Vertigo

Vertigo is a sensation of spinning or feeling that you or your surroundings are moving when you’re standing still. It’s not a disease itself, but rather a symptom of various conditions affecting your inner ear or brain, with a lifetime prevalence of around 20% to 30%.

Table of contents

• What is vertigo and how is it different from dizziness?
• Types of vertigo
• What causes vertigo?
• Symptoms of vertigo
• How vertigo is diagnosed
• Treatment options for vertigo
• Possible complications
• Living with vertigo

What is vertigo and how is it different from dizziness?

Vertigo is a sensation that you or the world around you is spinning, even though you are standing still. It is a specific type of dizziness that creates an illusion of motion, usually rotational motion.^[1] People experiencing vertigo often feel like they are spinning, tilting, swaying, or that their surroundings are moving around them.^[2]

Vertigo is not the same as general dizziness. When you feel dizzy, you might be lightheaded, weak, or unsteady on your feet. Vertigo specifically involves a spinning sensation and feeling off balance.^[1] The causes also differ between these conditions. Dizziness can result from a drop in blood pressure, medications, vision problems, or mental health conditions. Vertigo, on the other hand, occurs with conditions such as migraine, head injury, Meniere’s disease (an inner ear disorder causing fluid buildup), and the movement of crystals in your inner ear that help maintain balance.^[1]

Types of vertigo

Vertigo has two main types: peripheral and central. The difference between them lies in what causes the condition.^[1]

Peripheral vertigo

This is the most common type of vertigo. It happens because of a problem with your inner ear or the vestibular nerve (the nerve that connects your inner ear to your brain). These structures help you stay balanced.^[1] Peripheral vertigo usually has a good prognosis.^[3]

One common cause of peripheral vertigo is benign paroxysmal positional vertigo (BPPV), an inner ear disorder. BPPV causes vertigo when you move your head a certain way, such as tipping it backward. This condition occurs when tiny calcium particles get dislodged from their normal location and collect in the inner ear.^[1]

Central vertigo

This less common type of vertigo stems from a problem in the brain, such as a stroke or infection.^[1] Central vertigo is caused by issues in the brain, usually in the brain stem or the back part of the brain called the cerebellum.^[4] It causes more severe symptoms, such as difficulty walking, and often has worse outcomes if not diagnosed promptly.^[1][3]

What causes vertigo?

Vertigo often happens because of an inner ear problem. Your inner ear contains tiny, fluid-filled canals called the semicircular canals, which help your brain sense the position and movement of your head.^[13] Some of the most common causes include:^[1]

• Benign paroxysmal positional vertigo (BPPV): This inner ear disorder happens when tiny calcium particles called canaliths get dislodged from their normal location and collect in the inner ear. The inner ear sends signals to the brain about your head and body movements to help you keep your balance. BPPV can occur for no known reason and may worsen as you get older.
• Meniere’s disease: This inner ear disorder may be caused by a buildup of fluid and changing pressure in the ear. It can cause episodes of vertigo along with ringing in the ears (tinnitus) and hearing loss.
• Vestibular neuritis or labyrinthitis: This inner ear problem is usually related to a viral infection such as chickenpox, measles, or hepatitis. The infection inflames nerves that help your brain keep you balanced.

Vertigo can also happen because of a head or neck injury, brain problems such as a stroke or tumor, certain medications that cause ear damage including some antibiotics and heart drugs, migraine headaches, ear infection, acoustic neuroma (a noncancerous tumor in the ear), dehydration, irregular heart rhythms, ear surgery, low blood pressure, diseases such as multiple sclerosis or diabetes, and otosclerosis (abnormal bone growth in the middle ear).^[1]

Can stress cause vertigo?

