Vertigo (Spinning Dizziness): Symptoms, Causes, and Treatment
Vertigo is the medical word for a false feeling of movement, usually that you or your surroundings are spinning, tilting or swaying, strong enough to affect your balance. It is a symptom, not a disease. It is different from feeling faint or light-headed and from simple unsteadiness. Most vertigo comes from a problem in the balance organs of the inner ear. The most common cause is benign paroxysmal positional vertigo (BPPV), where brief spinning is set off by head movements such as rolling over in bed or looking up. Other inner-ear causes are vestibular neuritis and labyrinthitis (usually after a viral illness), Ménière's disease, and vestibular migraine. A smaller number of cases come from the brain, most importantly a stroke or mini-stroke affecting the back of the brain, and these need emergency treatment. Warning signs that point to a brain cause are vertigo with a new severe headache, double vision, slurred speech, weakness or numbness on one side, or being unable to walk. Most inner-ear vertigo settles by itself or with simple treatment: repositioning moves such as the Epley manoeuvre for BPPV, balance retraining exercises, and short courses of medicine to ease the spinning and sickness. Guidance from the NHS in the United Kingdom, US clinical references, and healthdirect in Australia all follow this approach.
In plain words
Vertigo is a false feeling that you or the room is spinning. It can make you feel sick and off balance. It is a symptom, not a disease. It is not the same as feeling faint. Most vertigo comes from a problem in the inner ear. The most common cause is called BPPV. In BPPV, tiny crystals in the ear move out of place. Short spins of dizziness then happen when you move your head, like rolling over in bed. Other inner ear causes are an ear infection, Meniere's disease, and migraine. A few cases come from the brain, such as a stroke. Call for an ambulance if vertigo comes with double vision, slurred speech, a weak or numb side, a drooping face, trouble swallowing, a very bad headache, or you cannot walk. Most inner ear vertigo gets better on its own or with simple care. A head-tilting move called the Epley manoeuvre fixes BPPV. Balance exercises help other kinds. Medicine can ease bad spinning and sickness, but only for a day or two.
What is Vertigo (Spinning Dizziness): Symptoms, Causes, and Treatment?
Vertigo is the medical word for a false feeling of movement, usually that you or your surroundings are spinning, tilting or swaying, strong enough to affect your balance. It is a symptom, not a disease. It is different from feeling faint or light-headed and from simple unsteadiness. Most vertigo comes from a problem in the balance organs of the inner ear. The most common cause is benign paroxysmal positional vertigo (BPPV), where brief spinning is set off by head movements such as rolling over in bed or looking up. Other inner-ear causes are vestibular neuritis and labyrinthitis (usually after a viral illness), Ménière's disease, and vestibular migraine. A smaller number of cases come from the brain, most importantly a stroke or mini-stroke affecting the back of the brain, and these need emergency treatment. Warning signs that point to a brain cause are vertigo with a new severe headache, double vision, slurred speech, weakness or numbness on one side, or being unable to walk. Most inner-ear vertigo settles by itself or with simple treatment: repositioning moves such as the Epley manoeuvre for BPPV, balance retraining exercises, and short courses of medicine to ease the spinning and sickness. Guidance from the NHS in the United Kingdom, US clinical references, and healthdirect in Australia all follow this approach.
