What Is Vertigo?

Vertigo is the sensation that either you or the environment around you is spinning or moving uncontrollably, per the National Library of Medicine MedlinePlus resource. If you experience dizziness, vertigo could be a symptom (along with lightheadedness).

Most causes of vertigo are benign—meaning they aren't dangerous nor serious, per an April 2016 paper published in the journal Australian Family Physician. Depending on the cause of vertigo, it may last a few minutes to several hours or even days, per StatPearls.

About 7% of people between 18–79 experience vertigo, per a chapter in the 2016 Handbook of Clinical Neurology. It's two to three times more common in women than in men.

There are two types of vertigo: peripheral vertigo and central vertigo. Peripheral vertigo is typically caused by a problem with the inner ear—a small organ communicating with the brain to control balance. Central vertigo is caused by a problem in the brain region called the cerebellum (which also controls balance) or the brain stem (which transmits messages between the cerebellum and the spinal cord).

Symptoms

Vertigo is the feeling of spinning—it feels as if either you or the room is moving, but you're standing still. In other words, it's an "illusion of movement of the body or its surroundings," per the April 2016 paper. Vertigo is not the same as lightheadedness, imbalance, or feeling like you're about to faint.

Although the spinning sensation can be your only symptom, people experiencing vertigo typically get nausea and vomiting. They may have balance problems and develop nystagmus—an condition in which the eyes move uncontrollably.

People with peripheral vertigo can experience hearing loss. Additional central vertigo symptoms may include, per the April 2016 paper:

• Weakness
• Slurred or slow speech
• Sensory changes
• Confusion
• Ataxia—loss of muscle coordination

If you're experiencing vertigo for the first time, call a healthcare provider or 911. If you need to go to the hospital, you may need help walking and should avoid driving.

Causes

Peripheral Vertigo

Peripheral vertigo usually stems from a problem in the inner ear. Sometimes, it can be due to an issue with the vestibular nerve—the nerve that "relays information related to motion and position." The most common causes of peripheral vertigo are:

• Benign positional vertigo or benign paroxysmal positional vertigo (BPPV): This is the most common cause of recurrent vertigo—vertigo that happens repeatedly. About one in 50 people will develop BPPV at some point in their lifetime. BPPV is characterized by frequent vertigo episodes of a few minutes or less, and it can be triggered by "typical changes of head position," such as lying down or bending forward. It can often be managed with a physical intervention by a healthcare provider called the Epley maneuver, per the 2016 handbook.
• Ménière disease: This is an inner ear disorder that triggers problems with balance and hearing, per MedlinePlus. People with Ménière disease can experience severe vertigo episodes that can last minutes to hours. Other significant symptoms are hearing loss, pressure in the ear, and tinnitus (ringing in the ear). Although the disease can happen due to head injury or ear infection, the exact causes are unclear. Ménière disease is the second most common cause of peripheral vertigo—though it's at least 10 times less common than BPPV, per the 2016 handbook. There's no cure, but lifestyle changes (such as avoiding sudden movements) and some treatments can help with symptoms.
• Vestibular neuronitis: This is the name for the inflammation of the vestibular nerve. Neuronitis, also called neuritis, comes with vertigo, nausea, vomiting, and balance problems, per StatPearls. Vertigo can last longer than in other conditions, possibly for hours, per StatPearls. Vestibular neuronitis typically resolves on its own within days, though some symptoms can linger longer.
• Medications: These include drugs toxic to the inner ear, such as certain antibiotics, cisplatin (a chemotherapy medicine used to treat some cancers), diuretics (which help you urinate), and salicylates (of which aspirin is most common), per MedlinePlus.
• Head or another injury
• Pressure on the vestibular nerve: This usually occurs from a non-cancerous tumor, per MedlinePlus.
• Labyrinthitis: This condition causes irritation and swelling of the inner ear, leading to vertigo and hearing loss. Other symptoms include uncontrollable eye movement, balance problems, nausea, vomiting, and tinnitus—similar to Ménière disease. Labyrinthitis can be viral or bacterial and typically resolves within a couple of days (though mild symptoms may last longer). It typically occurs in people between the ages of 30–60.

Central Vertigo

Central vertigo is caused by problems in the brain, usually in the brain stem or the cerebellum. The most common causes of central vertigo are:

• Vestibular migraine (VM): This is the second most common cause of recurrent vertigo, after BPPV. It can affect up to 1% of the population, and women are about five times more likely to experience it than men, per a February 2020 review published in Annals of Indian Academy of Neurology. Unlike migraine headaches, VM episodes may come without headaches. Medications are available for VM treatment. Virtual reality (VR) therapy and lifestyle changes (such as avoiding certain foods) may also help, per the February 2020 review.
• Medications: These include anticonvulsants (seizure treatments) and aspirin.
• Alcohol
• Multiple sclerosis (MS): This is an autoimmune disease of the brain and spinal cord that can cause symptoms in muscles (such as loss of balance), bowel and bladder (such as constipation), eyes (such as double vision), and other organs, per MedlinePlus. The condition typically occurs in recurrent episodes lasting from days to months. About 400,000 people in the US have MS, and women are three times more likely to get it than men.

Rarely, central vertigo can be caused by seizures, stroke, or cancerous or non-cancerous tumors. But vertigo is not a typical symptom of these conditions.

Diagnosis

It can be challenging for healthcare providers to pinpoint what causes a person's vertigo. And often, people don't realize they're experiencing vertigo or can't describe it, per the April 2016 paper. Most say they are dizzy.

Your healthcare provider can help you figure out what you're experiencing by asking a series of questions. They'll also ask about additional symptoms and your medical history, including health conditions, medications, and alcohol use. Once the provider has confirmed you have vertigo, they can determine what type of condition you have.

To figure out whether you have peripheral or central vertigo, a healthcare provider can perform a thorough physical examination, including ear, eye, neurological, and heart exams, per the April 2016 paper. For example, they may conduct balance and walking tests and check your pulse, blood pressure, and heart rate.

Sometimes, your healthcare provider may order imaging tests, such as a magnetic resonance imaging (MRI) or computerized tomography (CT) scan. These are typically reserved for cases when neurological symptoms such as headaches accompany vertigo, per the April 2016 paper.

Depending on what's causing your vertigo, your healthcare provider can prescribe medications, provide exercise recommendations, or refer you to a specialist such as a neurologist for additional tests.

Treatment

As a general rule, call 911 or go to the emergency room if you experience vertigo for the first time or if you get vertigo along with symptoms such as weakness, fainting, and continuous vomiting.

Try lying down and remaining as still as possible to relieve the spinning sensation. It helps to turn off any bright lights, including the TV, and avoid stimulating activities such as reading. Avoid sudden position changes during the vertigo episode and activities such as driving or climbing for at least a week after your symptoms improve.

When possible, healthcare providers will address the underlying cause of your vertigo, so treatments vary. For example, if you have BPPV, your healthcare provider can perform the Epley maneuver—a move that involves changing the position of your head and tilting it back, per MedlinePlus. If you have Ménière disease, your healthcare provider may ask you to avoid caffeine, alcohol, or a high-salt diet.

You may also receive some symptom-relieving medications, such as anti-nausea drugs, per MedlinePlus. Physical therapy can help improve your balance, as well as strengthen your muscles to prevent falls associated with vertigo. In some cases, surgery may be an option.