Vertigo is a sensation that makes you feel as though you or the world around you is spinning when nothing is actually moving. This unsettling experience affects millions of people worldwide and can range from brief episodes lasting seconds to persistent symptoms that last for days or even months. Understanding vertigo and its causes can help those affected manage their symptoms and seek appropriate treatment.

What Is Vertigo and How Does It Differ from Dizziness?

Many people use the terms “vertigo” and “dizziness” interchangeably, but they describe different sensations. Vertigo is specifically the false sensation of movement or spinning. When you experience vertigo, you might feel like you are rotating, tilting, or swaying, or that your surroundings are spinning around you. This spinning sensation can be strong enough to affect your balance and make simple movements difficult.^[1]

Dizziness, on the other hand, is a broader term that describes feeling lightheaded, weak, faint, giddy, or unsteady on your feet. The causes differ as well. Dizziness can result from a drop in blood pressure, certain medications, vision problems, or mental health conditions. Vertigo typically occurs due to conditions affecting the inner ear or brain, such as migraine, head injury, Meniere’s disease, or the movement of tiny crystals in your inner ear that help maintain balance.^[1][2]

Epidemiology: How Common Is Vertigo?

Vertigo is one of the most common symptoms that bring patients to see their doctors. The lifetime prevalence of vertigo and dizziness is approximately 20% to 30%, meaning that about one in every four to five people will experience these symptoms at some point in their lives.^[10] As people age, vertigo becomes an increasingly common complaint, with older adults experiencing these symptoms more frequently.^[11]

Among the various causes of vertigo, benign paroxysmal positional vertigo (BPPV) is the most common, accounting for approximately 18.6% of all vertigo cases. Other significant causes include phobic postural vertigo at 15.6% and central vestibular vertigo at 12.4%.^[10] Around 30% of people will experience a vertigo attack at least once in their lives, making it a very frequent symptom in emergency rooms and primary care settings.^[16]

Causes of Vertigo

Vertigo is not a disease itself but rather a symptom of various underlying conditions. Understanding what causes vertigo requires knowing about the two main types: peripheral and central vertigo. The classification depends on where the problem originates in your body.^[1]

Peripheral Vertigo

Peripheral vertigo is the most common type and happens because of problems with your inner ear or the vestibular nerve, which is the nerve that connects your inner ear to your brain. These structures work together to help you maintain balance. The inner ear contains fluid-filled loops called semicircular canals that respond to head rotation, along with structures called the utricle and saccule that detect gravity and forward-and-backward motion.^[4]

The most common cause of peripheral vertigo is benign paroxysmal positional vertigo (BPPV). This inner ear disorder occurs when tiny calcium particles called canaliths become dislodged from their normal location and collect in the inner ear. These particles interfere with the normal fluid movement in the semicircular canals, sending confusing signals to your brain about your head and body movements. BPPV can occur for no known reason and may worsen as you get older. It typically causes brief episodes of vertigo when you move your head in certain ways, such as tipping it backward, looking up, or rolling over in bed.^[1][7]

Meniere’s disease is another inner ear disorder that may be caused by a buildup of fluid and changing pressure in the ear. It can cause episodes of vertigo that typically last anywhere from 20 minutes to 12 hours, along with ringing in the ears (called tinnitus) and hearing loss. The attacks often come unexpectedly and can be quite debilitating.^[1][13]

Vestibular neuritis and labyrinthitis are inner ear problems usually related to viral infections such as chickenpox, measles, hepatitis, or even common cold and flu viruses. The infection causes inflammation of the nerves or structures in the inner ear that help your brain keep you balanced. These conditions typically cause vertigo that lasts for several days, along with nausea and vomiting.^[1][2]

Central Vertigo

Central vertigo is less common but tends to be more serious. It stems from problems in the brain, particularly in the brainstem or cerebellum, which are areas that process balance information. Central vertigo causes more severe symptoms, such as difficulty walking, problems with coordination, and severe instability.^[1][9]

Central vertigo can be caused by stroke, brain tumors (cancerous or noncancerous), multiple sclerosis, traumatic brain injury, or brain infections. Blood vessel diseases affecting the brain can also lead to central vertigo. In some cases, vertebrobasilar ischemia, which involves reduced blood flow to the back of the brain, can cause vertigo symptoms.^[4]

Other Causes

Vertigo can also result from head or neck injuries, certain medications that damage the ear (including some antibiotics, heart drugs, and anti-inflammatory medicines), migraine headaches, ear infections, acoustic neuroma (a noncancerous tumor in the ear), dehydration, irregular heart rhythms, ear surgery, low blood pressure, and diseases such as multiple sclerosis or diabetes.^[1][9]

Vestibular migraine is an important cause of vertigo that doesn’t always come with headaches, especially in women who have gone through menopause. About 30% of people with migraines experience dizzy spells. If every time you feel dizzy you also cannot stand bright light or find sounds unbearable, that suggests a migraine-related cause.^[13]

