Rocking

Timothy C. Hain, MD, Most recent save: July 19, 2010

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. In this regard, considerable recent progress have been made in assessing the otoliths (VEMP testing).

Considering knwon causes, rocking can rarely be a consequence of certain medications such as minocycline (Claussen, Schneider et al. 1987). Rocking is common in a variant of motion sickness called "Mal de Debarquement syndrome". Some physicians consider "rocking" vertigo to be a "psychogenic" type of dizziness. (Afzelius, Henriksson et al. 1980). Rocking, like most types of dizziness, is usually worse when individuals are under stress.

Diagnosis:

Persons with rocking should be examined by a physician with expertise in inner ear disorders as well as neurological disorders. An example is practice associated with the author of this page (Chicago Dizziness and Hearing). Most very large cities in the US have a medical practice of this type.

Testing that may be recommended can include:

1. ENG test
2. ECOG
3. Hearing test
4. VEMP of the brain test (where available, includng both SCM and ocular type)
5. MRI scan
6. Blood tests including FTA, Sed-rate, anti-thyroglobulin 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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