What Is Vertigo?

Vertigo is the dizzy sensation that makes you feel as if the world is spinning around you. It may be described in different ways—dizziness, spinning, swaying, or tilting—and can be mild or severe enough to cause walking difficulties and even falls. Depending on the underlying cause of vertigo (for example, inner ear or nerve problem, or migraine), other symptoms, such as nausea, may be present.

Vertigo Symptoms

Vertigo distorts your sense of direction and the spatial perception of your body. The episodes can last anywhere from a few minutes or less to several hours. They may be barely noticeable or completely disruptive (for example, a complete loss of balance to the point that you can't stand without falling).

Common symptoms of vertigo include:

• A dizzy feeling like you or your surroundings are spinning
• A feeling of swaying, tilting, or being pulled in a direction
• Loss of balance
• Difficulty standing or unsteady walking

Other symptoms may accompany vertigo and will depend on the underlying cause. These symptoms can include:

• Nausea
• Vomiting
• Headache
• Sensitivity to light and sound
• Sweating
• Abnormal eye movements
• Hearing loss
• Ringing in the ears
• One-sided tinnitus (ringing in the ear)
• Ear fullness
• Ear pain

Vertigo Causes

Vertigo can be a symptom of many conditions and vertigo-related diagnoses can be divided into those related to the peripheral nervous system and the central nervous system.

Peripheral Nervous System

The peripheral nervous system consists of nerve cells outside of the brain and spinal cord, such as the cranial nerves and spinal nerves.

Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is believed to be caused by calcium debris within the inner ear. Typically, a person with BPPV will describe a brief spinning sensation when moving their head in certain ways (e.g., tilting the head back to look up at the sky). Nausea may also be present, but rarely vomiting.

Vestibular Labyrinthitis

Vestibular labyrinthitis, also called vestibular neuronitis, is a viral or postviral inflammatory condition that affects the eighth cranial nerve—a.k.a. your vestibulocochlear nerve, which transmits sound and balance information from your ear to your brain.

This condition causes sudden, severe vertigo along with nausea, vomiting, and unstable walking.

Ménière’s Disease

Ménière’s disease results from abnormal fluid buildup in the inner ear. It's associated with episodes of severe vertigo that last for minutes to hours, in addition to one-sided tinnitus, hearing loss, and ear fullness. Nausea, vomiting, and imbalance also commonly occur during the vertigo episodes.

Otitis Media

Otitis media (infection of the middle ear) may cause nonspecific dizziness in addition to ear pain and decreased hearing.

Rare Conditions

There are a few rare peripheral nervous system conditions that may cause vertigo as well, such as:

• Otosclerosis: A condition that results from abnormal bone growth within the middle ear, causing hearing loss and, sometimes, vertigo and tinnitus
• Labyrinthine concussion: A condition that causes hearing loss and, in some cases, vertigo as a result of head trauma to the inner ear
• Perilymphatic fistula: A condition in which a fistula (an abnormal connection) develops in one or more membranes that separate the air-filled middle ear from the fluid-filled inner ear. Vertigo occurs as a result of middle-ear pressure changes that are transferred to the inner ear, often when a person strains or sneezes.
• Ramsay Hunt syndrome: This syndrome results from an infection of the facial nerve with the herpes zoster virus. In addition to a painful red, blistering rash along the ear or within the ear canal, a person experiences one-sided facial weakness, ear pain, hearing loss, and vertigo.

Central Nervous System

The central nervous system consists of your brain and spinal cord.

Examples of diseases that affect your central nervous system and may cause vertigo include the following.

Vestibular Migraine

Vestibular migraine refers to vertigo that occurs as a result of a migraine, which is classically a one-sided, throbbing headache. In addition to vertigo and headache, other symptoms may occur with vestibular migraine, such as nausea and sensitivity to light and/or sound.

Stroke

A stroke, especially in the brainstem or cerebellum, may cause vertigo. Other symptoms are usually present as well. For example, a brainstem stroke may also cause double vision and slurred speech.

Vestibular Schwannoma

Vestibular schwannoma, also called acoustic neuroma, is a benign (noncancerous) tumor that develops on the eighth cranial nerve. In addition to vertigo, tinnitus and hearing loss may occur.

Of note, because this type of tumor is slow growing, a person's vertigo may be subtle, often described as a vague feeling of swaying, tilting, or imbalance.

Multiple Sclerosis

Multiple sclerosis is an autoimmune, neurological disease in which a person's immune system misguidedly attacks the protective coating of nerve fibers (called myelin) within the brain and/or spinal cord. If myelin damage occurs within certain areas of the brainstem or cerebellum, vertigo may result.

Epileptic Vertigo

Epileptic vertigo refers to vertigo that occurs as a result of a seizure disorder.

Other Important Causes

It's important to keep in mind that heart problems, such as abnormal heart rhythms or vasovagal presyncope, can cause vertigo.

