NAUSEA AND VERTIGO

Nausea and vomiting (also called emesis)

Nausea is an uneasy or unsettled feeling in the stomach together with an urge to vomit. Nausea and vomiting, or throwing up, are not diseases. They can be symptoms of many different conditions. 

Many common problems may cause nausea and vomiting, including:

-food allergies

-infections of the stomach or bowels, such as the "stomach flu" or food poisoning

-leaking of stomach contents (food or liquid) upwards (also called gastro-oesophageal reflux or GORD)

-medicines or medical treatments, such as cancer chemotherapy or radiation treatment

-migraine headaches

-morning sickness during pregnancy

-seasickness or motion sickness

-severe pain, such as with kidney stones

Nausea and vomiting may also be early warning signs of more serious medical problems, such as appendicitis, blockage in the intestines, cancer or a tumor, ingesting a drug or poison (especially by children) or ulcers in the lining of the stomach or small intestine.

Nausea and vomiting are common. Usually, they are not serious. Medical advice should be sought immediately if :

-vomited for longer than 24 hours

-blood in the vomit

-severe abdominal pain

-headache and stiff neck

-signs of dehydration, such as dry mouth, infrequent urination or dark urine.

Vertigo

The most common symptoms of vertigo include a feeling of spinning (you or the room around you), tilting or swaying and feeling off balance. These feelings come and go, and may last seconds, hours, or days. You may feel worse when you move your head, change positions (stand up, roll over), cough, or sneeze. Along with vertigo, you may vomit or feel nauseous, have a headache or be sensitive to light and noise, see double, have trouble speaking or swallowing, feel weak or short of breath or sweaty and have a racing heart beat.

The most common causes of vertigo include:

• Inner ear problems: collections of calcium, inflammation, and certain infections can cause problems in the vestibular system. The vestibular system includes parts of the inner ear and nervous system, which controls balance.
• Benign paroxysmal positional vertigo (BPPV): sometimes called benign positional vertigo, positional vertigo, postural vertigo, or simply vertigo, is a type of vertigo that develops due to collections of calcium in the inner ear. These collections are called canaliths. Moving the canaliths (called canalith repositioning) is a common treatment for BPPV. Vertigo is typically brief in people with BPPV, lasting seconds to minutes. Vertigo can be triggered by moving the head in certain ways.
• Meniere disease:  is a condition that causes repeated spells of vertigo, hearing loss, and ringing in the ears. Spells can last several minutes or hours. It is probably caused by a buildup of fluid in the inner ear. 
• Vestibular neuritis: vestibular neuritis, also known as labyrinthitis, is probably caused by a virus that causes swelling around the balance nerve. People with vestibular neuritis develop sudden, severe vertigo, nausea, vomiting, and difficulty walking or standing up; these problems can last several days. 

• Head injury: head injuries can affect the vestibular system in a variety of ways, and lead to vertigo.
• Medications: rarely, medications can actually damage or affect the function of the inner ear or brain and lead to vertigo.
• Migraines: in a condition called vestibular migraine or migrainous vertigo, vertigo can be caused by a migraine. This type of vertigo usually happens along with a headache.
• Brain problems, such as a stroke or TIA (transient ischemic attack), bleeding in the brain, or multiple sclerosis can also cause vertigo. 

-Drugs used in nausea and vertigo:

• Antihistamines:                                                                         

           -cinnarizine (Stugeron, Arievert)                                                        -cyclizine (Valoid)                                                                    

           -promethazine hydrochloride                                                              -promethiazine teoclate (Avomine).                                                              

• Phenothiazines and related drugs: 

            -chlorpromazine hydrochloride

            -perphenazine

            -prochlorperazine (Stemetil, Buccastem)

            -trifluoperazine.

• Domperidone and metoclopramide:

           -domperidone (Motillium)                                      

           -metoclopramide hydrochloride (Maxolon)

• 5HT3 antagonists:

           -dolasetron mesilate (Anzemet)

           -granisetron (Kytril)

           -ondansetron (Zofran)

           -palonosetron (Aloxi)

• Neurikinin receptor antagonist:

          -aprepitant (Emend)

          -fosaprepitant (Ivemend)

• Cannabinoid: nabilone

• Hyoscine: hyoscine hydrobromide (Joy Rides, Kwells, Scopoderm TTS patches)

• Other drugs for Meniere's disease: betahistine dihydrochloride (Serc).  

Sources:

-https://medlineplus.gov/nauseaandvomiting.html

-http://www.medscape.org/

-https://medlineplus.gov/dizzinessandvertigo.html

-http://www.uptodate.com/contents/dizziness-and-vertigo-beyond-the-basics?view=print

-http://backinmotionfl.com/stop-suffering-vertigo/

-http://www.manxhealthcare.com/products/betahistine.html

-https://www.theindependentpharmacy.co.uk/onlinedoctor/treatment/cyclizine-50mg-tablets100/