Acupuncture for Vertigo

Acupuncture for Vertigo

            Acupuncture works for vertigo for both acute and long-term. Nearly 40% of United States adults experience vertigo at some point in their life with women being slightly more likely to have it than men. While it can happen at any age, it is most common in people 65 and older. As with something like sciatica, vertigo is often misinterpreted as a condition. However, it is in fact a symptom, and many conditions usually pertaining to the inner ear & brain can cause it. Many people who have long-term vertigo do not always see relief from western medicine and will turn to alternative methods like acupuncture, and find success.

Vertigo

            Vertigo is a sensation of spinning dizziness as though the room or the environment surrounding the person is spinning.  Most acute onset vertigo attacks last between 24 – 48 hours, but when it is long-term, usually resulting from an underlying disease, it can be daily life for some patients. Essentially, vertigo usually refers to any temporary or ongoing bouts of dizziness that occur due to the inner ear, brain, or sensory nerve pathway. While vertigo is a symptom, it can also lead to, or happen alongside of other symptoms.

Symptoms of vertigo:

  • Balance problems

  • A sense of motion sickness

  • Ringing in the ear (also known as tinnitus)

  • Headaches

  • Lightheadedness

  • Nausea & vomiting

  • Nystagmus (this is where the eyes move usually side to side uncontrollably)

In addition to accompanying symptoms, it is important to distinguish which type of vertigo the patient has. There are two different types of vertigo and they each vary depending on their cause.

Types of vertigo:

  • Peripheral vertigo – most cases of vertigo fall under this type coming in at around 80% of cases. This type is usually the result of problems in the inner ear. The organs in the inner ear send messages through nerve signals to the brain about the patient’s response to gravity and their position. BPPV, inflammation, Meniere’s disease, and acoustic neuroma are some of the causes of this type of vertigo.

  • Central vertigo – this type indicates problems with in the central nervous system (CNS), and makes up the other 20% of cases. It is usually stemmed from an issue in a part of the cerebellum or brain stem. Possible causes of this type include demyelination, vestibular migraine, and tumors involving the affected central nervous system region. Additionally, a problem with the cervical spine can also lead to this type of vertigo.

Since vertigo is a symptom not a condition itself, it is also important to address the underlying condition that is causing the vertigo.

Conditions that can lead to vertigo:

  • Meniere’s Disease – This is the most well-known condition in association with vertigo. This disease causes a buildup of fluid in the inner ear leading to vertigo attacks and tinnitus (ringing in the ears) and hearing loss. According to the Hearing Health Foundation, this condition affects between 600,000 – 750,000 people in the United states with 45,000 – 60,000 new cases diagnosed each year. This is an example of peripheral vertigo.

  • Benign Paroxysmal Positional Vertigo (BPPV) – This condition is also well-known in association with vertigo. The inner ear contains otolith organs which can be described best as small structures which contain fluid and crystals of calcium carbonate. When it comes to this condition, the crystals fall into the canals which touch the sensory cells within the cupula of the canals during movement.  Vertigo occurs from specific changes in the position of the head. This is also an example of peripheral vertigo.

  • Acute Peripheral Vestibulopathy (APV) – This condition is an inflammation of the inner ear which causes vertigo suddenly, and is another example of peripheral vertigo.

  • Multiple Sclerosis (MS) – This is a condition where the immune system eats away at the protective covering of the nerves, disrupting communication between the brain and the body possibly leading to vertigo. This is an example of central vertigo.

  • Migraine – This is a headache which varies in intensity often accompanied by nausea and sensitivity to light, and can also bring about vertigo. This is another example of central vertigo.

These are just some of the more common conditions that can lead to vertigo, but there are many conditions, and/or potential accidents that can also lead to vertigo. There are also things like a head injury, ear surgery, shingles in or around the ear, syphilis, a stroke, otosclerosis, ataxia, acoustic neuroma, and cerebellar or brain stem disease that can lead to vertigo. Not to mention that sometimes prolonged bed rest, and the use of some medications can also lead to vertigo.

In western medicine, in order to determine the cause of the vertigo, doctors will usually perform Romberg’s Test or Fukuda-Unterberger’s Test, and if these are inconclusive will possibly recommend a CT or MRI scan to obtain more details. While there are many cases of vertigo that resolve without treatment, there are others that use a variety of medications to assist the vertigo or underlying cause.

Western medicine treatments for vertigo:

  • Antibiotics – these would be used if the patient had vertigo due to a bacterial infection. They may also prescribe antiviral drugs for something like shingles that was causing the vertigo.

  • Vestibular Blocking Agents – these include antihistamines, anticholinergics, and benzodiazepines which are types of medications that reduce motion sickness and nausea.

  • Surgery – this would only be necessary if other treatments are not effective, and are usually seen for conditions like Benign Paroxysmal Positional Vertigo (BPPV) and acoustic neuroma.

Western medicine, although many have seen success with it for vertigo, does not come without its setbacks, and is certainly not 100% effective. Especially when considering the harm that some medications and surgery have on the patient. Acupuncture does offer a great deal of relief to many patients experiencing vertigo as we all know, no matter the underlying condition.

Acupuncture & Vertigo

             In traditional Chinese medicine, vertigo is linked root deficiency and branch excess. There are a variety of causes that can lead to vertigo, and are important to determine as they can lead to a proper or improper TCM diagnosis.

