Vertigo Causes, How To prevent, Ayurvedic Treatment

Article by Dr Raghuram Y.S. MD (Ay)
A person suffering from vertigo feels dizzy. In Ayurveda, this condition is called Bhrama. From limiting salt consumption to including celery in your diet, you can do very simple lifestyle an diet changes to cure vertigo. 

Do you often feel as if you are rotating around yourself?
Do you feel as if the objects around you are moving around you when they are actually not moving?
If yes, then you are suffering from a medical condition called Vertigo

‘I Have Vertigo. Vertigo makes it feel like the floor is pitching up and down. Things seem to be spinning. It is like standing on the deck of a ship in really high seas’ – Laura Hillenbrand, American author

Click to Consult Dr Raghuram Y.S. MD (Ayu)

What is Vertigo?

Vertigo is a medical condition in which you suffer from a sensation of spinning or swaying. If you have these dizzy spells, you might feel like you are spinning or the world around you is spinning

Vertigo is the commonest type of dizziness
It is typically worsened when the head is moved
Ayurvedic people call it as ‘Bhrama’ {Also spelt as Brama}

Associated symptoms of vertigo –
Nausea (sensation for vomiting)
Vomiting
Sweating
Difficulty in walking

Other names

• Dizziness, Giddiness, Light headedness, Shakiness, Unsteadiness, Loss of balance, Loss of equilibrium, Spinning head, Swimming of head
• Vertiginousness
• Wooziness, Informal wooziness, Wobbliness
• Disequilibrium
• Fear of heights
• Acrophobia
• Mirligoes
• Technical sturdy
• Rare turnsick

Prevention tips

Lifestyle tips – How to prevent vertigo? 

• Know your disease – Be aware of the possibility of losing your balance which can lead to serious falls and injuries
• Sit down immediately when you feel dizzy
• If you get up at night, make sure that you are using good lighting
• If you are at a risk of falling, walk with a cane support
• Avoid sudden jerky movements
• Don’t keep your head tilted back for a long time
• Avoid driving
• Avoid operating heavy machines
• Avoid taking stairs
• Prevent injuries from falls, use a cane or walking frame to control your balance
• Wear shoes with low heels, non-slippery soles and always see that they are tied.
• Be in touch with your doctor
• Regularly do Yoga and meditation
• Sleep well, sleep at least for 8 hours
• Sleep without pillow for better blood circulation to the brain
• Develop healthy lifestyle
• Exercise regularly to stay active and avoid stress
• Make your home safe to prevent unnecessary falls (ensure that the home is free of clutter, well lit, install grab bars and use non-skid mats in the bathroom
• Control high blood pressure (hypertension)
• Control high cholesterol.
• Manage and control stress and anxiety by practising relaxation techniques such as deep breathing exercises, Yoga or meditation
• Practice eye exercises by looking from near to far, up and down or side to side
• Vitamin D supplementation (BPPV)
• Take iron supplement, if your doctor has suggested it to you.
• Take breaks from computers.
• Avoid pushing shopping cart filled with groceries
• Don’t raise your arms over your head
• Focus your vision on any place or building when you feel the onset of an attack of vertigo
• Take slow and long breathing when you feel dizziness or vertigo
• Live happy and cool, keep stress away

Diet tips for Vertigo relief: 

• Eat something – Dizziness can be caused due to a low blood sugar level, especially for diabetics. Hunger can make you more prone to dizziness. So when you get dizzy, try eating something. Eat a snack that is high in carbohydrates or sugar like a chocolate bar or a banana. Eat any fruit which has high water content. A bowl of yogurt with fruit is also a good option when you feel dizzy. A handful of roasted nuts like cashews, almonds or walnuts may also work.
• Eat healthy food
• Drink lots of water
• Drink 2-3 glasses of cold ice water whenever you get dizzy due to vertigo
• Take fresh and organic, seasonal fruits and vegetable juices
• Develop a habit of eating salads
• Take green herbal tea
• Poppy seeds, Raisins, Dates, Citrus fruits are good
• Eat vitamins and protein rich foods including green leafy vegetables, salad and fruits
• Drink celery juice everyday
• Consume brown rice, wholegrain bread, veggies, legumes etc

Things to avoid

Things to avoid to cure vertigo: 

• Limit salt as this may help to minimize the amount of build up in the ear
• Avoid caffeinated drinks (coffee, tea), chocolates, foods high in sodium and fried foods
• Limit foods with high cholesterol like fried foods, whole dairy products and red meat
• Less oily foods
• Take less salt and sugar
• Reduce sweets and foods with high sugar
• Avoid refrigerated items and junks
• Quit smoking and tobacco (smoking constricts blood flow to the inner ear)
• Avoid alcohol
• Avoid caffeine
• Avoid fast & junk foods

Exercises to prevent or relieve vertigo: 
Move your eyeballs in all directions. Rotate your neck in clockwise and anticlockwise directions to counts of five. Do visual fixation exercises (focusing your eyes at a point for some time and then rapidly blinking them several times). Walking exercises are also useful. Walk with your eyes closed and alternate with eyes open. You can also walk on an inclined surface keeping your eyes focused at a point.

Ayurvedic home remedies

Ayurvedic treatment and home remedies for Vertigo:
Take home remedies if you are diagnosed with vertigo. Try them with the consent of your doctor.