Risk Factors for Developing Vertigo

Several factors can increase your risk of experiencing vertigo. Age is a significant risk factor, as vertigo becomes more common as people get older. BPPV, the most common cause of vertigo, can occur for no known reason but tends to worsen with advancing age.^[1][11]

A history of head or neck injury increases the risk of developing vertigo. Whiplash injuries or trauma to the head can affect the vestibular system or cause problems in the neck that interfere with balance signals sent to the brain. Certain types of vertigo, called cervical vertigo, occur because of problems in the cervical spine (neck), where arthritis or injury can affect the neck muscles that are part of your balance system.^[1][13]

Taking certain medications can put you at risk for vertigo. Some antibiotics, particularly aminoglycosides, can be toxic to the inner ear structures. Other medications that may increase vertigo risk include cisplatin, diuretics, salicylates, certain heart drugs, and anti-inflammatory medications.^[4][9]

People with migraine headaches are at higher risk for experiencing vertigo. Having conditions that affect blood flow, such as cardiovascular disease, arrhythmia (irregular heart rhythm), or low blood pressure, can also increase risk. Other risk factors include diabetes, multiple sclerosis, prolonged bed rest, ear surgery, and conditions affecting the nervous system. Stress and anxiety are also risk factors, as stress can be a trigger for labyrinthitis, and anxiety can produce dizziness and spinning sensations.^[1][9]

Symptoms Associated with Vertigo

The primary symptom of vertigo is the sensation that you or your surroundings are moving when you are actually still. People with vertigo typically describe feeling like they are spinning, tilting, swaying, unbalanced, or being pulled in one direction. This sensation is often triggered by a change in head position, and for some people, even small movements like turning over in bed, sitting up, lying down, or moving the head up or down can bring on symptoms.^[1][2]

Vertigo is usually accompanied by other symptoms that can make the experience even more distressing. Nausea (feeling sick) and vomiting (being sick) are very common and occur because the confusing signals about movement upset your digestive system. Many people also experience sweating during vertigo episodes.^[2][9]

You may notice abnormal eye movements during a vertigo attack. These involuntary, jerking eye movements are called nystagmus and usually accompany benign paroxysmal positional vertigo. Headaches can occur with vertigo, particularly if it’s related to migraine. Some people experience ringing in the ears (tinnitus), hearing loss in one or both ears, or a feeling of fullness or pressure in the ear, especially with Meniere’s disease.^[1][9]

Balance problems are a significant symptom of vertigo. You may have trouble standing or walking and may lose your balance, which increases the risk of falls. Some people describe feeling like they are rocking on the deck of a ship, bouncing on a pogo stick, or standing in an elevator that drops a few inches. In some cases, vertigo can cause double vision, motion sickness, or looking pale.^[1][13]

The duration of vertigo symptoms varies depending on the cause. Episodes can last anywhere from a few seconds to hours. If you have severe vertigo, it can last for many days or months. With BPPV, the first day might involve feeling woozy and dizzy all day long, but within 48 hours, vertigo typically happens only when you change position. Once you stay in a new position, the crystals settle, and the vertigo stops. In contrast, Meniere’s disease attacks typically last from 20 minutes to 12 hours.^[7][13]

Feelings of vertigo can sometimes come and go in waves or attacks. For some people, vertigo is a constant presence that disrupts daily life, while for others, it occurs only occasionally under specific circumstances. The unpredictability of vertigo attacks can be frightening and can significantly affect quality of life, making it difficult to work, drive, or perform everyday activities.^[2]

Prevention Strategies

While not all cases of vertigo can be prevented, there are several strategies that may help reduce your risk of experiencing vertigo episodes or lessen their frequency and severity.^[17]

Staying properly hydrated is one of the most important daily habits that can support your vestibular system. Many people are not adequately hydrated, and dehydration can contribute to dizziness and vertigo. Some individuals find that adding electrolytes to their water helps with hydration and reduces symptoms like brain fog, dizziness, and fatigue. However, you should talk to your doctor before adding electrolytes to your diet, especially if you have certain health conditions.^[17]

Managing stress is crucial for preventing vertigo, particularly if your symptoms are related to migraine or anxiety. Stress is one of the largest contributors to migraine attacks and can also act as a risk factor for labyrinthitis. Having coping mechanisms to address stress and tools to modify stressors within your control can improve your overall quality of life and help with vertigo management. Techniques might include meditation, deep breathing exercises, regular relaxation practices, or talking with a therapist.^[1][17]

Nutrition plays an important role in vertigo prevention. Making dietary changes such as limiting alcohol or caffeine intake can be helpful, as these substances can trigger or worsen symptoms. A well-balanced diet that includes protein, carbohydrates, and healthy fats can help stabilize blood sugar levels, which may reduce afternoon crashes or attacks that occur in the middle of the night or morning. Adding healthy fruits and vegetables supports overall health and can benefit your vestibular system. If you have Meniere’s disease, a low-salt diet combined with diuretics may help reduce the frequency of vertigo episodes.^[11][17]