Besides heart problems, other possible causes of vertigo include:

• Medication side effects (e.g., aminoglycoside toxicity)
• Psychiatric concern (e.g., depression or anxiety)
• Orthostatic hypotension from a variety of causes (e.g., dehydration, anemia, or pregnancy)

When to See a Healthcare Provider

Due to the plethora of possible causes behind vertigo—some of which are serious—it's important to make an appointment with your healthcare provider for this symptom.

If you have vertigo with any of these symptoms/signs, it's important to seek medical attention urgently:

• New or severe headache
• Fever
• Vision changes
• Fainting
• Neurological problems (e.g., facial drooping, weakness in an arm or leg, numbness or tingling, or trouble speaking)
• Chest pain or problems breathing
• Severe vomiting

The same is true if you experience vertigo and have underlying heart problems, a history of a stroke, or risk factors for a stroke.

Diagnosis

Diagnosing the "why" behind your vertigo often takes a multifaceted approach—one that entails a detailed medical history, physical examination, and sometimes imaging or blood tests, depending on your healthcare provider's suspicion for certain diagnoses.

Medical History

During your appointment, your healthcare provider will ask you several questions related to your vertigo, such as:

• Is your vertigo triggered by a sudden change in head position?
• How long do your vertigo episodes last, or is your vertigo continuous?
• What medications are you taking?
• Have you experienced any form of head trauma?
• Are you experiencing any additional symptoms (for example, hearing loss, tinnitus, ear pain, headache, or other neurological symptoms such as weakness, numbness, or slurred speech)?

Physical Examination

Your healthcare provider will perform a physical exam that will include a heart, neurological, head/neck, eye, and ear exam.

More specifically, in order to thoroughly evaluate your vertigo, your healthcare provider may perform one or more of the following tests or maneuvers:

• Dix-Hallpike maneuver 
• Head impulse test
• Nystagmus test
• Fukuda test
• Romberg test

Blood and Other Tests

Blood tests may be ordered if your healthcare provider suspects an underlying process, such as anemia or an electrolyte abnormality from dehydration, as the culprit behind your vertigo. Likewise, if your healthcare provider is concerned about or simply wants to rule out a heart problem, an electrocardiogram (ECG) or Holter monitor study may be ordered.

Imaging Tests

An imaging test, usually a magnetic resonance imaging (MRI), is warranted if a central nervous system cause of vertigo is suspected, such as a stroke, multiple sclerosis, or vestibular schwannoma.

Treatment

The treatment of vertigo depends on the underlying cause. While many diagnoses are benign, some are very serious and require emergent medical attention, most notably a stroke.

For most other diagnoses, lifestyle changes, medications, and/or vestibular rehabilitation remain the mainstay of treatment.

Lifestyle Changes

Lifestyle changes are important for treating certain diagnoses. For instance, for vestibular migraine, your healthcare provider may recommend keeping a migraine diary and avoiding potential migraine triggers, such as sleep deprivation or excess stress.

Lifestyle changes are also the primary treatment for Ménière’s disease and include limiting salt, caffeine, and alcohol intake. Although, high quality studies on these lifestyle restrictions for Ménière’s disease are lacking and more research is needed to confirm they're effective.

For vertigo related to a stroke, in addition to emergent care, your healthcare provider will recommend smoking cessation and addressing any underlying health problems like high blood pressure, diabetes, and high cholesterol.

Medication

Various vertigo-related diagnoses may be treated with medication. For instance, for vestibular labyrinthitis, your healthcare provider may recommend an antihistamine called Antivert (meclizine) and an anti-nausea medication like Phenergan (promethazine). Sometimes, a benzodiazepine like Valium (diazepam) is prescribed to help ease vertigo.

For Ménière’s disease (in addition to lifestyle changes), a thiazide diuretic may be recommended.

For vestibular migraine, a preventive migraine medication may be recommended, especially if the migraines are severe and/or frequent.

Epley Maneuver

A technique called the Epley maneuver is used to treat people with BPPV. The purpose of this maneuver is to remove the calcium debris from the semicircular canal located in the inner ear.

Research published in 2014 suggests that this maneuver is safe and effective, although there is a high rate of recurrence of BPPV after treatment (around 36%).

Vestibular Rehabilitation

Vestibular rehabilitation is a type of physical therapy in which patients with certain diagnoses of vertigo related to the peripheral nervous system (e.g., vestibular labyrinthitis) engage in various head, eye, and balance exercises to ease their dizziness and improve their stability and steadiness.

Complementary Remedies

Some people incorporate complementary therapies, most notably, acupuncture, into their treatment plan. In fact, for people with benign diagnoses—BPPV, vestibular labyrinthitis, and Ménière’s disease—acupuncture has been found to be an effective therapy for obtaining immediate relief from their dizziness. Breathing exercises and other relaxation techniques may also help.

Vertigo is an unpleasant symptom that can be debilitating. If you are experiencing vertigo, be sure to seek out an evaluation by a healthcare professional. While most cases of vertigo are benign, there are some serious ones, so getting checked out is important. Moreover, a healthcare provider can provide you with the guidance and tools you need to start feeling well and steady again.