• Powder of Shankapushpi 1-2 grams mixed in a cup of night, after food.
• Decoction of Guduchi (Tinospora cordifolia) – 30 ml of Guduchi Kashaya, in the morning, 30 minutes before food.
• Amrita churna (powder of Tinospora cordifolia) – 3 grams or Giloy satwa – half a gram along with a teaspoon of honey.
• Decoction of Aragwadha or Haritaki powder or powder of Aragwadha mixed in decoction at night of Terminalia chebula to ward off constipation.
• Half a teaspoon of Ashwagandha powder (Withania somnifera), mixed with a cup of milk is administered for a period of one month time.
• One teaspoon of Kapikacchu  powder (Mucuna pruriens) or Vanari Kalpa with milk,
• Powder of Shatavari (Asparagus racemosus) with milk
• Arjuna Ksheerapaka – Milk processed with powder Arjuna (Terminalia arjuna) {1 spoon Arjuna powder + 50ml milk + 200ml water – boil and reduced to 50ml, filtered and taken warm, twice daily}. Learn how to Arjuna Ksheerapaka, step by step
• Ashwagandha Ksheerapaka – Milk processed with powder Ashwagandha (Withania somnifera) {1 spoon Ashwagandha powder + 50ml milk + 200ml water – boil and reduced to 50ml, filtered and taken warm, twice daily}
• Bala Ksheerapaka – Milk processed with powder roots of Bala (Sida cordifolia) {1 spoon Bala powder + 50ml milk + 200ml water – boil and reduced to 50ml, filtered and taken warm, twice daily}
• Amalaki (Emblica officinalis) powder – half a teaspoon with a spoon of honey, once or twice a day.
• Mix ½ teaspoon each of finely powdered cardamom and cinnamom in warm sesame oil (2 spoons) and apply on the crown of the head
• Raisins – Dip 8-10 crushed raisins in water overnight. Crush them in the same water, the following morning and take it on empty stomach.
• Mix equal quantities of powders of Ashwagandha (Withania somnifera) and a quarter part of Vacha (Acorus calamus – sweet flag) and store it in an air tight container. Take 1 gram of this powder with 250 ml of milk once or twice daily
• Triphala Churna – 1 teaspoon should be mixed with ¼ tsp Sarpagandha powder (Rauwolfia serpentine). Take this twice daily mixed with hot water or honey or ghee or sugar as recommended by your doctor. This will help when episodes of vertigo are preceded by headache.
• Amalaki (Emblica officinalis) juice with honey
• Mukta bhasma (calx or ash of pearl) with honey or ghee
• Sutashekara Ras with juice of Indian gooseberry (Amla) and honey
• Lemon juice with sugar
• Take 1 teaspoon of cumin powder with half a gram of nutmeg powder, mix them well and take with honey, once or twice a day for 6 weeks time.
• Mix 1 teaspoon each of ginger juice and honey and have it, once or twice a day, after food for 1 month time. This also improves digestion and metabolism.
• Small piece of smashed ginger and 3 pieces of smashed garlic slices should be boiled with water and taken warm, twice daily
• Lemon – Squeeze ½ lemons in a glass full of lukewarm water, 2 pinches of pepper powder, 1 pinch of salt – mix well and drink. Sprinkle lemon peel in your salad. Use lemon as many as you can.
• Coriander seeds – Soak 1 teaspoonful coriander seeds in water with 1 tsp gooseberry powder at night. Strain it in the morning, add ½ tsp sugar and drink it.
• Almonds and watermelon seeds – Soak 8-10 almonds and watermelon seeds, 2 tsp wheat grains and 1 tsp poppy seeds in water overnight. Make a thick paste of them in the morning. Fry 2 cloves and the above said paste in 1 tsp ghee. Mix it in milk and drink (Boil the whole mixture in milk and mix some sugar or sugar candy powder if needed. Take it warm). Repeat this for a week. Take it for 7-10 days
• Almond milk – Soak some almonds in water overnight. Make a paste in the morning and mix well in a glass of milk and drink it.
• Ginger – Drink ginger tea or eat a piece of raw ginger
• Basil – Chew a few leaves or drink basil tea
• Mix 2 tsp each of honey and raw unfiltered apple cider vinegar in a glass of cold or hot water. Drink it 2-3 times in a day. Honey can be taken with lemon juice mixed in water. 1 tsp each of honey and cinnamon powder should be taken once daily in the morning for several weeks.
• Ripe strawberries mixed in yogurt
• Strawberry – Mash fresh and ripe strawberries in fresh yogurt and have it
• Take 1 teaspoon powder of Ginkgo Biloba with water or drink its juice
• Vinegar – Mix 2 tsp of apple cider vinegar with 2 tsp of honey in a glass of water. Take it twice or thrice daily.
• Feverfew – can cure headaches, nausea and vomiting associated with vertigo. It also improves blood circulation. Eat a few fresh feverfew leaves when you feel dizzy. Steep 1 tsp each of dried feverfew leaves and peppermint leaves in a cup of hot water for 15-20 minutes. Then strain it. Drink this tea a few times daily for a few weeks.
• Take 2 spoons sesame oil and heat it in a pan. Add 2 cloves of garlic to it and fry till they are brown. After the cloves get cooled, strain them through sterile cloth or a sieve. Make the extract lukewarm and fill the ear with it. Leave it for 5-6 minutes and drain it off. Repeat it with the other ear also.
• Dip a sterile cotton piece in peroxide. Squeeze it into your ears until it fills up. Drain after 8-10 minutes.
• Warm coconut oil drops into the ears
• Get 2 big strong magnet blocks. Put them together to make 2’ by 2’ block, 1/4’ thick. Put them together and wrap in hand towel and place them under the bump on the back of your head. Tie the 2 ends together at your forehead. Do it for 15-30 minutes

Manoeuvres for vertigo

Manoeuvre’s and easy-to-do therapies for vertigo 

• Deep breathing – Sit or lie down in a comfortable position. Place your thumb on one nostril, close your mouth and inhale slowly through your open nostril. Hold the breath in, close both nostrils and purse your lips. Exhale slowly after 2-3 seconds. Repeat these steps for 10 times. Sit quietly for 5 minutes and breathe normally to avoid getting dizzy again.
• Head massage with essential oils – like lavender oil
• Water therapy – drink a glass of ice cold water whenever you are dizzy. Later pour cold water on your head and back of your neck.
• Sterno-cleido-mastoid (that diagonal muscle on the front of your neck) muscle massage
• Acupuncture and
• Acupressure

Some easy interesting manoeuvres for Vertigo:
Epley manoeuvre – is a type of physical therapy which involves head and body movements done while sitting on a bed. Usually it is done in a clinic or under supervision of a physical therapist. It may also be done at home after having received proper guidance and instructions.