Dizziness and a spinning sensation can be symptoms of stress and anxiety. The same areas of the brain may be involved in producing feelings of anxiety and dizziness. Stress is also a risk factor for labyrinthitis, a cause of vertigo.^[1]

Symptoms of vertigo

Vertigo is often triggered by a change in the position of your head. People with vertigo typically describe it as feeling like they are spinning, tilting, swaying, unbalanced, or being pulled in one direction.^[1] Feelings of vertigo can sometimes come and go in attacks.^[2]

Other symptoms that may accompany vertigo include:^[1][2]

• Nausea and vomiting
• Abnormal or jerking eye movements (nystagmus)
• Headache
• Sweating
• Ringing in the ears or hearing loss
• A feeling of fullness in the ear
• Double vision
• Difficulty with balance
• Looking pale

Vertigo can sometimes be brought on or made worse by a sudden change in position. For example, turning over in bed or moving your head to look up.^[2]

How vertigo is diagnosed

Your doctor will ask about your symptoms to try to find out what could be causing them.^[2] A careful history remains the cornerstone of diagnosis. It’s helpful if you can tell your doctor about any movements or activities that bring on your vertigo.^[10] The duration of vertiginous episodes and the presence or absence of auditory symptoms can help narrow down the possible causes.^[11]

Your doctor will examine you. They might check your hearing, eyes, and balance.^[2] A simple test that involves you moving quickly from a sitting to a lying position might be done to check your balance. This could bring on symptoms.^[2] The doctor may perform certain head movements on you, such as the Dix-Hallpike maneuver, to differentiate peripheral from central vertigo.^[11]

Diagnostic tests

Healthcare providers may perform some tests to diagnose vertigo. These tests can include:^[9]

• Fukuda-Unterberger test: Your healthcare provider will ask you to march in place for 30 seconds with your eyes closed. If you rotate or lean to one side, it could mean that you have an issue with your inner ear labyrinth.
• Romberg’s test: During this assessment, your provider will ask you to close your eyes while standing with your feet together and your arms to your side. If you feel unbalanced or unsteady, it could mean that you have an issue with your central nervous system.
• Head impulse test: For this test, your provider will gently move your head to each side while you focus your eyes on a stationary target. As they move your head, they’ll pay close attention to your eye movements.
• Vestibular test battery: This includes several different tests to check the vestibular portion of your inner ear system.

Your doctor may recommend blood tests or imaging scans to rule out a serious cause for your symptoms. They may refer you to a specialist doctor or physiotherapist for more tests and treatment.^[2]

When to seek urgent care

Go to the nearest emergency department if you have vertigo and problems with walking or coordination, problems with speech, severe headache, double vision or loss of vision, hearing loss, leg or arm weakness, numbness or tingling, or trouble speaking.^[2] You should call emergency services if you have vertigo along with symptoms of a heart attack or stroke.^[18]

Treatment options for vertigo

Most people with vertigo get better without treatment.^[12] Treatment will depend on the cause. Once the correct diagnosis is made, specific and effective treatments are available for most peripheral, central, and psychogenic forms of dizziness.^[10]

Benign paroxysmal positional vertigo (BPPV)

The treatment of choice for BPPV involves repositioning procedures. The most common is the Epley maneuver, also known as the canalith repositioning procedure.^[11] This easy procedure can be done by yourself at home after consulting with a doctor.^[16]

Other maneuvers that can help include the Gufoni maneuver, Semont maneuver, and Zuma maneuver. It is recommended that you perform these exercises with a trained physician or after consulting with a doctor.^[16]

Vestibular neuritis

The treatment of choice for acute vestibular neuritis is the administration of corticosteroids.^[10] Vestibular suppressant medication is recommended for symptom relief, followed by vestibular rehabilitation exercises.^[11] Vestibular exercises are recommended for more rapid and complete vestibular compensation.^[11]

Meniere’s disease

Meniere’s disease is treated with high-dose, long-term betahistine.^[10] Treatment with a low-salt diet and diuretics is also recommended for patients with Meniere’s disease and vertigo.^[11]

