather than wishing for an absence of symptoms.
Start a daily practice of cultivating those desired feelings. If feeling calm is your goal, ask yourself, What makes me feel calm? Maybe it’s sitting in a lovely garden and taking 10 slow, deep breaths. Maybe it’s singing, doing gentle yoga or ticking things off your to-do list. Those activities now are part of your daily neuroplasticity practice. When you do them, pay attention to the sense of calm you feel and not to any sensations of vertigo that may occur. If you feel dizzy, notice it but try not to judge it. Don’t think, Ugh, I can’t even do yoga without feeling dizzy. Feel it. Don’t try to fight it, and don’t label it as “wrong” or “bad.” See if the dizziness passes.
Do your own body scan. This is an effective tool for learning how to let vertigo sensations pass without judgment while reinforcing healthier neural pathways. How to do it: In a quiet, safe space, sit, stand or lie in a position that feels comfortable and stable. Notice any sensations occurring in your body. Feel your clothing touching your skin…your feet pressing against the floor…the chair against your back. Feel your heart beating in your chest. Move your attention from the left side to the right side of your body, and mentally travel up and down, head to toe. Use your hands to feel your contours and shapes. If you experience vertigo symptoms, accept this as a sensation that can come and can go. You want to communicate to your brain and body that dizziness is not the only thing happening or that matters—it’s one tiny part of your experience. Focusing on the present and remaining emotionally neutral signals to your brain that you feel safe. Focusing on sensations of touch promotes a feeling of steadiness, the antidote to dizziness.
Congratulations—you’re creating new neural pathways! With practice, they will become automated. And you’re weakening the connections between vertigo-message–firing neurons by refusing to prioritize them. The vertiginous sensations won’t disappear immediately—that may take weeks or even months of daily practice. But as long as you allow yourself to feel the unpleasant sensations without blaming your body or numbing yourself with medication, you are sending your brain the message, I don’t need these vertigo neural patterns. They’re not helping me with work, with love, with life. The symptoms become quieter because the body is allocating fewer resources to them. Think of it like a seesaw, with your vertigo symptoms and related fears on one side and calm, joy and steadiness on the other. When one side rises, the other automatically lowers.
Get help. You can try doing these neuroplasticity exercises on your own or work with a vestibular rehabilitation specialist trained in neuroplasticity. Ask your doctor or a local university for a recommendation, or contact the Vestibular Disorder Association
(Vestibular.org/).
