Vertigo

Vertigo is the sensation that either you or the environment around you is spinning or moving uncontrollably. Most causes aren't dangerous or serious. The most common cause is benign paroxysmal positional vertigo (BPPV), which is an inner ear problem that affects balance. Vertigo may last a few minutes to several hours or even days, depending on the cause.

Vertigo could be a symptom of dizziness, along with lightheadedness. A healthcare provider can diagnose the underlying cause using a physical exam and imaging tests. Treatment depends on the cause but generally includes getting plenty of rest. You cannot cure vertigo permanently, but avoiding sudden movements can reduce the risk of episodes.

About 7% of people aged 18 to 79 experience vertigo. It's two to three times more common in women than in men. Read on to learn why people get vertigo and how you get it to go away.

Types

Vertigo causes you to feel dizzy and off balance, as if the environment around you is spinning. There are two types of vertigo: peripheral vertigo and central vertigo.

Peripheral Vertigo

Peripheral vertigo is typically caused by a problem with the inner ear. The inner ear is a small organ that communicates with the brain to control balance.

Central Vertigo

Central vertigo is caused by a problem in the brain region called the cerebellum or the brain stem. The cerebellum controls balance. The brain stem transmits messages between the cerebellum and the spinal cord.

Vertigo Symptoms

Vertigo is the feeling of spinning. You may feel as if either you or the room is moving, but you're standing still. Vertigo is not the same as lightheadedness, imbalance, or feeling like you're about to faint.

The spinning sensation can be your only symptom. Some people who experience vertigo also develop nausea and vomiting. Others have balance problems and develop nystagmus, in which the eyes move uncontrollably.

People with peripheral or central vertigo can experience hearing loss. Those with central vertigo may also experience symptoms like:

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

These symptoms may last a few minutes to several hours or even days, depending on the cause. Call a healthcare provider or 911 if you're experiencing vertigo for the first time. You may need help walking and should avoid driving if you need to go to the hospital.

Vertigo Causes

People get vertigo for several reasons. Causes of vertigo depend on what type, peripheral or central, you have.

Peripheral Vertigo

Peripheral vertigo usually results from a problem in the inner ear, but it can sometimes be caused by an issue with the vestibular nerve. This nerve communicates signals to the brain related to movements and position.

The most common causes of peripheral vertigo are:

• Benign paroxysmal positional vertigo (BPPV): This is the most common cause of recurrent vertigo episodes that are a few minutes or less. BBPV arises when tiny calcium crystals move into the semicircular canals. These tubes are found in the inner ear and are filled with fluid that moves when you move. This movement of fluid signals the position of your body to your brain. The presence of the crystals in these tubes can confuse your brain, causing BBPV symptoms.
• 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. The most common cause is a viral infection. It typically occurs in people aged 30 to 60.
• Medications: These include drugs toxic to the inner ear, such as certain antibiotics. Other drugs include cisplatin (a chemotherapy drug), diuretics (water pills), and salicylates (pain and fever reducers).
• Ménière disease: This is an inner ear disorder that triggers problems with balance and hearing. Severe vertigo episodes can last minutes to hours. Other symptoms include hearing loss, pressure in the ear, and tinnitus (ringing in the ear). The exact causes are unclear. It’s possible that symptoms develop when the pressure of fluid in the inner ear increases too much.
• Pressure on the vestibular nerve: This usually occurs from a non-cancerous tumor.
• Vestibular neuronitis: This is the name for the inflammation of the vestibular nerve. Neuronitis (neuritis) causes vertigo, nausea, vomiting, and balance problems. Vertigo can last as long as several hours. Vestibular neuronitis typically resolves on its own within days, but some symptoms can linger longer.

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:

• Alcohol: Drinking alcohol may increase your risk of vertigo, especially if you have an underlying health concern that's linked to vertigo. Alcohol suppresses the vestibular system, which creates a sense of balance.
• Medications: These include anticonvulsants (seizure treatments) and aspirin.
• Multiple sclerosis (MS): This autoimmune disorder of the brain and spinal cord can cause symptoms like loss of balance, constipation, and double vision. MS typically occurs in recurrent episodes lasting from days to months.
• Vestibular migraine (VM): This type of migraine headache is a common cause of recurrent vertigo.

Central vertigo is rarely caused by seizures, stroke, or cancerous or non-cancerous tumors. Vertigo is a typical symptom of a brain stem stroke, which accounts for as many as 15% of all strokes.