Regular movement and exercise are important for maintaining vestibular health. The vestibular system helps measure movements, and the brain uses those signals to make adjustments to keep you safe. Movement helps strengthen the connection between the vestibular system and the brain. Starting with gentle activities like short walks, gentle yoga, or tai chi can be beneficial. It’s important to start small and gradually progress, going slow and steady. Always discuss with your doctor before starting a new exercise program.^[17]

Getting quality, consistent sleep is essential for healing and giving your brain and body the rest needed to learn, rewire, and heal. Maintaining consistent sleep and wake times, even on weekends, setting up a bedtime routine, and ensuring you get adequate sleep can support general health and long-term management of vertigo. Poor sleep is a significant contributor to migraine attacks, which can trigger vertigo.^[17]

If you have BPPV, certain precautions can help prevent episodes. Be mindful when performing activities that involve moving your head into positions that trigger symptoms. When lying down or getting up, move slowly and carefully. Avoid sudden head movements when possible. Sleep with your head slightly raised on two or more pillows. When you get up from bed, sit on the edge for a while before standing up. These careful movements can help prevent the crystals in your inner ear from moving in ways that trigger vertigo.^[1][18]

If you have conditions that can cause vertigo, such as migraine, managing those conditions effectively can help prevent vertigo episodes. This might involve taking prescribed preventive medications, avoiding known triggers, and following your doctor’s treatment plan. For people prone to motion sickness or vertigo during travel, taking precautions before and during travel can be helpful.^[17]

Pathophysiology: What Happens in Your Body

To understand how vertigo develops, it’s important to know how your body normally maintains balance. Your sense of balance is controlled by signals sent to the brain about body movement and your position in relation to your environment. The brain integrates this information and sends signals back to your muscles on how to maintain balance.^[6]

Three sensory systems work together to manage balance. First, your vision provides information about your position and movement in space. Second, proprioception—which involves movement sensors in your skin, muscles, and joints—tells your brain where your body parts are in relation to each other. Third, your inner ears contain the organ of balance called the vestibular system, which includes three fluid-filled loops (semicircular canals) that respond to head rotation, plus the utricle and saccule, which detect gravity and forward-and-backward motion.^[6]

For good balance, at least two of these three sensory systems need to be working well. If one system isn’t working properly, the other two systems can help compensate to keep you balanced. However, when there’s a problem with the vestibular system or when the brain can’t properly process the signals from these systems, vertigo can occur.^[6]

In BPPV, the pathophysiology involves the displacement of calcium carbonate crystals (otoconia) from a part of the inner ear called the utricle. These crystals normally help detect linear acceleration and head position relative to gravity. When they become dislodged and move into one of the semicircular canals, they interfere with the normal fluid movement in those canals. The semicircular canals are designed to detect rotational movements of the head. When the misplaced crystals move within these canals during head movements, they cause abnormal fluid displacement, which sends incorrect signals to the brain about head rotation even when you’re not actually rotating. This mismatch between what your inner ear is signaling and what your other senses (vision and proprioception) are telling your brain creates the sensation of spinning.^[7][15]

In vestibular neuritis and labyrinthitis, inflammation of the vestibular nerve or inner ear structures disrupts the normal transmission of balance signals from the inner ear to the brain. When one side is inflamed and not functioning properly, it creates an imbalance in the signals the brain receives from each ear. The brain interprets this imbalance as movement, producing the spinning sensation of vertigo. Over time, through a process called vestibular compensation, the brain learns to rely more on signals from the unaffected ear and the other balance systems to restore equilibrium.^[1]

In Meniere’s disease, the pathophysiology involves an abnormal buildup of fluid in the inner ear, creating increased pressure in the membranous labyrinth. This condition, called endolymphatic hydrops, disrupts the normal function of both the hearing and balance portions of the inner ear. The fluctuating pressure can trigger episodes of vertigo along with hearing changes and tinnitus.^[1]

Central vertigo involves disruption of the brain’s processing centers for balance information. When areas of the brain like the brainstem or cerebellum are affected by stroke, tumor, infection, or demyelinating disease like multiple sclerosis, they cannot properly integrate the sensory information from the vestibular system, vision, and proprioception. This leads to vertigo symptoms that are often accompanied by other neurological signs because these brain areas also control many other functions beyond balance.^[3]

In vestibular migraine, the exact mechanism isn’t fully understood, but it involves the brain’s abnormal processing of sensory information during a migraine event. Migraines affect how the brain interprets signals from various senses, not just causing headaches but also creating sensitivity to light, sound, touch, and movement. The vestibular pathways in the brain are affected during migraine episodes, leading to the sensation of vertigo even without necessarily having a headache.^[13]