A false sense of spinning or movement, often linked to inner ear or nerve problems affecting balance.

Overview

• Vertigo is the feeling that you or the world around you is spinning or moving, when in reality nothing is moving
• It is not simply 'feeling dizzy'; vertigo is a specific spinning sensation that can range from a mild annoyance to a severe, disabling condition
• Vertigo is a symptom, not a disease in itself and is caused by a problem in the inner ear or, less commonly, in the brain

How common is vertigo?

• Nearly 40% of adults in the United States will experience vertigo at some point in their lives
• Vestibular vertigo affects 1.8–4.9% of adults every year
• It can affect people of any age, from teenagers to older adults
• Women are more commonly affected than men

Causes

Most vertigo comes from a problem in the inner ear; this is called peripheral vertigo. A smaller number of cases come from the brain called central vertigo.

Most common causes

• BPPV (Benign Paroxysmal Positional Vertigo) — the most common cause. Tiny calcium crystals (called otoconia or 'ear rocks') break loose inside the inner ear and send false balance signals to the brain. Triggered by head movements like rolling over in bed or looking up
• Vestibular Neuritis — a viral infection inflames the balance nerve in the inner ear, causing sudden, intense vertigo that can last days to weeks
• Labyrinthitis — similar to vestibular neuritis, but also affects hearing, causing hearing loss along with vertigo
• Ménière's Disease — abnormal build-up of fluid in the inner ear causing recurring episodes of vertigo, hearing loss, ringing in the ears (tinnitus) and a feeling of fullness in the ear
• Vestibular Migraine — migraine-related vertigo; the most commonly diagnosed vestibular disorder in some studies, often co-existing with other conditions

Less common causes

• Head injury or concussion
• Stroke or mini-stroke (TIA) — these are serious causes that require emergency attention
• Acoustic neuroma — a benign tumour on the balance nerve
• Multiple sclerosis affecting balance pathways
• Certain medicines (e.g., aminoglycosides, some blood pressure medicines)
• Low vitamin D levels have been associated with BPPV

Who is at higher risk?

• Adults over 40 years of age
• Women (hormonal factors may play a role)
• People with a history of migraines
• People with diabetes, hypertension, or high cholesterol
• People who have had a head injury
• People with osteoporosis or vitamin D deficiency

Symptoms

What does vertigo feel like?

The main symptom is a spinning or tilting sensation — either you feel like you are spinning, or that the room around you is spinning.

• Spinning, swaying, or tilting sensation
• Loss of balance or unsteadiness
• Nausea and vomiting
• Abnormal eye movements (nystagmus)
• Difficulty walking or standing
• Headache

Symptoms specific to the cause

• BPPV: Brief spinning episodes (usually less than 1 minute) triggered by specific head movements
• Ménière's Disease: Recurring attacks of vertigo lasting 20 minutes to several hours, with hearing loss, tinnitus, and ear fullness
• Vestibular Neuritis: Sudden severe vertigo lasting hours to days, no hearing loss
• Labyrinthitis: Vertigo with hearing loss or ringing in the ears

Diagnosis

How is vertigo diagnosed?

Your doctor will take a detailed history of your symptoms — when they started, how long they last, and what triggers them. This is the most important part of diagnosis.

Tests and examinations used

• Dix-Hallpike Test — the doctor moves your head into specific positions to check if this triggers vertigo and eye movements. Used to diagnose BPPV
• Hearing tests (audiometry) — to check for hearing loss linked to Ménière's disease or labyrinthitis
• Caloric test — warm or cool water or air is used to stimulate the inner ear and check balance nerve function
• MRI or CT scan — used if a central cause (stroke, tumour, MS) is suspected
• Blood tests — to rule out other causes such as anaemia, thyroid problems, or low blood sugar

Treatment

Can vertigo be treated?

Yes — treatment depends on the cause. Most types of vertigo can be effectively managed, and many resolve completely with the right treatment.

Canalith repositioning manoeuvres (for BPPV)

This is the most effective treatment for BPPV — a simple, non-invasive procedure done in the doctor's office.

• Epley Manoeuvre — a series of guided head and body movements that move the displaced crystals to a part of the inner ear where they can no longer cause symptoms. Very effective — success rate up to 95%
• Other manoeuvres such as the Semont, Gufoni, or BBQ Roll may be used depending on the type and location of BPPV
• Most patients feel significant relief after one to three sessions

Vestibular rehabilitation therapy (VRT)

• A specialised form of physiotherapy designed to retrain the brain to compensate for inner ear problems
• Includes specific exercises for balance, gaze stability, and movement tolerance
• Performed by a trained physiotherapist or occupational therapist
• Effective for vestibular neuritis, labyrinthitis, and other persistent vestibular disorders

Medicines

• Vestibular suppressants (e.g., meclizine, dimenhydrinate) — help reduce the spinning sensation and nausea. For short-term use only
• Betahistine — used for Ménière's disease to reduce frequency and severity of vertigo attacks. Approved in over 115 countries
• Steroids — may be used for vestibular neuritis to reduce nerve inflammation
• Diuretics (water tablets) — used in Ménière's disease to reduce inner ear fluid pressure
• Anti-nausea medicines — to control vomiting during acute attacks

Treatment for Ménière's Disease

• Low-salt diet (reduces inner ear fluid build-up)
• Betahistine and diuretics
• Intratympanic injections (steroid or gentamicin injected into the middle ear) for severe cases
• Surgery is rarely needed but available for refractory cases

What to do during an acute vertigo episode

• Sit or lie down immediately — do not try to walk without support
• Move slowly and keep your head straight
• Lie down with your head slightly elevated on a pillow
• Find a quiet, dark room and close your eyes
• Avoid driving or operating machinery until symptoms fully resolve

Complications

• Falls and injuries — vertigo can cause sudden loss of balance at any age, increasing fall risk significantly
• Reduced quality of life — frequent vertigo can limit daily activities, work, and social participation
• Anxiety and depression — living with unpredictable vertigo is strongly linked to anxiety, social withdrawal, and depression
• Hearing loss — in Ménière's disease, progressive hearing loss can occur over time
• Persistent Postural-Perceptual Dizziness (PPPD) — a chronic condition where the brain becomes hypersensitive to movement even after the original vertigo resolves

Lifestyle and long-term care

• Identify and avoid your triggers — keep a symptom diary to track what sets off attacks
• Move slowly — sudden head movements can trigger episodes; get out of bed slowly
• Reduce salt intake if you have Ménière's disease — this directly helps reduce fluid in the inner ear
• Limit caffeine, alcohol, and tobacco — these can worsen vestibular symptoms
• Stay hydrated — dehydration can worsen dizziness
• Continue prescribed exercises even between episodes — vestibular rehab works best with consistency
• Remove rugs, loose wires, and clutter from walkways
• Install grab bars in the bathroom and near the toilet
• Ensure good lighting in all rooms, especially at night
• Use a walking aid (cane or walker) if your balance is unreliable
• Avoid climbing ladders or standing on stools
• Attend all scheduled follow-up appointments with your ENT specialist, neurologist, or vestibular physiotherapist
• Report any new symptoms promptly — especially new hearing loss, weakness, or vision changes
• Do not stop medicines without consulting your doctor

Seek emergency care immediately if you have

• Sudden severe headache along with vertigo
• Weakness or numbness in the face, arms, or legs
• Slurred speech or difficulty swallowing
• Double vision or sudden vision loss
• Difficulty walking or severe loss of coordination
• Loss of consciousness

These symptoms may indicate a stroke and require immediate emergency attention.

Myths & Facts

Frequently Asked Questions