Symptoms
Early symptoms
- A spinning or tilting sensation: A feeling that you, or the room, is rotating, tilting or swaying, even when you are still. It can be mild or severe enough to make you fall. (1) (2) (3)
- Worse with head movement: Inner-ear vertigo is typically triggered or worsened by moving the head, such as rolling over in bed, lying down, sitting up quickly, or looking up. (2) (1)
- Feeling sick, being sick, sweating and looking pale: Nausea and vomiting often come with vertigo because the balance system is linked to the part of the brain that controls sickness. (3) (1)
- Loss of balance and unsteadiness: Difficulty standing or walking straight during an attack, and a lingering off-balance feeling for a while afterwards. (1) (2)
- Ear symptoms in some causes: Ringing in the ear (tinnitus), a feeling of fullness or pressure, or hearing loss point towards Ménière's disease or labyrinthitis rather than BPPV. (2) (3)
- Attacks that last seconds, hours or days depending on the cause: BPPV causes bursts lasting under a minute. Ménière's attacks last 20 minutes to several hours. Vestibular neuritis causes constant vertigo for a few days that then slowly improves. (2) (1)
Serious or emergency symptoms
- Vertigo with any sign of a stroke: Vertigo together with a sudden severe headache, double vision or loss of vision, slurred speech, weakness or numbness on one side of the body or face, drooping of the face, difficulty swallowing, or being unable to stand or walk, can be a stroke or mini-stroke affecting the back of the brain. This is more likely if you have not had vertigo like this before and if you have risk factors such as high blood pressure, atrial fibrillation, diabetes or smoking. Call the emergency services now: 911 in the United States, 999 in the United Kingdom, or 000 in Australia. Do not wait to see if it passes. (1) (2) (3)
- Sudden constant severe vertigo that will not settle, with vomiting, and you cannot walk: New, continuous, severe vertigo that lasts hours with repeated vomiting and an inability to walk unaided needs same-day assessment. Most such cases are vestibular neuritis, but a stroke has to be ruled out, especially in older people or those with vascular risk factors. Seek urgent same-day medical care, or call the emergency services if there is any stroke sign, a severe headache, or you feel very unwell. (2) (1)
- Vertigo with a new severe headache, high fever, or a stiff neck: These combinations can point to a serious infection or bleeding around the brain. Seek urgent same-day care, or call the emergency services (911 / 999 / 000) if the headache is sudden and severe or you become confused or drowsy. (1) (3)
Causes
Primary causes
- Benign paroxysmal positional vertigo (BPPV): The most common cause. Tiny crystals that normally sit in one part of the inner ear come loose and move into a balance canal, so certain head positions set off a short, intense spinning spell lasting seconds. It is harmless and very treatable with a repositioning move. (2) (1) (3)
- Vestibular neuritis and labyrinthitis: Inflammation of the balance nerve (vestibular neuritis) or the whole inner ear (labyrinthitis), usually after a viral infection such as a cold. It causes sudden, constant vertigo for several days, often with vomiting; labyrinthitis also affects hearing. (2) (1)
- Ménière's disease: A build-up of fluid pressure in the inner ear causing repeated attacks of vertigo lasting 20 minutes to a few hours, with fluctuating hearing loss, tinnitus and a feeling of fullness in one ear. (2) (1)
- Vestibular migraine: Migraine that causes episodes of vertigo lasting minutes to hours, often but not always with a headache, light and sound sensitivity, or a history of migraine. It is a common and under-recognised cause. (2) (3)
Contributing factors
- Stroke or mini-stroke (TIA) affecting the back of the brain: A blocked artery to the brainstem or cerebellum can cause vertigo. It usually comes with other signs such as double vision, slurred speech, weakness, numbness or being unable to walk, and it is a medical emergency. This is the most important cause not to miss. (2) (1) (3)
- Head injury: A blow to the head can loosen the inner-ear crystals (causing BPPV) or damage the balance organ, leading to vertigo in the days to weeks afterwards. (3) (2)
- Medicines: Some medicines can cause vertigo or unsteadiness, including certain antibiotics (such as gentamicin), some water tablets, some blood-pressure medicines, sedatives and anti-epileptic drugs. Do not stop a prescribed medicine on your own; ask the prescriber to review it. (1) (3)
- Less common causes: Multiple sclerosis, a slow-growing non-cancerous growth on the balance nerve (vestibular schwannoma or acoustic neuroma), and problems where the neck meets the skull can all cause vertigo. These are uncommon and are looked for when the pattern is unusual or a scan is needed. (2) (3)
Risk factors
Older age
BPPV and balance problems become more common with age, partly because the inner ear and balance pathways change over time. (2) (1)
A previous episode of vertigo
BPPV in particular often comes back, sometimes months or years later, and can usually be treated again the same way. (2) (1)
A history of migraine
People who have migraines are more likely to have vestibular migraine as a cause of their vertigo. (2) (3)
A recent viral infection
A cold or flu-like illness in the previous week or two is common before vestibular neuritis or labyrinthitis. (2) (1)
Head injury
Recent trauma to the head raises the chance of BPPV and other inner-ear vertigo. (3) (2)
Risk factors for stroke
High blood pressure, atrial fibrillation, diabetes, high cholesterol, smoking and older age raise the chance that a new vertigo is caused by a stroke rather than the inner ear, which changes how urgently it is assessed. (2) (1)
Diagnosis
The cause of vertigo is usually found from the story and a bedside evaluation, not from a scan. The doctor asks how long attacks last, what sets them off, whether there are ear symptoms or headache, and whether there are any stroke-type symptoms. They watch the eyes for the flicking movement called nystagmus and check walking and coordination. For suspected BPPV they gently tip the head back and to one side (the Dix-Hallpike test) to see if it reproduces the vertigo and eye movements. When a stroke needs ruling out in someone with sudden constant vertigo, a set of three eye and head-movement tests known as the HINTS examination, done by a trained clinician, is more accurate in the first day or two than an early CT scan. A hearing test helps if Ménière's disease or labyrinthitis is suspected. An MRI scan is arranged when the examination points to a brain cause, when there are other neurological signs, or when the vertigo is one-sided with hearing loss. This approach is used in NHS and NICE guidance in the UK, US clinical references, and by healthdirect in Australia.