Etiological factors of vertigo:

  • Liver Yin leading to a rise in Liver Yang or Wind – Emotional depression or anger [a diagnosis commonly seen with vertigo].

  • Weak Heart or Spleen causing qi & blood deficiency – extended illness, stress, and anxiety.

  • Kidney Jing Deficiency – overindulgent sexual activity, extended illness, and aging.

  • Middle Jiao by Phlegm-Dampness or Phlegm-Fire – improper diet, and stress. This can damage the Spleen & Stomach.

Vertigo from the TCM perspective (in most cases) will involve phlegm, deficiency, wind, or fire. Along with TCM diagnosis, it is important as providers to do a thorough consultation and analysis of the patient to determine points that will benefit both their vertigo and possible underlying condition.

Acupuncture works for Vertigo by:

  • Increasing blood flow – depending on the needling, it is improved in the vertebral-basilar artery which improves vertigo.

  • Increasing endorphins – stimulating nerves located in muscles & other tissues which leads to their release changing the processing of pain in the brain & spinal cord.

  • Reducing inflammation

  • Increasing local microcirculation – this helps with any swelling associated with or causing vertigo.

  • Reducing dizziness/vertigo – needling certain points such as PC6 and ST36 are often used in the reduction of dizziness/vertigo.

While success with acupuncture alone is difficult to achieve, many practitioners see results when combining appropriate acupuncture points with herbal formulas depending on the patient’s cause of the vertigo. Truth be told, the proper acupuncture points and herbal formulas used are key to addressing a patient’s vertigo without western intervention.

Acupuncture points for vertigo:

  • GV20 – Hundred Convergences – Bai Hui – located 5 cun posterior to the AHL. This point can provide near immediate results, and in the way of vertigo can treat vertigo itself, extreme headache, dizziness, visual dizziness, and tinnitus.

  • GB20 – Wind Pool – Feng Chi – located in the depression between the upper portion of the sternocleidomastoid muscle and the trapezius level with GV16. This will relieve dizziness, vertigo, numbness, headache, and neurological issues.

  • SI19 – Auditory Palace – Ting Gong – located anterior to the tragus and posterior to the condyloid process of the mandible in a depression formed when the mouth is opened. This point calms the spirit, and is helpful with ear problems like inflammation, tinnitus, & hearing loss.

  • PC6 – Inner Pass – Nei Guan – located 2 cun above the wrist crease between the tendons of palmaris longus and flexor carpi radialis. This point is useful for motion sickness, nausea & vomiting, and headache.

  • GB21 – Shoulder Well – Jian Jing – located on the shoulder directly above the nipple at the midpoint of a line connecting GV14 and the acromion at the highest point of the shoulder. This point is useful for treating nausea, dizziness, and motion sickness.

  • TH17 – Wind Screen – Yifeng – located posterior to lobule of the ear in the depression between the mandible and mastoid process. This point is useful for dizziness, tinnitus, and deafness.

  • ST36 – Leg Three Li – Zusanli – located 3 cun below ST35 one finger width lateral from the anterior border of the tibia. This point is useful for tonifying deficient qi or blood as well as nausea & vomiting.

  • EX-HN3 – Hall of Impression/Seal – Yintang – located midway between the medial ends of the eyebrows. This point is beneficial for calming the spirit, frontal headache, vertigo, and congestion.

All of these points are also good acupressure points to possibly equip your patients with to aid any vertigo issues that may take place outside of the office.

Herbal formulas for vertigo:

  • Ban Xia Bai Zhu Tian Ma Tang – strengthens the Spleen, dispels dampness, transforms Phlegm, soothes the Liver, extinguishes Wind. For those with Wind-Phlegm and Damp-Phlegm. Contraindicated for those with Liver Yang rising or Blood deficiency.

  • Zhi Yun Tang – moves Qi, strengthens Spleen, dredges the Liver, tonifies Qi, clears Heat, moistens the Liver and Stomach, eliminates Dampness, and transforms Phlegm. For those with Liver Qi Stagnation & Spleen Qi Deficiency with Heat & dryness in the Liver and Stomach and Phlegm – Dampness. For dizziness & vertigo.

  • Chuan Xiong Cha Tiao San – alleviates pain and dispels Wind. For those with External Wind. Contraindicated for those with headache due to Liver Yang Rising or Liver Wind. Also, it is contraindicated for those with Kidney or Liver Yin Deficiency or with Qi & Blood Deficiencies.

There are also herbs that are more easily accessible to patients such as turmeric, and ginger root that will also aid vertigo. The most effective points and formulas will address some form of deficiency, wind, heat, and phlegm. Prolonged use of an herbal treatment may be necessary to have complete positive results from the treatment of vertigo.

Acupuncture Research for Vertigo

A study in 2015 Efficiency & Safety of Acupuncture for Dizziness & Vertigo in Emergency Department, and a meta-analysis in 2017, The Efficiency of Acupuncture for the Treatment of Cervical Vertigo both concluded that acupuncture helped to reduce symptoms of dizziness and vertigo. In fact, in the 2017 study, they stated “acupuncture may be more effective in effectiveness and improvement of clinical symptom and average blood flow velocity of vertebral-basilar artery compared with conventional medicine therapy for cervical vertigo (CV).” Although more research is needed in this arena, acupuncture clearly has a place in the treatment of vertigo.


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