While a cancelled concert is always annoying, it’s hard to fault singer George Ezra who this week called off gigs in London and Leeds after doctors diagnosed him with “acute vertigo”. Ticket-holders were told their tickets would remain valid for a reschedule of the shows – but how serious is the condition and is it likely to affect George in future?
Vertigo causes sufferers to feel bouts of intense dizziness and can make it feel like the world is spinning. It’s a relatively common condition, slightly more so in women, but it’s thought that it will affect 40 per cent of people during their lifetimes.
While vertigo can be caused by mild strokes and Ménière’s disease (a condition affecting the inner-ear), these are “vanishingly rare”, says Mr Paul Montgomery, consultant ear, nose & throat surgeon at King Edward VII’s and the Cromwell hospitals. “The most common causes are either crystals in the inner-ear coming loose or a response to trauma.”
Just as a cough or a runny nose can have multiple causes, the same is true for vertigo. The two most common diagnoses Mr Montgomery references are benign positional paroxysmal vertigo (BPPV) and persistent postural perceptual dizziness (PPPD).
The former, BPPV, is generally much easier to rectify. “You get displaced calcium crystals called otoconia in the inner-ear, which makes you feel incredibly spinny-dizzy,” says Mr Montgomery. “We often see that in people who’ve had a bash on the head or sometimes in people who do lots of Pilates. It also becomes more common as you get older.”
Thankfully, there’s a simple manipulation called Epley’s Manoeuvre which realigns the inner-ear crystals. “Most doctors can perform it and it’ll fix the vertigo either instantly or within a few days.”
The more complex version, PPPD, is more likely what Ezra is suffering from and is often triggered by stress or trauma. This is why people often begin experiencing vertigo after a big life change such as becoming a parent, retiring or going through a relationship break-up.
It can cause sufferers to feel like they are constantly unsteady, like they’re swaying or drunk. If untreated it can last for weeks, months or even years.
“It’s essentially a response by the brain to an injury – emotional, mental or physical - and it could be a severe illness, untreated migraines, BPPV, inner-ear problems, or even just getting some really bad news,” says Mr Montgomery. “It’s the brain trying to cope with a disturbance by installing a ‘software update’, but it’s a bad program that doesn’t work.”
To understand this form of vertigo it’s important to note the human body doesn’t use the eyes to tell us that we’re standing up straight. We rely on imperceptible signals from our necks, joints and inner-ears. But when we’re feeling threatened it can activate a fight-or flight mode.
“You become hyper-vigilant and hyper-visual, with your eyes searching for threats,” explains Mr Montgomery. “The brain suddenly starts to use the eyes to control your muscles, but your eyes are not good judges of whether you’re standing straight so suddenly you start to sway.” Patients describe feeling as though their eyes are wobbling or vibrating.
Most of us have probably experienced something like this after receiving bad news, whether that be a bereavement or bad exam results. It can make it feel like the world is spinning.
A classic component of this more-entrenched form of vertigo is that it tends to get triggered by a “visual environment which is too complicated,” says Mr Montgomery. “TV and computer screens are a nightmare because they spin and turn a lot. I often see patients who can’t stand going down supermarket aisles because there’s too much going past their eyes at once, or who are perfectly happy driving at 30mph but as soon as they go over that they feel dizzy. They’re dependent on their eyes to make them feel steady and secure. When the visual environment starts to turn and change rather quickly, it’s too much for the brain – it can’t cope with it.”
Stress locks in this response and it becomes a vicious cycle. “Often the primary cause – the bad infection or the emotional trauma settles down but you’re left with this bad adaptation where you’re swaying, which retriggers your fear and flight reflex,” says Mr Montgomery.
Interestingly, PPPD is typically diagnosed in patients like George Ezra. “It tends to occur in people who think a lot: writers, artists, painters, chief executives,” says Mr Montgomery. “People who live in an abstract, front-of-brain world, who tend to be rather bright. Essentially, those who are prone to overthinking.” Patients like this might be more predisposed to anxiety, which can activate the fight-or-flight response that results in PPPD. For his part, Ezra revealed in 2020 that he experiences a version of OCD called “Pure O”, which involves having unstoppable obsessive thoughts.
“My own pet theory is that the modern mind doesn’t switch off enough,” says Mr Montgomery. “With social media, our phones, Netflix - we’re on all of the time and it’s not good for you. An overactive brain is made worse by people who are over activating the front of their brain.”
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