Dix-Hallpike test
A guided head movement that brings on the vertigo and eye movements of BPPV, confirming the diagnosis and which ear is affected. (2) (1)
HINTS examination
Three quick eye and head-movement tests that help tell an inner-ear cause from a stroke in someone with sudden, continuous vertigo. It is done by a trained clinician. (2)
Hearing test (audiometry)
Used when Ménière's disease, labyrinthitis or a one-sided problem is suspected. Hearing loss with vertigo needs closer assessment. (2) (3)
MRI scan (when a brain cause is suspected)
Looks for a stroke, multiple sclerosis, or a growth on the balance nerve. It is not needed for typical BPPV. (2) (3)
Treatment
Medication options
Repositioning moves and balance exercises (first-line for most inner-ear vertigo)
For BPPV, a repositioning move such as the Epley manoeuvre guides the loose crystals out of the balance canal and often stops the vertigo in one or two sessions; a clinician can do it, and home versions such as Brandt-Daroff exercises can be taught. For vestibular neuritis, Ménière's disease between attacks, and long-lasting unsteadiness, vestibular rehabilitation, a set of graded eye, head and balance exercises with a physiotherapist, is the most effective treatment because it retrains the brain to cope with the faulty balance signals. (2) (1) (3)
Short-term medicine for the spinning and sickness
For severe vertigo with vomiting, a short course of a vestibular sedative such as prochlorperazine or an antihistamine such as promethazine or dimenhydrinate, and an anti-sickness medicine, can make the first day or two bearable. (2) (1)
Treatment aimed at the cause
For Ménière's disease, a low-salt diet, betahistine (widely used in the UK, Europe and Australia) and sometimes a water tablet aim to reduce the frequency of attacks; severe cases may need injections into the ear or, rarely, surgery. For vestibular migraine, migraine prevention medicines and trigger management are used. Labyrinthitis from a bacterial infection needs antibiotics. (1) (2) (3)
Lifestyle and self-care
- During an attack, keep still and safe: Sit or lie down straight away when vertigo starts, stay still in a quiet, dimly lit room, and get up slowly afterwards. Move the head gently rather than sharply. (1) (3)
- Reduce the risk of falls: Remove trip hazards, use good lighting and handrails, take care on stairs and in the bathroom, and consider a walking aid during a bad spell. Falls are the main real danger of vertigo, especially in older people. (2) (1)
- Do your balance exercises regularly: Vestibular rehabilitation only works if the exercises are done consistently, usually daily for several weeks. It is normal for them to bring on mild dizziness at first; this settles as the brain adapts. (2) (3)
- Manage Ménière's or migraine triggers if these are the cause: For Ménière's, reducing salt, caffeine and alcohol can help. For vestibular migraine, keeping regular sleep and meals and identifying triggers such as certain foods, stress or dehydration can reduce attacks. (1) (2)
- Do not drive or use ladders while symptomatic: Do not drive, cycle, climb or operate machinery while you have vertigo or are drowsy from medicine. Ask your doctor when it is safe to resume, and check local driving rules for conditions such as Ménière's disease. (1) (2)
Always discuss dosing and treatment changes with your own prescriber.
