Rocking

Timothy C. Hain, MD, Most recent update: June 10, 2003.

Introduction:

Rocking vertigo means that one has a sensation of movement such as on a boat. Practically, there may be a sensation of periodic rotation, or a sensation of sway. The rocking sensation is rarely accompanied by true vertigo (i.e. spinning).

Causes:

Little is know about the cause of rocking sensation. In theory, it might be due to disturbance in the vertical semicircular canals of the inner ear (see figure above), due to a disturbance in the sensors for linear acceleration, the otoliths, or a disturbance in the central connections of these structures. As presently our ability to test these structures is very limited, it is difficult to be sure. Rocking can be a consequence of certain medications such as minocylcine (Claussen, Schneider et al. 1987)Some physicians consider "rocking" vertigo to be a "psychogenic" type of dizziness. (Afzelius, Henriksson et al. 1980;)

Diagnosis:

Persons with rocking should be examined by a physician with expertise in inner ear disorders as well as neurological disorders. Testing that may be recommended usually includes:

1. ENG test
2. Hearing test
3. VEMP test (where available)
4. MRI scan
5. Blood tests including FTA, Sed-rate, anti-microsomal and TPO antibodies, ANA

Additional testing may be suitable for individuals in which Meniere's disease is a strong possibility.

Treatment:

Treatment is usually symptomatic. Benzodiazepines, such as Klonapin usually are very effective, but of course are addictive. SSRI type antidepressants are also often worth considering. Vestibular rehabilitation therapy should also be tried.

References:

Afzelius, L. E., N. G. Henriksson, et al. (1980). "Vertigo and dizziness of functional origin." Laryngoscope 90(4): 649-56.
Claussen, C. F., D. Schneider, et al. (1987). "[Equilibriometric measurements of central vestibular dysregulation following administration of minocycline]." Arzneimittelforschung 37(8): 950-3.
Henriksson, N. G., L. E. Afzelius, et al. (1976). "Vertigo and rocking sensation. A clinical analysis." ORL J Otorhinolaryngol Relat Spec 38(4): 206-17.

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