How to perform Epley manoeuvre? Watch videos:

Deep head hanging maneuver

Lempert (BBQ) Maneuver to Treat BPPV Vertigo
Video –

Brandt – Daroff Exercises for BPPV
Watch videos:

Some effective herbs tried in vertigo:

• Ginger
• Coriander
• Lemongrass – helps to treat nausea and dizziness, effective in vertigo. Herbal tea prepared with lemongrass is highly effective. It will relieve the symptoms within few minutes of onset.
• Cayenne – contains a chemical called capsaicin which helps enhance blood flow in your brain. Boil a cup of water with some cayenne and take it whenever you are feeling lightheaded.
• Gingko biloba – its herbal tea is effective in vertigo if taken everyday
• Use mustard greens (Brassica juncea)
• Butcher’s broom
• Indigo

Yoga and Mudra

The below said Yoga asana’s and Mudra will enable a healthy, pure blood flow to the brain cells and cure vertigo.
Caution: Sudden forward bends and downward facing poses should be avoided. Yoga should be practised slowly and with calm mind. Over anxiety in doing the poses may exacerbate vertigo. Any how it is always preferable to do the Yoga asanas under the guidance and supervision of Yoga instructors.

Shanmukhi Mudra

Nadi Shodhan Pranayam

https://www.youtube.com/watch?v=apLOi3y0iyA

https://www.youtube.com/watch?v=4OJMULD_Lxw

https://www.youtube.com/watch?v=_DwZ3MU-HAk

Salamba Shirsasana

Halasana

Paschimottanasana

Shavasana

Malasana

Ardha matsyendrasana

Etymology, causes

Vertigo – Disease information (modern)
Etymology:
Vertigo is derived from Latin word ‘verto’ which means ‘a whirling or spinning movement’

What causes vertigo?
Vertigo happens when there is a problem in a part of the vestibular system, the part of the ear which controls our body balance

Common diseases

Most common diseases that result in vertigo are –
Benign paroxysmal positional vertigo – BPPV – It occurs when tiny calcium particles (canaliths) clump up in canals of the inner ear. The inner ear sends signals to the brain about head and body movements relative to gravity. It helps you keep your balance. In this people get repeated episodes of vertigo with movement. In between vertigo episodes, they are normal. The episodes of vertigo last less than 1 minute. Dix-Hallpike test produces a period of rapid eye movements known as nystagmus.

Meniere’s disease – This is an inner ear disorder thought to be caused by a build up of fluid and changing pressure in the ear. It is thought to be caused by an increase in the amount of endolymphatic fluid present in the inner ear. In this there is often ringing in the ears, hearing loss and attacks of vertigo last more than 20 minutes. It is a vestibular disorder of unknown origin. It presents with recurrent, spontaneous attacks of severe vertigo in combination with ringing in the ears (tinnitus), a feeling of pressure or fullness in the ear (aural fullness), severe nausea or vomiting, imbalance and hearing loss. As the disease worsens, hearing loss will progress.

Labyrinthitis – It is the inflammation of the labyrinth or inner ear. In this, the onset of vertigo is sudden and the nystagmus occurs without movement. Vertigo can last for days. There may be weakness, headache, double vision or numbness

Vestibular neuritis with labyrinthitis – This is an inner ear problem usually related to infection (usually viral). The infection causes inflammation in the inner ear around nerves that are important for helping the body sense balance. It is a disorder which affects the nerve of the inner ear (vestibulocochlear nerve – a nerve which sends balance and head position information from the inner ear to the brain). It presents with severe vertigo with associated nausea, vomiting and generalized imbalance. Patients typically don’t have auditory symptoms but may experience a sensation of aural fullness or tinnitus.

Vestibular Migraine – It is the association of vertigo and migraines. It is one of the most common causes of recurrent, spontaneous episodes of vertigo. Stimulation of the trigeminal nerve leads to nystagmus in individuals suffering from migraines (hypothesized cause).

Acoustic neuroma – Uncommon cause of vertigo, vertigo is caused die to a tumour of the nerve tissue of the inner ear. Symptoms include vertigo with one-sided ringing in the ear and hearing loss

Decreased blood flow (to the base of the brain) – Bleeding into the back of the brain (cerebellar haemorrhage) presents with vertigo, headache, difficulty walking and inability to look toward the side of the bleed. The person’s eyes gaze away from the side with the problem. Walking is extremely impaired.