Risk Factors

Risk factors for vertigo depend on the underlying cause. Factors that increase your risk for BBPV, the most common cause of vertigo, include:

• A family history of the disease
• Labyrinthitis, which is an inner ear infection
• Osteoporosis, which causes brittle, weak bones that fracture easily
• Previous head injury
• Vitamin D deficiency

Diagnosis

It can be challenging to pinpoint what causes a person's vertigo. People often don't realize they're experiencing vertigo or can't describe it. Most people simply say they are dizzy.

A healthcare provider can help you figure out what you're experiencing by asking a series of questions. They'll also ask about other symptoms and your health history, including conditions, medications, and alcohol use.

A healthcare provider can perform a thorough physical exam to figure out whether you have peripheral or central vertigo. A physical exam generally includes ear, eye, neurological, and heart exams. They may conduct balance and walking tests and check your pulse, blood pressure, and heart rate.

A healthcare provider can determine possible underlying causes once they confirm vertigo. They may order further testing to rule out or confirm these causes, including:

• Blood tests: A healthcare provider might advise routine blood testing to rule out other causes of dizziness that are unrelated to vertigo. These tests can check your blood cell count, blood glucose (sugar) levels, electrolytes, and thyroid function.
• Brainstem auditory evoked potential studies: This test measures brain wave activity in response to clicks. A healthcare provider will instruct you to lie down and then place electrodes on your scalp and earlobes. These electrodes will sense and record brain wave activity as clicks sound through earphones.
• Caloric stimulation: This test can detect damage to the acoustic nerve, which helps control balance and hearing. It sends cold or warm water or air through the ear canal to stimulate the nerve.
• Electroencephalogram (EEG): Brain cells send impulses, or electrical signals, to each other to communicate. A healthcare provider will place electrodes on your scalp to measure these impulses.
• Electronystagmography: This test can diagnose a balance or nerve disorder. It examines eye movements to assess several nerves, including the vestibular nerve. A healthcare provider will place electrodes above and below your eye to measure electrical activity.
• Gait testing: A healthcare provider can administer gait, or walking, tests to measure your sense of balance. These tests can differentiate between peripheral and central vertigo. Those with peripheral vertigo, for example, are more likely to lean in the direction of a brain lesion.
• Head-thrust test: This test involves quick rotations of the head. A healthcare provider will then examine your eye movements and reflex functions. A head-thrust test can signal that something's wrong with the semicircular canals, such as in the case of BPPV.
• Imaging tests: These tests create detailed pictures that help a healthcare provider see the structures inside your head. You may require a CT or MRI scan of the head.
• Lumbar puncture: This test examines cerebrospinal fluid (CSF), which cushions the brain and spinal cord. A lumbar puncture can detect infections and damage to the brain or spinal cord.

Vertigo Treatment

To relieve the spinning sensation, try lying down and remaining as still as possible. Turn off any bright lights, including the TV, and avoid stimulating activities like reading. Avoid sudden position changes during the episode and activities like driving or climbing for at least one week after symptoms improve.

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

You may also receive some symptom-relieving medications, such as anti-nausea drugs. Physical therapy can improve your balance, as well as strengthen your muscles to prevent falls. Surgery may be an option in some cases.

Go to the emergency room if you get vertigo along with symptoms like weakness, fainting, and continuous vomiting or are concerned about the vertigo symptoms you are experiencing.

Prevention

You can't always prevent vertigo or cure it permanently. There are still ways you can prevent episodes:

• Avoid suddenly moving or changing the position of your head.
• Eat a healthy diet that's balanced and full of nutrients.
• Get plenty of sleep.
• Gradually increase your activity after you feel better.
• Keep away from bright lights, TV, and reading during an episode.
• Practice relaxation techniques, such as meditation, yoga, or tai chi.
• Record when you feel dizzy and what you are doing in a diary to keep track of triggers.
• Stay physically active.
• Stay still and get rest if you're having an episode.

Complications

Vertigo can negatively impact driving, lifestyle, and work. If left untreated, vertigo can increase your risk of complications like falls and injuries.

It's essential to contact a healthcare provider right away if you experience new or worsening vertigo. Other signs to get immediate medical attention include:

• Chest pain or shortness of breath
• Fainting and loss of alertness
• A fever that's higher than 101 degrees
• A head injury
• Headache or stiff neck
• Inability to move an arm or leg
• Persistent vomiting
• Seizures
• Speech or vision changes
• Weakness

A Quick Review

Vertigo is a sensation that causes you to feel dizzy and like the environment around you is spinning. There are several causes, including problems with the inner ear or parts of the brain. A healthcare provider can administer a physical exam and imaging tests to determine the underlying cause.

It's important to see a healthcare provider right away if you have new or worsening vertigo. This symptom can impair driving, lifestyle, and work. Complications, such as falls and injuries, can occur if vertigo remains untreated.