An Overview of Vertigo in MS

Show Article Table of Contents

Vertigo—an acute sensation of spinning, unsteadiness or disequilibrium—is not an uncommon complaint of people with multiple sclerosis (MS). Brain damage resulting from the disease is one reason this can occur, though there are many others not related to MS. Fortunately, it's not a permanent symptom for most people and doesn't necessarily indicate a new lesion.

Symptoms

Classic vertigo, whether caused by MS or something else, produces a sensation of spinning. You may feel like:

  • The ground is suddenly rushing upward.
  • The room is moving continuously.
  • The room only seems to rotate part of the way, return to normal, and rotate part way again.

It can be a very powerful and disconcerting feeling of movement and can cause nausea or vomiting. At its worst, vertigo can cause difficulty standing or walking and even lead to falls.

It rarely persists for a long time, but in some cases, it can take weeks or months to go away completely (which it usually does gradually). Some people, however, experience it chronically.

Benign paroxysmal positioning vertigo (BPPV) is also possible. BPPV is like severe vertigo that occurs upon movement of the head, especially when rolling over in bed, getting out of bed, or tipping the head back to look up. It feels like you (or your surroundings) are spinning or tilting when you are not. It usually lasts just a couple of minutes.

Causes

Vertigo can be caused by MS lesions in the cerebellum or brainstem. It can also be a result of damage to the vestibulocochlear nerve (VIII cranial nerve), which controls the vestibular functions of the ear.

In addition, dizziness is a common side effect of some of the drugs prescribed for MS symptoms, such as tricyclic antidepressants like Elavil (amitryptiline) for neuropathic pain, or baclofen for spasticity.

Blood pressure issues, low blood sugar, or cardiovascular disease may also be the cause of your vertigo. Vertigo can be caused by infections, such as the flu.

BPPV differs in that it is not due to demyelination (destruction of myelin), but rather debris that has collected in the semicircular canals of the inner ear, which is part of the vestibular system.

The debris, called otoconia or canaliths, are actually small calcium carbonate crystals that everyone has. They are usually attached to the tiny hairs in your inner ear that detect movement but can become dislodged and float around. When a person with BPPV moves his or her head, these crystals shift and stimulate these tiny hairs, sending false signals to the brain.

The vertigo happens because of the confusion caused by these signals and other systems controlling proprioception (your ability to sense where you are in space without looking).

Since many people with MS already have difficulty with proprioception, this may make them feel BPPV even more acutely. In other words, their threshold for experiencing vertigo may be lower.

However, BPPV is not specific to MS, so the vertigo may or may not be a direct result of the MS disease process.

Diagnosis

If you have MS and are experiencing vertigo, you should ideally see an otoneurologist or a neurotologist—specialists in both matters of the inner ear and neurology. An otolaryngologist, also known as an ear, nose, and throat specialist (ENT), is another option if you don't have access to these types of providers.

Your doctor will ask for information on your medical history, including details about your symptoms. He may ask what the sensation feels like, how often it occurs, whether it occurs more frequently when you move a particular way or at certain times of the day, and whether you also experience hearing loss or ringing in the ears. He'll want to rule out other possible causes of vertigo, such as migraines or an infection.

He may also perform the Romberg test to assess your proprioception.

Treatment

Episodes of vertigo tend to pass fairly quickly. If the suspected cause is your MS, a short course of a prescription corticosteroid may be helpful.

If the cause is BPPV, your doctor may perform a canalith repositioning procedure (a.k.a. the Epley maneuver), which consists of several simple and slow head-positioning maneuvers. The goal is to move particles from the fluid-filled semicircular canals of your inner ear into a region of your ear (called the vestibule) where these particles are resorbed. It is possible to perform on yourself if necessary.

Other treatments include acupuncture and acupressure.

Acute symptoms like nausea and vomiting may respond to a prescription antihistamine called Antivert (meclizine). Dramamine, an over-the-counter medication for motion sickness, can also help.

A Word From Verywell

Vertigo can be an uncomfortable and unnerving symptom of MS, but, with a proper diagnosis, it can be treated. If you frequently experience vertigo, modifying your home by installing grab bars, removing throw rugs, and keeping a cane or walker handy can help you feel safer and less vulnerable when an attack strikes.

Was this page helpful?
Article Sources