Causes, Symptoms, and Treatment of Vertigo in MS

Show Article Table of Contents

woman experiencing vertigo
Katia Kirchir/Getty Images

Vertigo is a brutal symptom of multiple sclerosis. Think back to when you were a child and spun around and around, then stopped. That’s pretty much the sensation—only now you're an adult, you're not at the playground, and you can't make it stop. It is an acute, uncomfortable feeling of unsteadiness or disequilibrium, making those of us who are already a little unsteady on our feet feel even more nervous.


Vertigo is a fairly common symptom of multiple sclerosis (MS), occurring in about 20 percent of people with MS at some point. Fortunately, it's not a permanent symptom for most people and may not even indicate a new lesion or inflammation (as vertigo can have non-MS causes). However, it may be from new brain lesions or old lesions that are getting bigger.


Vertigo can be caused by MS lesions in the cerebellum. It can also be a result of damage to the nerves that control the vestibular functions of the ear (acoustic cranial nerve, CN VIII) in the brain stem.

However, it appears that a very common cause in people with MS is something called benign paroxysmal positioning vertigo (BPPV), rather than demyelination (destruction of myelin). This means that just because you have MS doesn't necessarily mean that the vertigo is a direct result of the MS disease process.

Benign Paroxysmal Positioning Vertigo (BPPV)

BPPV feels like severe vertigo that occurs upon movement of the head, especially when rolling over in bed, getting out of bed, or tipping the head back to look up. It feels like you (or your surroundings) are spinning or tilting when you are not. It usually lasts just a couple of minutes.

BPPV is caused by debris that has collected in a specific part (semicircular canals) of the inner ear, which is part of the vestibular system. The debris, called otoconia or canaliths, are actually small calcium carbonate crystals that we all have. They are usually attached to the tiny hairs in your inner ear that detect movement but can become dislodged and float around.

When a person with BPPV moves his or her head, these crystals shift and stimulate these tiny hairs, sending false signals to the brain. The vertigo happens because of the confusion caused by these signals and other systems controlling proprioception. Since many people with MS already have difficulty with proprioception, this may make them feel BPPV even more acutely. In other words, their threshold for experiencing vertigo may be lower.


Vertigo can also be made worse by some of the drugs prescribed for MS symptoms, such as tricyclic antidepressants (Elavil) for neuropathic pain or Baclofen for spasticity. Blood pressure issues, low blood sugar, or cardiovascular disease may also be the cause of your vertigo. So, seeing your primary care physician for a complete check-up is a good idea. Also, vertigo can be caused by infections, such as the flu.


Vertigo, caused by MS and otherwise, is a sensation of spinning—whether it feels like you are spinning or your surroundings are rotating. It can feel like:

  • The ground is suddenly rushing upwards.
  • The room (or surroundings) is moving continuously.
  • The room only seems to rotate part of the way, return to normal, and rotate part way again.

It can be a very powerful feeling of movement and can cause nausea or vomiting. At its worst, vertigo can cause difficulty standing or walking and even lead to falls. It rarely persists for a long time, but can take weeks or months to go away (which it usually does gradually). Some people, however, experience it chronically.


If you have MS and are experiencing vertigo, it's a good idea to see an otolaryngologist, a fancy name for an ear, nose, and throat specialist (ENT). Really ideally, if you live in a place with access to such a specialist, you would be seen by an otoneurologist or a neurotologist (specialists in both matters of the inner ear and neurology) for any cases of MS-related vertigo.

This is important because some causes of vertigo (such as BPPV) can be treated without medications (painless maneuvers, as in the case of BPPV) and you can prevent unnecessary MRI scans and drugs with side effects like fatigue.

If your vertigo is from MS, vestibular rehabilitation may be useful. If your MS-related vertigo is particularly severe, especially if it is making you so nauseous you are unable to keep water down or take medications by mouth, intravenous fluids and high-dose corticosteroids may ease your symptoms.

A Word From Verywell

While certainly an uncomfortable and burdensome symptom, know that vertigo in MS can be treated. With a proper diagnosis and comprehensive treatment plan that often includes medication and some form of balance therapy, you can get back to enjoying your life.

Was this page helpful?
Article Sources
  • National MS Society. Vertigo. 

  • Randall T. Schapiro. Managing the Symptoms of Multiple Sclerosis (5th Ed.). New York: Demos Publishing. 2007.