Less common causes for vertigo are –

• Multiple sclerosis – Onset is usually abrupt. On examination, the eyes may reveal the inability of the eyes to move past the midline toward the nose.
• Migraines – Headache is usually followed by a headache (not always). There is often a prior history of similar episodes but no lasting problems.
• Stroke
• Brain tumours
• Brain injury

Less frequent causes:

• Complications from diabetes can cause arteriosclerosis (hardening of the arteries) which can lead to lowered blood flow to the brain causing vertigo
• Head injury
• Neck injury
• Certain medications that cause ear damage

Other causes:
Toxin exposures (carbon monoxide, alcohol, aspirin)
Physiological vertigo – after being exposed to motion for a prolonged period such as when on a ship or simply following spinning with eyes closed

Signs and Symptoms

Vertigo is often triggered by a change in the position of your head.
People typically describe it as feeling like they are – spinning, tilting, swaying, unbalanced, pulled to one direction. Below mentioned are common symptoms of vertigo –

• Sensation of spinning (while stationary)
• Nausea
• Vomiting
• Unsteadiness (postural instability)
• Falls
• Changes in thoughts
• Difficulty in walking
• Blurred vision
• Difficulty speaking
• Lowered level of consciousness
• Hearing loss

Signs and symptoms can present as –
Persistent (insidious) onset vertigo: characterized by –
Symptoms lasting for longer than 1 day
Caused by degenerative changes that affect balance as people age
Nerve conduction slows with ageing
Decreased vibratory sense
Degeneration of ampulla and otolith organs with an increase in age
Commonly paired with central vertigo signs and symptoms

Episodic (sudden) onset: characterized by –
Symptoms last for a smaller, more memorable amount of time, typically lasting for only seconds to minutes
Correlated with peripheral symptoms
Can be a result of (not limited to) diabetic neuropathy or autoimmune disease

Motion sickness:
Most prominent symptoms of vertigo and develops most often in persons with inner ear problems
Characterized by dizziness and light headedness accompanied often by nystagmus (involuntary movement of eye characterized by a smooth pursuit eye movement followed by a rapid saccade in the opposite direction of the smooth pursuit eye movement)
This action occurs repeatedly in a single episode of vertigo
Symptoms can come down while sitting still with eyes closed

Classification

Peripheral Vertigo –
It is caused by problems with inner ear or vestibular system (semicircular canals, vestibule and vestibular nerve located in the inner ear)
It is also called otolgic vertigo or vestibular vertigo
Most common cause is BPPV (Benign paroxysmal positional vertigo) – accounts for 32% of all peripheral vertigo

Other causes –
Meniere’s disease (12%), Superior canal dehiscence syndrome, Labyrinthitis and Visual vertigo
Any cause of inflammation such as common cold, influenza and bacterial infections
Chemicals (ex. aminoglycosides) or physical trauma (ex. skull fractures)
Motion sickness

Symptoms –

• Mild to moderate imbalance
• Nausea
• Vomiting
• Hearing loss
• Tinnitus
• Fullness
• Pain in the ear
• Facial weakness (lesions of internal auditory canal) on the same side

Central vertigo –
It arises from injury to the balance centres of the central nervous system (CNS), often from a lesion in the brainstem or cerebellum
It is generally associated with less prominent movement illusion and nausea
It has accompanying neurological deficits (slurred speech, double vision etc) and pathological nystagmus (which is pure vertical / torsional)
It can cause disequilibrium (sensation of being off balance), patient unable to stand or walk in severe cases

Conditions (involving CNS) leading to vertigo –

• Lesions caused by infractions or haemorrhage
• Tumours (vestibular schwannoma, cerebellar tumours etc)
• Epilepsy
• Cervical spine disorders such as cervical spondylosis,
• Degenerative ataxia disorders
• Migraine headaches
• Lateral medullary syndrome
• Chiari malformation
• Multiple sclerosis
• Parkinsonism
• Cerebral dysfunction

Other classification:
Objective vertigo – person has the sensation that stationary objects in the environment are moving
Subjective vertigo – the person feels as if they are moving
Pseudo-vertigo – an intense sensation of rotation inside the person’s head

Diagnosis

Most of the diagnosis is made on the basis of clinical signs and symptoms
Tests are conducted to elicit nystagmus and differentiate vertigo from other causes of dizziness such as pre-syncope, hyperventilation syndrome, disequilibrium or psychiatric causes of light headedness

Tests of vestibular system (balance) function include:

• ENG – Electro-nystagmography
• Dix-Hallpike manoeuvre
• Rotation tests
• Heat-thrust test
• Caloric-reflex test
• CDP (computerized dynamic posturography)
• CT Scans
• MRI

Tests of auditory system (hearing) function include –

• Pure tone audiometry
• Speech audiometry
• Acoustic reflex
• ECoG – Electrocochleography
• OAE – Otoacoustic emissions
• Auditory brainstem response test

Certain signs and symptoms of vertigo may require evaluation in a hospital’s emergency department such as:

• Double vision
• Headache
• Weakness
• Difficulty speaking
• Abnormality eye movements
• Altered level of consciousness, not acting appropriately or difficulty arousing
• Difficulty walking, lack of coordination, or weakness of the arms and / or legs

Bhrama

Vertigo – Disease information (Ayurveda)
In Ayurvedic literature, Bhrama is a term given to a disease which resembles vertigo. Bhrama means ‘to move’ or ‘to rotate’ or ‘to spin’. We do not get an elaborate explanation of Bhrama in Ayurvedic texts.

What causes Bhrama?
..रजः पित्त अनिलात् भ्रमः। {यो.र.मूर्छा चिकित्सा.Verse18}
Bhrama is a condition which is caused due to the vitiation of Vata and Pitta and involvement of Rajo guna. The morbid Vata, Pitta and Rajo guna afflict the brain and cause Bhrama.

Bhrama is a condition explained in the context of a disease called ‘Murcha’ i.e. loss of consciousness or fainting. This gives us an idea that Bhrama is a type of Murcha, may be a premonitory condition of Murcha.

But Murcha (Moha) and Bhrama are different conditions. Bhrama is a condition in which the person experiences a spin or things rotating around him, but Murcha is much complicated. In murcha the afflicted person loses his consciousness and will faint.

