Vertigo: overview and more


Vertigo is a feeling of dizziness that makes you feel like the world is spinning around you. It can be described in many different ways – dizziness, spinning, wiggling, or bending over – and can be mild or severe enough to cause difficulty walking or even falling. Other symptoms, such as nausea, may be present depending on the underlying cause of the dizziness (such as inner ear or nerve problems, or migraines).

Symptoms of dizziness

Vertigo distorts your sense of direction and spatial perception of your body. The episodes can last from a few minutes or less to several hours. They can be subtle or completely destructive (for example, total loss of balance to the point that you cannot stand without falling) .

Common symptoms of vertigo include:

  • Feeling dizzy, as if you or those around you are spinning.
  • Rocking, leaning or pulling sensation in any direction.
  • Loss of balance
  • Difficulty standing or walking unsteady;

Dizziness can accompany other symptoms, depending on the underlying cause. These symptoms can include:

  • Nausea
  • Threw up
  • Headache
  • Sensitivity to light and sound.
  • Perspiration
  • Abnormal eye movements
  • Hearing loss
  • Tinnitus
  • Unilateral tinnitus (ringing in the ears)
  • Full ears
  • Earache

Causes of dizziness

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

Get Medication Information / Gary Foerster

Peripheral nervous system

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

Benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is believed to be caused by calcium deposits in the inner ear. Typically, a person with BPPV will describe a short-term spinning sensation with certain head movements (for example, tilting the head back to look up at the sky). There may also be nausea, but rarely vomiting .

Vestibular labyrinthitis

Vestibular labyrinthitis , also called vestibular neuronitis, is a viral or postviral inflammatory disease that affects the eighth cranial nerve, also known as the vestibulocochlear nerve, which carries sound and balance information from the ear to the brain.

This condition causes sudden, severe dizziness, as well as nausea, vomiting, and erratic gait .

Meniere's disease

Meniere's disease occurs as a result of an excessive accumulation of fluid in the inner ear. It is associated with episodes of severe dizziness lasting from minutes to hours, in addition to unilateral tinnitus, hearing loss, and fullness of the ear. During bouts of dizziness, nausea, vomiting, and imbalance are also common .

Otitis media

Otitis media (middle ear infection) can cause nonspecific dizziness in addition to earache and hearing loss.

Rare conditions

There are several rare peripheral nervous system conditions that can also cause dizziness, such as :

  • Otosclerosis a condition resulting from abnormal bone growth in the middle ear, causing hearing loss and sometimes dizziness and tinnitus.
  • Labyrinthine concussion – A condition that causes hearing loss and, in some cases, dizziness as a result of a head injury to the inner ear.
  • Perilymphatic fistula : A condition in which a fistula (abnormal connection) develops in one or more membranes that separate the air-filled middle ear from the fluid-filled inner ear. Dizziness occurs as a result of pressure changes in the middle ear that are transmitted to the inner ear, often when a person strains or sneezes.
  • Ramsey Hunt syndrome: This syndrome occurs as a result of an infection of the facial nerve with the herpes zoster virus . In addition to a painful red, bubbly rash along the ear or within the ear canal, the person experiences one-sided facial weakness, earache, hearing loss, and dizziness .
Get Medication Information / Gary Foerster

Central Nervous System

The central nervous system is made up of the brain and spinal cord.

Examples of conditions that affect your central nervous system that can cause dizziness include the following.

Vestibular migraine

Vestibular migraine refers to the dizziness that occurs as a result of the migraine , which is usually a one-sided, stabbing headache. In addition to dizziness and headache, vestibular migraines may have other symptoms such as nausea and sensitivity to light and / or sound .


A stroke , especially in the brain stem or cerebellum, can cause dizziness. Other symptoms are usually present. For example, a brain stem stroke can also cause double vision and slurred speech.

Vestibular Schwannoma

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

It should be noted that because this type of tumor grows slowly, a person's dizziness can be mild, often described as a vague wiggling, tilting, or unbalanced sensation.

Multiple sclerosis

Multiple sclerosis is an autoimmune neurological disease in which a person's immune system mistakenly attacks the protective covering of nerve fibers (called myelin) in the brain and / or spinal cord. If myelin damage occurs in certain areas of the brain stem or cerebellum, dizziness can occur.