Possible complications
- Falls and injury: The main risk of vertigo is falling during an attack, which can cause fractures or head injury, particularly in older people. (2) (1)
- A missed stroke: Because most vertigo is harmless, a stroke causing vertigo can be mistaken for an inner-ear problem. This is why vertigo with any neurological sign, or sudden severe constant vertigo in someone with vascular risk factors, is assessed urgently. (2) (1)
- Lasting imbalance, anxiety and low mood: After vestibular neuritis or repeated attacks, some people have a persistent off-balance feeling and become anxious about triggering vertigo, which can lead to avoiding activity. Vestibular rehabilitation and, if needed, treatment for anxiety help. (2) (3)
- Hearing loss with some causes: Ménière's disease and labyrinthitis can cause permanent hearing loss in the affected ear over time, so hearing is monitored. (2) (1)
- Outlook (prognosis): The prognosis for inner-ear vertigo is good. BPPV usually clears with repositioning, vestibular neuritis improves over weeks, and living with Ménière's or vestibular migraine is about reducing the frequency and impact of attacks with treatment and self-care. (2) (1)
When to see a doctor
Routine follow-up
- Book a routine appointment if vertigo keeps coming back, lasts more than a few days, affects your daily life, or comes with ringing in the ear, a feeling of ear fullness or hearing changes, so the cause can be identified and treated. (1) (3)
- Ask specifically about a clinician-guided Epley manoeuvre if brief position-triggered vertigo suggests BPPV, and about a referral for vestibular rehabilitation if imbalance lasts more than a few weeks. (2) (1)
Seek emergency care
- Call the emergency services now, 911 in the United States, 999 in the United Kingdom or 000 in Australia, if vertigo comes with double vision or loss of vision, slurred speech, weakness or numbness on one side, a drooping face, difficulty swallowing, being unable to walk, a sudden severe headache, or confusion or drowsiness. These can be signs of a stroke. Seek urgent same-day care for new, severe, constant vertigo with vomiting that you cannot walk through, even without those signs. (1) (2) (3)
Frequently asked questions
Is vertigo the same as dizziness?
Not quite. Dizziness is a broad word that includes feeling faint or light-headed and general unsteadiness. Vertigo is the specific feeling that you or your surroundings are spinning or moving. Most vertigo comes from the inner ear. (2) (3) (1)
What is the most common cause of vertigo?
Benign paroxysmal positional vertigo (BPPV), where loose crystals in the inner ear cause short bursts of spinning triggered by head movements such as rolling over in bed or looking up. It is harmless and usually clears with a repositioning move. (2) (1) (3)
When is vertigo a sign of a stroke?
Vertigo can be caused by a stroke at the back of the brain. Warning signs are vertigo with double vision, slurred speech, weakness or numbness on one side, a drooping face, difficulty swallowing, a sudden severe headache, or being unable to walk. Any of these needs an emergency call. A stroke cause is more likely in older people and those with high blood pressure, an irregular heartbeat, diabetes or a smoking history. (2) (1) (3)
How is BPPV treated?
With a repositioning move, most often the Epley manoeuvre, in which a clinician guides your head through a set of positions to move the loose crystals out of the balance canal. It often works in one or two sessions. Home exercises can be taught for repeat episodes. (2) (1) (3)
Should I take medicine for vertigo?
Short courses of medicine such as prochlorperazine or an antihistamine can help with severe spinning and vomiting for the first day or two. They are not for long-term use because they slow the brain's natural recovery and can make balance worse. The main treatments are repositioning moves and balance exercises. (2) (1)
How long does vertigo last?
It depends on the cause. BPPV bursts last under a minute but can recur over days or weeks until treated. Ménière's attacks last 20 minutes to several hours. Vestibular neuritis causes constant vertigo for a few days that then improves over 2 to 6 weeks. A persistent off-balance feeling can linger and responds to balance exercises. (2) (1)
Can I drive with vertigo?
Not while you have symptoms or are drowsy from medicine. For ongoing conditions such as Ménière's disease there may be specific rules about driving, which depend on your country and licence, so ask your doctor or the driving authority. (1) (2)
Will vertigo come back?
BPPV often returns at some point and can be treated again the same way. Ménière's disease and vestibular migraine cause recurring attacks that treatment aims to reduce. Vestibular neuritis usually happens once. Keeping up balance exercises lowers the chance of lasting unsteadiness. (2) (1)
What can I do at home during an attack?
Sit or lie down straight away so you do not fall, keep still in a quiet, dimly lit room, and get up slowly when it eases. Move your head gently, sip fluids, and make your home safer against falls. See a doctor if attacks keep happening or come with hearing changes, and call the emergency services for any stroke sign. (1) (3)