Vertiginous migraine

Effective treatments for vertiginous migraine include migraine prophylaxis with tricyclic antidepressants, beta blockers, or calcium channel blockers, along with migraine-abortive medications and vestibular rehabilitation exercises.^[11] Vertiginous migraine headaches generally improve with dietary changes and these medications.^[1]

Medications

A doctor might prescribe antibiotics if vertigo is caused by an infection.^[12] Antihistamines can sometimes help with vertigo symptoms.^[12] You may be prescribed medicines to treat symptoms of peripheral vertigo, such as nausea and vomiting.^[4] Vertigo associated with anxiety usually responds to a selective serotonin reuptake inhibitor, though slow titration is recommended because of side effects.^[11]

Physical therapy and exercises

Physical therapy may help improve balance problems. You’ll be taught exercises to restore your sense of balance. Exercises can also strengthen your muscles to help prevent falls.^[4] You could also be given exercises to do to try to correct your balance.^[12]

Surgery

You may need help if other treatments don’t work. Surgery may be suggested in some cases.^[4]

Possible complications

Vertigo can cause falls, which may result in bone fractures or other injuries. Vertigo can also interfere with your quality of life and hinder your ability to drive or go to work.^[9] Vertigo can interfere with driving, work, and lifestyle, including causing many injuries such as hip fractures.^[4]

Ongoing vertigo can stop you from doing your usual activities. It may put you off exercising or make it unsafe for you to drive.^[2] Attacks of vertigo can be terrifying, temporarily disabling, and dangerous, increasing the risk of falls and injuries.^[13]

Living with vertigo

Things you can do during an attack

There are things you can do to ease vertigo symptoms when they’re happening:^[12]

• Lie still in a quiet, dark room to reduce the spinning feeling
• Move your head carefully and slowly during daily activities
• Sit down straight away when you feel dizzy
• Turn on the lights if you get up at night
• Use a walking stick if you’re at risk of falling
• Sleep with your head slightly raised on 2 or more pillows
• Get out of bed slowly and sit on the edge of the bed for a while before standing up
• Try to relax, as anxiety can make vertigo worse

If you’re experiencing a vertigo attack, the best thing to do is lie down in a quiet, dark room, close your eyes, and take deep breaths. This may help ease any nausea symptoms and reduce the sensation of spinning.^[16] Do not lie flat on your back. Prop yourself up slightly, as this may reduce the spinning feeling. Keep your eyes open.^[18]

Things to avoid

Do not bend over to pick things up. Instead, squat to lower yourself. Do not stretch your neck, for example, while reaching up to a high shelf.^[12] Avoid sudden position changes and do not try to read when symptoms occur. Avoid bright lights.^[4]

You may need help walking when symptoms occur. Avoid hazardous activities such as driving, operating heavy machinery, and climbing until 1 week after symptoms have disappeared.^[4] It is also important to avoid stressful situations because anxiety and anger can make vertigo symptoms worse.^[16]

Long-term strategies

Recognizing and tracking your triggers can help you avoid unnecessary discomfort. Try keeping a journal of symptoms and activities when dizziness occurs. Note head positions that trigger spinning, even if it’s brief.^[15]

Several lifestyle habits may help manage vertigo and dizziness:^[17]

• Ensuring proper hydration by drinking enough water. Many people find adding electrolytes helps with brain fog, dizziness, and energy.
• Managing stress and mindset, as stress is a large contributor to migraine attacks.
• Maintaining good nutrition. Sometimes limiting alcohol or caffeine intake can be helpful. Adding healthy fruits and vegetables to have a well-balanced diet can help stabilize blood sugar.
• Regular movement and exercise. The body craves movement, and it helps strengthen the connection between vestibular system and the brain.
• Getting quality, consistent sleep. Consistent sleep-wake times help healing and give the brain and body the rest needed to learn, rewire, and heal.

If you drive, you must tell the appropriate authorities about your vertigo in some regions.^[12]