Epileptic vertigo

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

Other important reasons

It is important to remember that heart problems, such as an irregular heartbeat or vasovagal presyncope , can cause dizziness .

Although dizziness associated with heart problems is often described as dizziness rather than spinning or dizzy, the difference can be subtle, so the doctor will often investigate the heart problem with any complaints of dizziness or dizziness.

Besides heart problems, other possible causes of dizziness include:

When to contact a healthcare provider

Due to the many possible causes of dizziness, some of which are serious, it is important to make an appointment with your doctor about this symptom.

If you experience dizziness with any of these symptoms / signs, it is important to seek immediate medical attention :

  • New or severe headache
  • Hot
  • Vision changes
  • Fainting
  • Neurological problems (eg, drooping face, weakness in an arm or leg, numbness or tingling, trouble speaking)
  • Chest pain or shortness of breath
  • Severe vomiting

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


Diagnosing the "why" of vertigo often requires a multifaceted approach that includes a detailed medical history, physical exam, and sometimes blood or imaging tests, depending on your healthcare provider's suspicions of certain diagnoses.

History of the disease

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

  • Is your dizziness caused by a sudden change in head position?
  • How long do dizziness episodes last or do dizziness last?
  • What medications do you take?
  • Have you had any type of head injury?
  • Do you have additional symptoms (such as hearing loss, tinnitus, earache, headache, or other neurological symptoms such as weakness, numbness, or slurred speech)?

Physical exam

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

More specifically, to carefully assess your dizziness, your healthcare provider may perform one or more of the following tests or maneuvers:

Blood tests and others

Blood tests may be ordered if your healthcare provider suspects that an underlying condition, such as anemia or electrolyte imbalance due to dehydration, is the cause of the dizziness. Similarly, if your healthcare provider is concerned or simply wants to rule out a heart problem, an electrocardiogram (EKG) or Holter monitor may be ordered.

Visual tests

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

Watch out

Treatment for vertigo depends on the underlying cause. Although many diagnoses are benign, some are very serious and require urgent medical attention, especially in the case of stroke .

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

Changes in lifestyle

Lifestyle changes are important in treating certain diagnoses. For example, for vestibular migraines, your healthcare provider may recommend keeping a migraine diary and avoiding potential migraine triggers , such as poor sleep or excessive stress.

Lifestyle changes are also the main treatment for Meniere's disease and include limiting your intake of salt, caffeine, and alcohol. Although qualitative research on these lifestyle restrictions in Meniere's disease is lacking, more research is needed to confirm their effectiveness.

For stroke-related dizziness, in addition to emergency treatment, your healthcare professional will advise you to quit smoking and address any underlying health problems, such as high blood pressure , diabetes , and high cholesterol .


Various diagnoses associated with vertigo can be treated with medication. For example, for vestibular labyrinthitis, your doctor may recommend an antihistamine called Antivert (meclizine) and an anti-nausea medicine like Phenergan (promethazine). Sometimes a benzodiazepine such as Valium (Diazepam) is prescribed to relieve dizziness.

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

For vestibular migraines, prophylactic migraine medications may be recommended, especially if the migraine is 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 remaining calcium from the semicircular canal located in the inner ear.

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

Vestibular rehabilitation

Vestibular rehabilitation is a type of physical therapy in which patients with certain vertigo diagnoses related to the peripheral nervous system (such as vestibular labyrinthitis) perform various head, eye, and balance exercises to relieve vertigo and improve their stability and stability .

Additional remedies

Some people include complementary therapies in their treatment plan, especially acupuncture . In fact, for people with benign diagnoses (BPPV, vestibular labyrinthitis, and Meniere's disease), acupuncture has proven to be an effective treatment for immediate relief from vertigo .

Get the word of drug information

Dizziness is an unpleasant symptom that can harm your health. If you experience dizziness, be sure to seek medical attention. While most cases of vertigo are benign, there are some serious cases, so it is important to get tested. Plus, your healthcare provider can give you the guidance and tools you need to feel good and sustainable again.

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