Need to Know: Is My Vertigo Caused by MS?
Editor’s note: “Need to Know” is a series inspired by common forum questions and comments from readers. Have a comment or question about MS? Visit our forum. This week’s question is inspired by the forum topic “Multiple Sclerosis-related Vertigo: What Can You Do?” from Nov. 23, 2018.
About a year ago, I experienced a strange encounter with dizziness — while I was asleep.
It seems odd that one should feel dizzy while asleep. Yet there I was, feeling as if the world was spinning all around me.
At first, I thought it was an earthquake that awakened me. When I rolled over to get out of bed, I crashed to the floor, completely out of balance as the room continued to spiral.
I pressed my hands flat against my nightstand, then the wall, then the door, struggling to make a sideways path to my bathroom. Not only was I unable to “straighten up and fly right,” I was now feeling nauseated by it all.
The feelings subsided, but came and went a few more times until I finally called my MS specialist. A follow-up visit taught me two things.
Vertigo can be an MS symptom
According to the National Multiple Sclerosis Society, “These symptoms are due to lesions — damaged areas — in the complex pathways that coordinate visual, spatial and other input to the brain needed to produce and maintain equilibrium (balance).”
MS-related vertigo is a common problem. Recent research to address the challenges of identifying and monitoring MS-related vertigo suggests that using the vestibular evoked myogenic potentials (VEMP) test is one way to better view tiny lesions along the inner ear pathways, as MRI may not be sensitive enough to identify them.
Vertigo can be a symptom of something besides MS
MS Focus Magazine suggests that a number of reasons beyond demyelinating events can cause vertigo, such as:
- Inner ear problems
- Medication side effects
- Cardiovascular disease
- Infections (such as the flu)
- Benign paroxysmal positioning vertigo (BPPV)
Other symptoms that can accompany vertigo include common MS symptoms such as ringing ears, vision problems, and problems with standing or walking. This makes it hard to know if one’s vertigo is actually MS-related or a separate problem entirely.
What is BPPV?
It turns out that I had BPPV. This occurs when your ear canal collects tiny crystals of calcium. They can loosen and collect in the tiny “hair cells,” or stereocilia, in your ears. The stereocilia are disturbed when this happens, sending confusing signals to the brain that can lead to balance problems originating in the inner ear.
For those with frequent BPPV, you can learn a simple procedure known as canalith repositioning to relocate those crystals into a different part of the ear where they can be reabsorbed. My MS neurologist taught me this simple form of physical therapy in about five minutes.
What you can do about vertigo
- First things first: Be safe. Find a position where you can be the most comfortable and where you can also access the help of another, when possible.
- Take note of it in a symptom journal. If it happens several times over more than 48 hours, it’s a good time to seek advice from your MS specialist. If it happens randomly, but does not persist or is infrequent, you might want to see your primary care doctor. If it rarely happens and it doesn’t bother you, just sitting things out might be the best recourse.
- Seeing a doctor will help you to identify whether it is MS-related or due to other problems. Whatever the case, follow your doctor’s advice.
- For MS-related vertigo, treatments might include medications used to treat motion sickness or nausea. For longer periods of MS-related vertigo, these medications can be applied in a patch form.
- For other forms of vertigo, you might need to review your current medications for side effects, treat other health problems you might have, or confirm and treat BPPV accordingly.
Have you experienced vertigo? What tips and tricks can you share with others who are looking for relief? Post your replies in the comments below or at the original “Multiple Sclerosis-related Vertigo: What Can You Do?” forum entry.
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Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, Bionews Services, and are intended to spark discussion about issues pertaining to multiple sclerosis.
TIm
Interesting article. My wife has MS, and she occasionally has vertigo-like symptoms. I suspect it is a pathway problem to the inner ear. Several of her medications list dizziness as a possible side effect. Also I wonder if she has trouble with depth perception
Tamara Sellman
You know, Tim, it could be any one or all of those things. I'm hoping she's had at least one good discussion about this with her MS specialist. Sometimes it feels like we are all playing detective with our oddball MS symptoms.
Tamara
FB
The "simple procedure known as canalith repositioning to relocate those crystals into a different part of the ear" is also known as "Epley manoeuvres" and many physiotherapists can perform it for you. However, although it is possible to do it yourself, actually achieving success with it is not so simple when you try to do it yourself - in the process of moving the crystals to another part of the ear the manoeuvre itself can cause extreme dizziness and nystagmus and be extremely unpleasant. This unpleasantness means that many people who try the "do it yourself" route are not successful because the instinctive urge to do whatever it takes to avoid the awful dizziness means that the manoeuvre is not performed fully and correctly, especially in relation to holding particular head positions for the correct amount of time. If it's done by another person you hand over control to them and a successful outcome is much more likely.
Another important point - you should not attempt Epley manoeuvres yourself without first having an appropriate clinician determine which ear is affected - this is because you can actually make your BPPV worse if you just do the manoeuvres without targeting the affected ear - BPPV is usually one-sided.
Balance and dizziness problems were one of my first MS symptoms, and my PCP sent me to an ENT specialist who told me, in the absence of any replicable symptoms by the time I finally got to the top of his waiting list, that he thought I'd had a bout of BPPV. This was even though what I described to him was nothing like BPPV - which I have since developed after an ear infection several years ago. The MS vertigo/dizziness I had and still have are nothing like BPPV, which is often nicknamed "top shelf syndrome" because the dizziness it causes is often triggered by tilting your head back as if looking up at a high shelf. Here's a really nice clear webpage about BPPV.
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/benign-paroxysmal-positional-vertigo-bppv?fbclid=IwAR06yR3fQnPwgv6b0O3UoJQZWKTr7pSWd7WYKRZkenTRXfmnSmCAfJHKl1M
Tamara Sellman
It's true that performing the maneuver should only be done after being shown how to do it successfully by your specialist. I have been taught the maneuver myself but, thankfully, haven't had to try it since my vertigo issues more than a year ago. I'm keeping my fingers crossed that it doesn't happen again!
Tamara
Peggy Hoffmann
I get it occasionally. I will try Ginger Essential oil. And ginger candy. Same thing for seasickness etc. On a recent Cruise they gave out pieces of fresh ginger after dinner. That also helps.