The causative factors may be one or more of the below mentioned:
Vata Prakopaka Ahara Vihara – Foods and activities causing aggravation of Vata (Vayu)
Pitta Prakopaka Ahara Vihara – Foods and activities causing aggravation of Pitta
Increase in Rajo Guna – Manas or mind is made up of 3 entities (gunas –qualities) named Satva, Raja and Tama. The latter two are called as Mano-Doshas or morbidities of mind. Increase of Rajasika (Rajo) Guna is reflected by –

• Dukha bahulya – Excessive grief
• Atana sheelata – Instability
• Adhriti – Lack of self control
• Ahankara – Pride
• Aanritikatwam – Nature of telling lies
• Akarunya – Cruelty
• Dambha – exhibition of vanity
• Maana – Aspiration for self flattering
• Harsha – Emotion and excitement
• Kaama – Desire or lust
• Krodha – Anger

Atana sheelata or instability is a presenting feature of Vertigo vis-à-vis Bhrama
Dhatu ksheenata – Depletion of tissues
Virudda ahara – Mutually incompatible foods
Vega aghata – Forcibly controlling the Vega’s or naturally impending body reflexes or urges
Abhighata – Trauma (injury to the neck or head is said to be a causative factor of Vertigo)
Heena satva – Depletion of Satva guna of the mind

Pathogenesis

How is Bhrama caused?
The physical factors – Vata & Pitta and the mental factor – Rajo guna gets disturbed due to the exposure of the above said causative factors. When these morbid factors afflict the mind and sense organs the person suffers from Bhrama.

One of the principal functions of Kapha is Sthiratva (stability). With regards to the brain (nervous system) and sense organs, stability is provided by the Tarpaka Kapha located in the head. This sub-type of Kapha also acts as a buffer against the degenerative action of morbid Vata and inflammatory action of morbid Pitta on the nerves.

In Bhrama, morbid Vata, Pitta and Rajo guna disturbs the integrity of Tarpaka Kapha. The body loses its sthiratva and the person afflicted by the morbidity starts experiencing ‘chakravat bhramana’ i.e. feeling of everything around spinning and rotating like a wheel. This condition is called Bhrama.

Treatment on the lines of Bhrama and Murcha:
Treatment of Bhrama primarily focuses towards balancing Vata and Pitta and Tamo gunas.
Even among Vata and Pitta, the morbidity of either Vata or Pitta is severe in different individuals.
Vata is predominant in those with Vata constitution and when Bhrama is manifested as a result of Vata Roga’s (diseases caused due to morbid vayu) mainly degenerative diseases. In such cases treatment should predominantly be oriented towards eliminating morbid Vayu while controlling Pitta and Rajo Guna. Ushna-upachara (hot foods and hot comforts) should be given

Pitta is predominant in those with Pitta constitution and when Bhrama is manifested as a result of Pitta Roga’s (diseases caused due to morbid vayu) mainly degenerative diseases. In such cases treatment should predominantly be oriented towards eliminating morbid Pitta while controlling Vata and Rajo Guna. Sheeta-upachara (cold foods and cold comforts) should be given. This variant is generally seen to dominate the clinical picture of Vertigo most of the times.

Ayurvedic treatment

Preferable treatments for Bhrama (Vertigo) –
Nitya snehapana – Daily consumption of small metered doses of medicated ghee or oils or both will help in getting relieved from vertigo and its symptoms. They will alleviate morbid Vata and Pitta and also pacify the predominance of Rajo guna.

Ghritam / Tailam (medicated ghee and oils) used for Nitya snehana–

• Shatavari ghritam
• Ashwagandha ghritam
• Ksheerabala tailam 101
• Dhanwantaram tailam 101
• Kalyanaka Ghritam
• Brahmi Ghritam
• Panchagavya Ghritam

Nasya – Nasal instillation of medicated ghee or oil provides unparalleled relief in vertigo. Below said medicines are used –
Ksheerabala tailam 101
Dhanwantaram tailam 101
Anu Tailam
Shadbindu Tailam

Virechana – Therapeutic purgation to alleviate morbid Vata and Pitta

Nitya Virechana – Daily consumption of small metered doses of purgation medications will detoxify the body, flush off the morbid Vata and Pitta, soothes the nerves and cures Vertigo. The below mentioned medicines are preferred for Nitya Virechana –

• Gandharvahastadi Kashayam
• Sukumara Kashayam
• Sukumara Ghritam
• Kalyanaka Ghritam
• Gandharvahastadi Eranda tailam
• Nimbamritadi Eranda tailam
• Drakshadi leham
• Trivrit leham etc

External treatments:

• Abhyanga – Soothing herbal massages
• Shiro-Abhyanga – Head massage with herbal oils
• Taila-Shiro Dhara – Stream pouring of medicated oils over the head
• Ksheera-Shiro Dhara – Stream pouring of medicated milk over the head (pitta predominant vertigo)
• Taila-Sarvanga Dhara – Stream pouring of medicated oils all over the head
• Ksheera-Sarvanga Dhara – Stream pouring of medicated milk over the body (pitta predominant vertigo)
• Shiro-Vasti – Oil pooling over the head
• Shiro-Pichu – Keeping a sterile cotton pad dipped in medicated oil on the crown of the head
• Shiro-Lepa – Application of herbal pastes over the head
• Karna-Purana – Filling of the ear with medicated oil
• Anjana – Collyrium
• Dhumapana – medicated smoking

Medicines used for Abhyanga, Dhara etc measures mentioned above:

• Ksheerabala tailam
• Mahamasha tailam
• Dhanwantaram tailam
• Balashwagandhadi tailam
• Yashtimadhu tailam etc

Useful medications used in treatment of Bhrama:

• Pippali churna (powder of Piper longum) with honey
• Paste of Kola majja (fleshy part of jujube fruit), Maricha (black pepper), Ushira (Vetiveria zizanioidis) and Kesara (Crocus sativus – saffron) mixed with honey
• Decoction of Shunti (ginger), Guduchi (Tinospora cordifolia), Draksha (Vitis vinifera), Pushkaramula (Inula racemosa) and Chitraka (Plumbago zeylanica) mixed with powder of Pippali (Piper longum)
• Narikelambu (coconut water) mixed with Sattu (powder of parched barley / roasted gram flour) and sugar
• Shatavaryadi Ksheera – milk processed with Shatavari (Asparagus racemosus), Bala mula (roots of Sida cordifolia) and Draksha (Vitis vinifera) mixed with sugar
• Powder of seeds of Bala (Sida cordifolia) mixed with sugar
• Duralabha Kashaya – Decoction of Duralabha (Tragia involucrate) mixed with ghee
• Triphala churna (powder of Terminalia chebula, Terminalia bellirica and Emblica officinalis) mixed with honey in the night
• Gudardhraka – Equal parts of ginger paste and jaggery in the morning
• Amalaki kalka – Paste of boiled fruits of Indian gooseberry is mixed with paste of Draksha (raisins), added with Shunti (ginger) powder, mixed with honey and taken
• Kalyanaka ghrita is taken daily in small dosages
• Ghee processed with Haritaki (Terminalia chebula)
• Ghee processed with Amalaki (Emblica officinalis)

Pathya

Pathya in Bhrama / vertigo (beneficial things):

• Purana Yava – old barley
• Lohita shali – red rice
• Kaumbha – 100 years old ghee
• Mudga yusha – Soup of green grams
• Godugdha – Cow milk
• Sita – Sugar
• Purana kushmanda – Old ash gourd
• Patola – Pointed gourd
• Mocha – Plantain
• Haritaki – Terminalia chebula
• Dadima – Pomegranate
• Narikelam – Coconut
• Laghu anna – Food which is light to digest
• Pranayama – breathing exercises
• Virechana – Therapeutic purgation
• Vamana – therapeutic emesis
• Shatadhouta ghrita – Medicated ghee which is washed for 100 times
• Madhu – honey etc

Apathya

Apathya (non-beneficial things):

• Tambulam – Betel leaf
• Patrashaka – leafy vegetables
• Danta manjana – brushing hardly
• Atapam – Exposure to extreme sunlight
• Virudda ahara – Mutually incompatible foods
• Maithuna – Sexual intercourse
• Swedana – Steaming treatment / sweating therapies
• Katu – Hot, spicy and pungent foods
• Vinmutra vega dharana – Forcibly controlling the urge for defecation and urination etc

Vata Prakopa –
Aggravation of Vata can independently cause Bhrama. Bhrama is mentioned as one of the symptoms of Vata Prakopa Lakshanas (symptoms of aggravation of Vayu).
Treatment of such conditions includes balancing the morbid Vayu.

Avoiding Vata prakopaka ahara vihara
Avoiding food and life style activities which aggravate Vata include –
Vata Prakopaka Karanani (Causative factors responsible for Vata vitiation):

• Vyayama – Excessive exercises
• Apatarpana – Fasting in excess
• Prapatana – Fall, injury
• Bhanga – Fractures
• Kshaya – Depletion of tissues
• Jaagarat – Excessive vigil (awakening all night)
• Veganam cha vidharanat – Suppression of natural body urges (reflexes)
• Ati shuchi – Excessive administration of cleansing procedures (Panchakarma)
• Shaityadi – Excessive consumption of cold foods and activities
• Traasaat – Fear
• Ruksha – Excessive consumption of dry foods
• Kshobha – Irritation
• Kashaya – Excessive consumption of astringent foods
• Tikta – Excessive consumption of bitter foods
• Katu – Excessive consumption of pungent foods
• Vari-ghanagame – cloudy and rainy season
• Parinate anne – After the digestion of food
• Aparahne – Evening

Treating Vayu: The morbid Vayu can be taken care of by intellectually combining the below said measures –

• Sneha – Administration of medicated oils / ghee, Massage, oil pouring etc
• Sweda – Steaming / sudation / sweating therapy
• Mridu shodanam – Evacuation treatment (mild cleansing treatments like Virechana etc)
• Swadu bhojana – Consuming sweet foods
• Amla bhojana – consuming sour foods
• Lavana bhojana – consuming salt foods
• Ushna bhojana – Hot and fresh foods
• Abhyangam – Massage with herbal oils
• Mardana – Tapping the body with closed fists after application of vata alleviating oils
• Seka – Pouring of medicated oils over the body in streams
• Paishtika Madhya – Alcohol or fermented products prepared with flours
• Goudika Madhya – Alcohol or fermented products prepared with jaggery
• Snigdhoshna Vasti – Medicated enemas with oils and ghee, given luke warm
• Deepana pachana sneha – Oils and ghee processed with deepana (appetizer) and pachana (digestant) drugs

Karna Nada / Karna Kshweda –
Karna Nada and Karna Kshweda are the diseases explained in the context of Karna Roga (Ear disorders). Both conditions present with sensation and feel of abnormal sounds ringing in the ears. Tinnitus (ringing or booming sensation in one or both ears) is a symptom of vertigo, especially Meniere’s disease.

It is seen that the treatment and medications of Bhrama or Murcha and Karna Nada/ Kshweda are interchangeable even in terms of excellent results.

Treatment on the lines of Karna Roga (Ear Disorders, especially Karna Nada / Kshweda) –
Avoiding the causative factors leading to Ear disorders:
Avashyaya – avoiding exposure to mist or fog for long durations
Jalakreeda – Avoiding water games, swimming etc
Karna kanduyana – digging the ear with instruments, pins, nails etc
Vata Prakopaka Karana – Vata aggravating factors
Karna Nada is caused when the vitiated Vayu accumulates and afflicts the channels of the ear. It presents with sensation of sounds of beating drums and blowing conch in the ears.

