Vertigo is a sensation of spinning, swaying, or feeling that the world is moving when it is not. This can range from mild unsteadiness to severe spinning, often accompanied by nausea, vomiting, or difficulty walking. It is a symptom of an underlying condition, not a disease.
Understanding Hereditary Vertigo
While vertigo itself is not directly inherited, certain underlying conditions causing it can have a hereditary component. Genetic factors can increase an individual’s likelihood of developing specific types.
Ménière’s disease is characterized by episodes of vertigo with fluctuating hearing loss, ringing in the ears (tinnitus), and a feeling of fullness. While often idiopathic, a genetic predisposition is observed in some families, with 10-20% of cases familial.
Familial vestibulopathy is an inherited condition causing chronic imbalance and episodic vertigo. This disorder results from genetic factors, leading to vestibular system dysfunction. Familial episodic ataxias are recurrent vertigo syndromes, characterized by incoordination, speech difficulties, and truncal ataxia.
Vestibular migraine demonstrates a strong genetic link to migraine disorders. Individuals with a family history of migraines are more susceptible, with vertigo occurring before, during, or after a migraine headache, or even as the primary symptom. This condition is a common cause of recurrent, spontaneous vertigo.
Benign Paroxysmal Positional Vertigo (BPPV), while primarily idiopathic, may have a genetic predisposition in a small percentage of recurrent or early-onset cases. Recent studies identified genetic variants that may predispose individuals to vertigo by affecting inner ear development and maintenance.
Common Non-Hereditary Causes
Many common forms of vertigo are not hereditary. Benign Paroxysmal Positional Vertigo (BPPV) is the most frequent cause, typically from displaced otoconia, tiny crystals within the inner ear’s balance organs. When dislodged, these crystals float into the semicircular canals, sending confusing signals to the brain, especially with head movements.
Vestibular neuritis and labyrinthitis are inner ear infections, often viral. Vestibular neuritis inflames the vestibular nerve, causing sudden, severe vertigo, nausea, and imbalance, without affecting hearing. Labyrinthitis involves inflammation of the entire labyrinth, causing vertigo, hearing loss, and tinnitus.
Head injuries are another non-hereditary cause of vertigo, as trauma can damage the inner ear’s vestibular system or disrupt brain balance pathways. Even mild traumatic brain injuries can lead to vertigo, often from BPPV due to dislodged crystals.
Certain medications, including antibiotics, anti-inflammatory drugs, and cardiovascular medications, can induce dizziness or vertigo as a side effect by interfering with inner ear balance or brain function. More serious conditions like stroke or transient ischemic attack (TIA) can also manifest with vertigo, indicating brain blood flow issues.
Orthostatic hypotension, a sudden drop in blood pressure upon standing, is another non-hereditary cause, leading to lightheadedness or vertigo due to insufficient brain blood supply. Other factors include diabetes, multiple sclerosis, and dehydration.
Diagnosis and Management
Individuals experiencing vertigo should seek medical evaluation. A primary care physician can provide an initial assessment and may refer patients to specialists like ENTs or neurologists. A detailed medical history is collected, including symptom details and family medical history, especially for suspected hereditary forms.
A physical examination usually involves balance tests and analysis of eye movements, as involuntary eye movements (nystagmus) can indicate inner ear or brain issues. Specific maneuvers like the Dix-Hallpike test are often performed to diagnose BPPV by observing eye movements triggered by head position changes.
Specialized diagnostic tools pinpoint the cause of vertigo. Vestibular Function Tests, such as Videonystagmography (VNG) or Electronystagmography (ENG), evaluate inner ear function by recording eye movements. Audiometry (hearing tests) assesses auditory system health, especially for Ménière’s disease. Imaging tests, including CT or MRI scans, may rule out central causes like brain tumors or stroke.
Management approaches for vertigo vary based on the underlying cause. Vestibular Rehabilitation Therapy (VRT) is an exercise-based program helping the brain compensate for inner ear dysfunction and improve balance. VRT reduces vertigo, dizziness, and fall risk through customized exercises. Medications manage acute symptoms or treat underlying conditions. Lifestyle adjustments are important for conditions like Vestibular Migraine and Ménière’s disease.