The balance maintenance system is one of the most complex in the organism. Not surprisingly, it has taken our species thousands of years to gain the ability to stand upright. It is therefore not surprising that vertigo, dizziness and imbalance are among the pathologies most frequently encountered in daily clinical practice: it is said that between 25% and 40% of the population will see a doctor at some point in their lives because of one of these symptoms.
In recent years we have witnessed a profound change in the study of the vertiginous patient. Today we have a large number of elements that allow us to reach a correct diagnosis and treatment.
Advances such as videonystagmography, posturography, computerized tomography and magnetic resonance imaging have revolutionized otoneurology and allow precise treatment in most cases, ranging from the simplest rehabilitation exercises to the most complex surgery.
Despite these advances, the diagnosis and treatment of vertigo always begins with a good clinical history and a close doctor-patient relationship.
The purpose of these tips is not to replace this relationship, which is essential if we want to obtain good results, but to make it simpler, trying to make the patient aware of certain aspects of this pathology that will help him and his doctor understand each other better, while trying to avoid two of the most frequent complications of this pathology. On the one hand, changes in character, irritability, anxiety and even depression, and on the other hand, falls, many of them with serious consequences, especially after a certain age.
What advice should the patient with vertigo follow?
- Medication: The patient should inform his physician of any medication he uses, as some medications may cause vertigo or dizziness as a side effect. Vestibular sedatives decrease the vertiginous sensation, but make compensation more difficult. It is necessary to reduce their use and replace them with drugs that favor vestibular compensation and have a cellular protective effect.
- Diet: Alcohol, tobacco and stimulant substances such as coffee, tea or cola should be avoided. In some cases it is advisable to reduce salt intake, and in migraine-associated vertigo, spices, chocolate, wine, cured cheeses and preservatives (foods containing glutamic acid or tyramine) should be avoided. Hydrate well.
- Life habits: It is advisable to lead an orderly life, rest well and sleep regularly, without excess or defect, avoiding sedentary life, stress, anxiety and fatigue.
- Movements: Change position slowly, especially when lying down or sitting when standing up. Avoid rapid head movements. Avoid climbing stairs or putting yourself in situations where there is a risk of falling.
- Footwear: To avoid tripping, the front part of the sole should be slightly elevated and should have a pattern that prevents slipping, without being too thick or too soft. The heel should be neither too high, no higher than 2.5 cm, nor too soft and wide enough to provide a stable base.
- Changes in the environment: It is advisable to make changes in the house to improve postural control and avoid the risk of falling. Lighting conditions should always be adequate: before getting out of bed turn on the light, put emergency lights in case of power failure. Avoid or remove thick carpets or carpets scattered around the house, avoid obstacles in the usual places of passage, loose wires… Use non-slip floors, essential in the bathroom and shower, stable chairs and tables, modify shelves and cabinets to avoid bending or getting up, use stairs with handrails….
- Exercise and physical activity: The patient who suffers a vestibular lesion should be stimulated to recover activity as soon as possible. The exercise allows the nervous system to know exactly the degree of injury and stimulates the uninjured structures. Exercises should be performed in a large room where you cannot be hit if a fall occurs and always be accompanied.
- Vestibular rehabilitation: If your doctor recommends a program of rehabilitation exercises you should know that during the first weeks you may suffer some worsening as it is necessary to perform exercises or positions that cause the symptomatology, but never beyond a mild or moderate level of vertigo or dizziness.
- Cervical problems: The most frequent vertigo is Benign Paroxysmal Positional Vertigo (BPPV), characterized by sudden episodes of vertigo of short duration, recurrent and positional: when lying down in bed, when sitting up, when raising the head to look up, when bending over… It is possible that some vertigo blamed on the “cervical” may actually be Benign Paroxysmal Positional Vertigo; in these cases it is the vertigo caused by head movements that causes the “fixation” and cervical pain, and not the cervical problem that triggers the vertigo.
- Driving: If you have vertigo or imbalance you should not drive until cleared by your physician.