In Karna Kshweda, the vitiated Vayu along with Pitta and Kapha afflicts the ear channels. In this, the patient hears sounds resembling the sounds coming when air is blown through the bamboo.

Treatment of Karna Nada and Karna Kshweda includes –
Alleviating of morbid Dosha’s by administering suitable treatments in the form of Virechana, Nasya etc

Karna Purana – Ear filling (with medicaments like herbal juices, powders, oils etc) is a specialized Ayurvedic treatment for ear disorders. It is known to balance Vata and Pitta and curing ear and hearing related disorders. Ear is one of the main abodes of Vayu, karna purana thus becomes a root treatment for Vayu. Karna Purana provides a dramatic relief in vertigo

The below mentioned can be effectively used for Karna Purana –
Ardraka Rasa (ginger juice), Madhu (honey), Saindhava Lavana (Rock salt) and Sarshapa taila (mustard oil) made warm
Lashunadi Tailam – Oil processed with garlic, ginger, bark of drumstick, root of Indravaruni (Citrullus colocynthis) and mustard oil
Shyonaka tailam – oil processed with decoction of roots of Shyonaka (Oroxylum indicum)
Hingvadi Tailam – oil processed with asafoetida, rock salt and ginger
Oil processed with vata alleviating drugs
Apamarga kshara tailam – oil processed with alkali of Apamarga (Achyranthes aspera)
Other oils – Bilwa tailam, Hingwadi Kshara tailam, Deepika taila, Karanja tailam, Nagaradi Tailam
Rasnadi Guggulu is highly beneficial in KarnaRogas

What’s best in Karna Nada / Kshweda?

• Vamana – therapeutic emesis
• Virechana – therapeutic purgation
• Nasya – nasal instillation of medicines
• Dhumrapana – therapeutic smoking
• Siravedha – bloodletting through vein puncture
• Godhuma – wheat
• Shali – rice
• Mudga – green gram
• Yava – barley
• Purana ghrita – old ghee
• Mayuradi mamsa – flesh of peacock, deer, cock,
• Patola – pointed gourd
• Vartaka – brinjal
• Katillakam – bitter gourd
• Rasayana – all types of rejuvenators (anti-ageing medicines)
• Brahmacharya – celibacy
• Abhashanam – voice rest

What’s not good in Karna Nada / Kshweda?

• Dantadhavana – brushing tooth (violently)
• Shira snana – head bath
• Vyayama – strainous exercises
• Shleshmala ahara – kapha aggravating food
• Guru ahara – heavy to digest foods
• Kanduyana – itching or digging the ears
• Tushara – exposure to dew drops / fog / mist etc

The above mentioned treatment line up, medications, good’s and non beneficial things explained in the context of Karna Nada and Karna Kshweda are also applicable for Vertigo

Extended treatment approach

Extended concept of treatment approach for Vertigo –
Karna Kshweda (tinnitus) is one of the symptoms of Pandu Roga (Anaemia, Jaundice, Liver and Spleen disorders, Diseases of blood and haemopoietic system). Treatment of tinnitus and vertigo done on the treatment lines of Pandu Roga gives an excellent relief in the former conditions. Rather people with vertigo and tinnitus will have anaemia, liver disorders or one or the other haemopoietic disorder in the backdrop. I have got substantially good results adapting Pandu Roga Chikitsa in vertigo. (Some of the best medications used in Pandu Roga will be enlisted in the formulation list at the end of the discussion).

Shleshma Kshaya – Kapha or shleshma is the integrating and cementing system which holds the cells of our body together which in turn reflects a good immunity. Kapha, in normal conditions provides integrity and stability to our body and mind. When kapha undergoes a pathological decrease this stability is lost. Kapha should be stabilized while treating the conditions like vertigo.

Rasayana (Rejuvenators, anti-ageing medicines, immune-modulators) and Vajikarana (Aphrodisiacs) are known to improve the overall health by maintaining the tissue balance in the body, controlling the morbid Dosha’s, soothing our nerves and improving our immunity. Rasayana and Vajikarana drugs play a potential role in curing vertigo and also preventing their relapse.

Example: Guduchi (Tinospora cordifolia), Ashwagandha (Withania somnifera), Amalaki (Emblica officinalis), Shatavari (Asperagus racemosus), Shankapushpi (Convolvulus pluricaulis), Brahmi (Bacopa monnieri), Kushmanda (Benincasa hispida), Kapikachchu (Mucuna pruriens), Musali (Chlorophytum borivilianum) etc

Bhrama as a secondary presentation

Bhrama may be a symptom, premonitory symptom, complication or symptom of bad prognosis of some other systemic disease. In these conditions treating the concerned disease on the backdrop of Bhrama should be treated to get rid of vertigo –

Bhrama presents as Purvarupa (premonitory symptom) in:
Kushta (skin diseases, leprosy)
Masurika – (chicken pox)
Jwara mukti (remission of fever)

Bhrama is available as Lakshana (symptom) in:
Ajeerna (Indigestion) – as Samanya Lakshana (part of generalized symptom) and as a symptom of Vidagdhajeerna (pitta predominant indigestion)

Amlapitta (Hyperacidity, GERD, Gastritis) – as a symptom of Adhogata Amlapitta (Amlapitta presenting in a downward direction), Kaphadhika Amlapitta (Kapha predominant Amlapitta), Vatadhika Amlapitta (Vata predominant Amlapitta) and Sanila Kapha Amlapitta (Vata-Kapha predominant Amlapitta)

Vataja Arsha – Vata predominant haemorrhoids (piles)
Pittaja Udara – Pitta predominant abdominal diseases
Samanya lakshana of Krimi – Part of general symptoms of helminthic disorders (worm, microbe, parasites)
Chardi – Vomiting
Jwara (Fever) – as a symptom of Antarvega jwara (internal fever), Pachyamana Jwara (intermediate stage of fever), pittaja jwara (pitta predominant fever), Raktagata jwara (fever afflicting blood), Vata-pittaja jwara (Vata-pitta predominant fever), Sannipataja jwara (fever manifested due to the vitiation of all the Dosha’s)

Daha – Burning sensation predominant diseases
Parigarbhika – Infantile diarrhoea
Vataja Pandu – Anaemia or liver disorders caused due to vitiation of Vata
Pittavrita Udana – In conditions where Pitta is blocking the normal functions of Udana Vayu
Dushi visha – Weak (slow) poisons
Visarpa – Erysipelas (Agni, Kardama, Granthi and Pittaja varieties)
Masurika – Chicken pox
Vrana – Ulcers and wounds
Shotha – Swelling, inflammation
Shula – Colic (pitta predominant)
Halimaka – A type of jaundice

Bhrama is visible as Upadrava (complication) in –
Ajeerna – indigestion
Asrugdhara – Heavy bleeding during menstrual cycles
Amavata – Rheumatoid arthritis, Gout
Madatyaya – Alcoholic intoxication (Alcoholism)
Hridroga – Heart diseases
Bhrama is an Asadhya Lakshana (symptom indicating worst prognosis) in –
Vatarakta – Gout

Ayurvedic medicines

Ayurvedic medicines for vertigo:
Kashayas – Herbal Decoctions:
Drakshadi Kashayam
Duralabha Kashayam with ghee

Vati / Gulika (Tablets) –

• Sutashekara Rasa
• Suvarna Sutashekara Rasa
• Sarivadi Vati
• Yogendra Rasa
• Punarnava mandura
• Navayasa loha
• Shotari mandur
• Mandura vatakam

Rasayana / Leha (confections / herbal jam):

• Ashwagandha Rasayana
• Amalaki Rasayana
• Drakshadi Leham
• Vilwadi Leham
• Gudardrakam
• Chyavanaprasham
• Brahma Rasayanam
• Agastya Haritaki Rasayana
• Kushmanda Rasayana

Asava / Arishta:

• Ashwagandharishtam
• Saraswatharishtam
• Balarishtam
• Arjunarishtam (Parthadyarishtam)
• Draksharishtam
• Punarnavasavam
• Dashamularishtam
• Ayaskriti

Ayurvedic herbs

Herbs useful in treating Vertigo

• Guduchi – Tinospora cordifolia
• Amalaki (Emblica officinalis),
• Vacha – Acorus calamus
• Parpataka – Fumaria officinalis
• Yavasa – Alhagi pseudalbagi
• Sariva – Hemidesmus indicus
• Ashwagandha – Withania somnifera
• Shatavari – Asparagus racemosus
• Draksha – Vitis vinifera
• Lashuna – Allium sativum
• Bilwa – Aegle marmalos
• Apamarga – Achyranthus
• Brahmi – Bacopa monnieri
• Shankapushpi – Convolvulus pluricaulis
• Ushira – Vetiveria zizanioidis
• Kushmanda – Benincasa hispida
• Kapikachchu – Mucuna pruriens

Modern management of vertigo

Management of Vertigo – Modern approach
In many cases, vertigo goes away without any treatment
Treatment of vertigo depends on the underlying cause.

Treatment includes –
Vestibular rehabilitation – This is a type of physical therapy aimed at helping strengthen the vestibular system (The function of the vestibular system is to send signals to the brain about head and body movements relative to gravity.

It is recommended if you have recurrent bouts of vertigo

It helps to train your senses to compensate vertigo

Canalith repositioning manoeuvres – Guidelines from the American Academy of Neurology recommend a series of specific head and body movements for BPPV. The movements are done to move the calcium deposits out of the canal into an inner ear chamber so they can be absorbed by the body.

Surgery – may be required in few cases
Common drugs used to treat vertigo:
Anticholinergics
Anticonvulsants
Antihistamines
Beta blockers
Corticosteroids

For Meniere’s disease:
Low salt diet
Intra-tympanic injections of antibiotic gentamicin
Surgical measures such as a shunt or ablation of the labyrinth
Meniere’s disease – Diuretics to reduce pressure from fluid build up

Epidemiology

• Dizziness affects approximately 20-40% of people at some point in time while about 7.5-10% people have vertigo.
• About 5% have vertigo in a given year
• It becomes more common with age
• It affects women 2-3 times more often than men
• It accounts to about 2-3% of emergency department visits in the developed world
• BPPV occurs in 0.6% population yearly with 10% having an attack during their lifetime
• Vestibular migraines are estimated to affect 1-3% of the general population and may affect 10% of migraine patients

To sum up;
Vertigo is not as simple as it looks or appears to be. It may mess up the life of people who suffer from it.
‘Around, around the sun we go: The moon goes round the Earth. We do not die of death: We die of VERTIGO’ – Archibald MacLeish, American poet

The important strategy lies in tracking down the cause and keeping it or them away. Lifestyle changes and home remedies might just work wonders but it is always good to see your Ayurvedic doctor before trying anything. Make sure that there is no serious cause behind your spin!
‘Vertigo is the conflict between the fear of falling and the desire to fall’ – Salman Rushdie

‘I felt a kind of vertigo, as if I were merely plunging from one world to another and in each I arrived shortly after the end of the world had taken place’ – Italo Calvino
Click to Consult Dr Raghuram Y.S. MD (Ayu)